Ear Problems

 

bulletThe dog and cat ear canal has a vertical and a horizontal component.  This predisposes them to ear infections as debris must work its way upward rather than straight out.
 
bulletDisease of the ear usually stems from over-production of wax as occurs in response to irritation.  Allergic skin disease affecting the ears is one possible cause (especially in recurring cases).   Other causes of ear infections include ear mites,  foreign bodies (such as grass awns or foxtails),  hair growth deep in the canal (common in poodles, schnauzers, shih tzus, and many other small breed dogs), and getting water into the ear canal during swimming or bathing. The moisture of the wax promotes bacterial and yeast growth and resulting infection. Soon wax in ears is joined by pus.
 
bulletDogs show discomfort around their ears by scratching, rubbing their ears on the floor or furniture, or by shaking the head.  If the infection reaches the middle ear, affected animals may have a head tilt, a lack of balance, and unusual eye movements.

AURAL HEMATOMA

When a dog or cat with uncomfortable ears shakes and scratches vigorously, a blood vessel in the ear flap may rupture.  This leads to bleeding into the tissues of the pinna, or flap of the ear. The usual recommendation is to have the blood clots removed and the ear bandaged and cleaned under anesthesia. If the hematoma is not so big as to occlude the ear canal (thus preventing medication), the option to forgo surgery exists; but without surgery, the ear may scar down into an abnormal appearance.

TREATMENT FOR EAR INFECTIONS

STEP ONE

Most ear infections are cleared up simply with professional cleaning followed by medication at home. If only mild debris is present in the ear canals, simple disinfection and washing of the ear is adequate; however, in most cases, a full ear flush is needed to even examine the ear drum. For patient comfort, we recommend sedation for this procedure as the ears are sore and the instruments can be damaging if the pet jumps at the wrong time.

STEP TWO

Some pets have chronic ear problems (the infection is not controlled by general medication or returns when general medication is discontinued).  In these cases, the ear discharge should be cultured so that the precise organism can be pinpointed and treated specifically.  Regular treatment at home with disinfecting ear washes should become part of the pet's grooming routine.  Water, peroxide, alcohol and vinegar are often mistakenly used to clean pets ears.  These can actually make the infection or inflammation worse.  It is best to use a pet ear-cleaning solution as recommended by your veterinarian.

Further testing may be in order to determine why the infection continues to recur. Allergy is the most common reason for recurrent ear problems.

STEP THREE

Depending on the severity of the problem, the vertical canal may need to be opened surgically.  This enables debris to be removed more effectively. This is done to prevent severe scarring after prolonged specific medical therapy has been ineffective.

If the canal becomes so scarred that it is practically closed, "ablation" may be the final option.  In this surgical procedure the entire ear canal is removed and healthy tissue is allowed to grow in.  These procedures are "last resorts" after severe infection has made effective medical treatment impossible.  Although surgery is expensive, dogs with chronic severe otitis usually require no further ear treatment for the rest of their lives.

SOME SPECIAL INFORMATION ON PSEUDOMONAS INFECTION:

Pseudomonas aeruginosa is a very special species of bacteria; it is resistant to almost every possible antibiotic. It is common for ear infections to be recurrent and in time, many antibiotics have been used. The unfortunate tendency is for most bacteria to be killed off, leaving infection with the very resistant and practically immortal (not to mention especially smelly) Pseudomonas.

If one is lucky, a culture of the ear discharge will reveal that the Pseudomonas is still sensitive to an oral antibiotic such as Baytril. It should be noted that especially high doses of this type of antibiotic are needed to treat Pseudomonas in the ear and that inadequate dosing will just make Pseudomonas even more resistant. In other words, Pseudomonas must be treated definitively from the moment it is diagnosed; once it becomes resistant to oral therapy, treatment becomes vastly more difficult.

Oral therapy is generally combined with some kind of topical treatment of the ear. Fortunately there are several concoctions that should be useful though some your vet must mix him/herself.

 

Tris-EDTA

EDTA is a binder of metals which are important to the bacterial cell wall. Tris is used to buffer the EDTA to a pH that is not irritating to the ear and to maximize the anti-bacterial effect.

Injectable Medications

It would be unusual for a Pseudomonas species to be resistant to absolutely everything.  While there may not be an oral treatment available, sometimes an owner may be taught to give injectable treatments. These are often expensive, however. These same medications can also be mixed up for topical use; many are already available as commercially prepared solutions.

Chronic ear infections, as mentioned, typically have an underlying cause
(usually allergy). It is important to address this problem in addition to the infection itself so as to minimize on-going ear inflammation.

 

WHAT ARE EAR MITES?

Ear mites are tiny infectious organisms resembling microscopic ticks.  The mite can just barely be seen as a small white dot with the naked eye but usually must be detected by examination of a sample of ear wax under a microscope.  Infection usually, but not always, produces a characteristic dry black ear discharge commonly said to resemble coffee grounds. Because of the classical appearance of this discharge, infection is often diagnosed based on the presence of such discharge, though without visual confirmation of the mite under the microscope, it is possible to be led astray.  The discharge is composed of ear wax, blood, inflammatory biochemicals, and ear mites themselves.  A common mistake for people to make is to treat for ear mites with over-the-counter mitacidal medication when, in fact, the infection is not due to ear mites. 

HOW DID MY PET GET EAR MITES?

Ear mites readily transmit from host to host by physical contact.  Ear mites came from some other animal with whom your pet has been socializing. Because mites are easily transmissible by physical contact, treatment for mites often must include all household pets.

WHAT HARM COMES FROM EAR MITE INFECTION?

The presence of the mites is very inflammatory and can generate very irritating ear infections.  Skin disease can also result from infection by the ear mite, especially on the head and rear feet (from scratching the ears).

IS THIS CONTAGIOUS?

Ear mite infection is certainly contagious among cats and dogs.  Typically, the victim is an outdoor cat or puppies and kittens from shelters or pet stores.  Humans have been reported to develop skin rashes rarely; in general, we may consider that a human pet owner is extremely unlikely to experience any symptoms when their pet is infected with ear mites.

HOW DO I GET RID OF EAR MITES?

There are numerous products available for ear mite eradication.  Most older and over-the-counter products contain insecticides which do not kill incubating mite eggs and may cause toxicity, especially in cats. 

It is preferable to take your pet to your veterinarian for treatment.  He or she will confirm the presence of mites, determine whether or not the ears need to be flushed, and prescribe a more effective medication which will be placed in the ears once a week for 4 weeks, usually.  

 A newer approach involves the use of ivermectin, a broad spectrum anti-parasite medication. Ivermectin is especially helpful in cases where the patient simply will not allow topical ear treatment. Ivermectin is administered by your veterinarian either as a single dose directly in the ear (Acarexx®) or as an injection (Ivomec®) weekly or every couple of weeks for a month. This is a highly effective method of ear mite eradication but there are some limitations.  Certain breeds of dogs are sensitive to this medication and cannot take it. Certain individuals have similar sensitivities which cannot be predicted by breed. Injectable ivermectin is not approved for the treatment of ear mites in small animals; ivermectin for use in the ear is indeed approved for use in cats only.

Another product that has been popular is fipronil, the active ingredient in the flea control product Frontline®.  While Frontline® is not helpful against ear mites when used on the skin as directed for fleas, it is effective when used topically in the ear. This use is also not sanctioned by the manufacturer and possible adverse effects from the product’s use in this way have not been formally studied.

The newest product now available against ear mites is Revolution® (selamectin).   A single application is used on the skin, the product is absorbed into the body where it kills numerous other parasites and then returns to be concentrated in the skin.  Revolution® is primarily a flea control product but is approved for both dogs and cats for the treatment of ear mite infection. Continuing use of Revolution® for flea control has the added benefit of preventing further ear mite infections (especially helpful for outdoor cats). It is important to realize that Revolution® is a prescription medication and cannot be obtained without proper veterinary evaluation.  Further, while Revolution® use will kill the mites, ear cleaning is needed at the beginning of therapy (and possibly at the end) to remove the irritating wax and debris.  Be sure to have the ears re-checked according to your vet’s recommendations.

Success will not be met unless the ear canal is thoroughly cleaned. This is true whether a topical solution or one the systemic products is used.

WHAT IF THEY JUST DON’T SEEM TO EVER GO AWAY?

Occasionally, we receive messages regarding a case of ear mites for which “everything” has been used and the mites simply will not go away. Here are some tips should one find oneself in this situation:

  1. Was the mite infection confirmed initially? Remember, it is easy to be fooled by the presence of a discharge that appears “mite typical.”
     
  2. Has the mite infection been confirmed after therapy? Sometimes, a telltale hard bit of ear wax must be removed from the ear before comfort is finally achieved.  Sometimes a bacterial infection remains though the mites are long gone.  Treating for ear mites when there are none present, will not achieve results.
     
  3. Were all the hosts in the family treated? If all pets were not treated, begin again this time including all pets in the protocol.
     
  4. Consider using one of the new products.

Do not make the diagnosis of ear mite infection yourself.  If you think your pet has an ear infection, see the vet for proper evaluation rather jumping straight to an over-the-counter remedy. You will need the right diagnosis before you can intelligently choose an ear treatment  product

EAR CLEANING

Pet's ear canals are longer than ours and typically produce more wax. Thus they tend to get infected more often, particularly in breeds with floppy and/or hairy ears.

To reduce the chance of ear infection beginning or reoccurring in your pet's ear please clean them on a regular basis with the cleansing agent prescribed by the doctor, as follows:

  1. Fill the entire ear canal with cleansing solution, and massage the base of the ear gently for 1-2 minutes to loosen the wax and debris;
  2. Use cotton balls to wipe out the debris;
  3. Repeat the process until the cotton balls come out clean. If extreme redness occurs discontinue this cleaning episode;
  4. Hairy eared pets benefit by having the hair clipped or, preferably, plucked from the inside of the ear to improve air circulation and dry out the canal;
  5. Warning: Do not use Q-Tips in the canal as you may pack debris into the canal and damage the ear drum. Q-Tips may be used only to clean the folds of the ear flap.

A bit of prevention goes a long way towards keeping your pet's ears clean and healthy. Please be diligent with your ear cleaning program, and incorporate it into a regular grooming process such as bathing.  It is especially important to clean after swimming or bathing, when water may enter and be trapped within the canal.

Click Here For a Printable Version of Our New Client Form and Save A Lot of Time!!!