Ouch!!! Don’t touch my ear!
Ear infections are common dermatologic problems in our pets, and more commonly in our dogs. These can be very painful when they occur, even if your pet is not displaying obvious symptoms of pain. Pain can be expressed by whining, rubbing the affected ear(s), a droop in the ears or can be expressed by decreased appetite and lethargy. Although it is very important to treat the infection as soon as it is recognized, it is just as important to try to figure out what is causing the infection as majority of infections have a primary underlying cause (environmental or food allergies, endocrine disorders, foreign bodies, tumors, mites) and will recur until that cause is being adequately treated. Therefore, if an ear infection has been treated more than once, a work up should be performed to determine the cause.
Once you bring in your pet to your vet, they will evaluate the ears with a handheld otoscope which allows visualization of the ear canal and ear drum. It allows assessment for amount of redness and swelling of the canal indicating inflammation as well as type of exudate (build up of wax and cellular debris), presence of foreign bodies such as foxtails, presence of tumors/polyps and if the ear drum is normal. If the ear drum is abnormal or ruptured, this can indicate a middle ear infection. Often your vet will obtain a sample of the exudate to determine what type of organisms (bacteria or yeast) or parasites (mites) are present in order to determine the best medications to put your pet on. If infection does not seem to clear up with appropriate treatments, a culture may be needed to determine if the bacteria has become resistant to the antibiotics as bacterial infections in our pets are starting to become resistant to commonly used antibiotics, much like in people.
In some dogs and cats, it is very difficult to fully evaluate the ear canal either because the pet is too painful or because there is too much exudate in the canal. In these cases, it may be recommended to sedate or anesthetize your pet so that an ear flush can be performed, allowing better visualization and assessment of the ears. A video-otoscopy is another procedure that can be performed in certain cases. This is a specialized rigid scope that has a camera attached, allowing significant magnification and superior ability to visualize what is going on in the ear. Additionally, catheters and instruments can be placed through the scope to aid in flushing or to allow a biopsy if a mass is noted. If the middle ear is affected and the ear drum is bulging, a myringotomy can be performed where a very small hole is created in the ear canal. This allows us to sample the middle ear for culture as well as to flush any infection or debris build up in the canal. Don’t worry…the holes will heal!
As mentioned, if an ear infection becomes recurrent, additional measures should be taken to determine what is the primary cause of the infection. It is a common misconception that swimming is the cause of ear infections in dogs. Generally speaking, these dogs are swimming during the warmer months when environmental allergies from pollens are at their highest, and, therefore, majority of these dogs actually have environmental allergies that are triggering the infections. If ear infections occur during specific times of the year (seasonally), then environmental allergies are to blame. If the problem occurs year round, then the primary cause will need to be determined based on ruling out problems one at a time. If the problem starts up in an older animal, blood work may first be recommended to rule out common endocrine problems such as hypothyroidism or Cushing’s disease. An elimination diet trial with a prescription diet may be recommended to be performed to rule out a food allergy. If, in a year-round affected animal, all other causes have been eliminated (food allergy, endocrine disorders, foreign bodies, mites, etc), then it is likely that your pet suffers from year-round environmental allergies. Once the underlying disease is identified and adequately treated/controlled, then recurrence of the ear infections is likely to be much reduced or eliminated.
Unfortunately, in some animals with chronic ear infections, progressive changes of the ear canal can occur. The ear canal can start to thicken and develop fibrosis which can then calcify. Once calcification of the ear canal has occurred, there is often little that can be done medically to treat these ears. These “end stage” ears will likely need a surgical procedure called a total ear canal ablation, or TECA for short. This is a procedure which is generally performed by a surgeon where the ear canal is removed. This is a very cosmetic procedure, and once healing has occurred, all the discomfort of the chronic ear infections is resolved. If chronic infections are addressed and treated appropriately early on, this procedure can be avoided.
In summary, it is just as important to identify the cause of ear infections as it is to treat them. With proper treatment, your pet can lead a comfortable, happy life!