EAR PROBLEMS IN DOGS

ABOUT THE PROBLEM
The common ear problems of dogs involve the pinna (the flap of the ear), the curved surfaces that lead into the outer ear canal, and the outer ear canal (the canal from the outside down to the eardrum). Just inside the ear drum are the middle and the inner ear. In people, the middle and inner ear are the more common locations for ear problems. 

More anatomy: in people, the outer ear canal is a relatively short, straight path from the outside to the ear drum. In dogs, it is a relatively long, narrow path that starts inside a large heavy pinna that often flops over and covers the opening to the canal. From the outside, a dog's outer ear canal travels straight down the side of its head, makes almost a right-angle turn, and then travels inward about the same distance it went down before finally reaching the ear drum. the space from the ear drum to the outside is the outer ear canal.

Ear problems in dogs are skin problems, involving the skin and the underlying cartilage and soft tissues of the outer ear canal. In a small but substantial number of cases the problem progresses to the middle and inner ear. 

CAUSES
Ear problems in dogs are commonly referred to as infections, but the cause of the head shaking, scratching, redness, discharge and other signs is rarely, if ever, simple infections. For any patient there are usually predisposing factors, primary causes, and perpetuating factors that combine to produce the symptoms. 

Predisposing factors include (but are not limited to):
    Heavy ear flaps that cover the opening to the outer ear canal
    Hair growing in the ear canal
    Hot, humid weather
    Swimming
    Breed related, eg, Cocker Spaniels and Springer Spaniels produce an abnormally 
      large amount of wax

Primary causes include (but are not limited to):
    Allergy (the most common and important cause; not just food allergy - seasonal allergy is as
      important if not more important)
    Bacterial infection
    Yeast infection
    Mites (ear mites and sarcoptic mange mites are both possibilities)
    Polyps and tumors

Perpetuating factors:
    Any of the above predisposing or primary causes could become perpetuating factors
    Inflammatory changes to the outer ear canal, including narrowing of the canal due to 
      thickening of the skin, and change of the underlying cartilage to bone
    Increased amount of discharge in the outer ear canal
    Middle and inner ear involvement
    Self-trauma from scratching and head-shaking

Ear problems in dogs are almost always chronic and persistently present, even if the symptoms only appear once in awhile.

DIAGNOSTICS
The physical exam, including exam with the same type of otoscope your physician uses to examine your ears, is our most valuable diagnostic test. For chronic ear problems repeating exams to monitor a patient's progress is vital.

Cytology is a simple, fast test that we often use as an extension of the physical exam. We make a swab of the ear canal, smear it on a microscope slide, and examine it under the microscope. We can identify bacteria, yeast, mites, and inflammatory cells. 

Some patients need diagnostics in addition to the exam and cytology. At YVC we are equipped with special otoscopes that allow us to perform detailed exams of the outer ear canal, and sometimes the middle ear. 

 We use xrays of the skull (which require anesthesia) to diagnose middle and inner ear disease.

Allergy testing, (a hypoallergenic diet for food allergy; blood or skin testing for seasonal allergies) is sometimes worthwhile. 

Trial therapy is another very important, valuable diagnostic test.

TREATMENT OPTIONS
We tailor treatment to the individual patient. We often need to use multiple treatment options  simultaneously to be successful. In no particular order, the options include:

CLEANING  Cleaning the ears, in the exam room and at home. YVC Ear Wash has a unique formulation that, in addition to the cleaning action, helps to restore the inflamed ear to normal.

TOPICAL MEDICATIONS  We have a wide variety of prescription drops and lotions from which to choose. Most of these require daily at-home use, but a couple of newer medications can be applied in the exam room, and a single application will last one to two weeks. 

ORAL MEDICATIONS  We use oral medication along with topical medication for many, if not most of our ear problem patients. Anti-inflammatory medication is the most common and important, and we also occasionally use antibiotics and antifungal medications. 

EAR FLUSHING Our deep, thorough ear flushing, done in our office, is often the best way of removing particularly heavy and tenacious accumulations of discharge. This infrequently requires general anesthesia. 

LASER THERAPY  Anti-inflammatory laser therapy is a unique YVC specialty. Please see the YVC Laser Therapy tab on the home page of yarmouthvetcenter.com for more information.

FISH OIL SUPPLEMENTS  Long term daily use of fish oil supplements can provide significant anti-inflammatory effect. We feel it is best to use high-dose fish oil therapy; we can help you calculate the correct dose for your pet.

SURGERY  Because we are equipped with laser surgery and endoscopes at YVC, we can surgically remove some foreign objects, tumors and polyps from the ear canal. Rarely, a patient will have ear disease that will not respond to medical therapy, and has become intractably painful. For these patients, surgical removal of the ear canal is an option. 

EXPECTATIONS / PROGNOSIS
Because of the predisposing and perpetuating factors mentioned earlier in this article, and also because allergy is the most common cause of ear disease in dogs, we often cannot cure patients with ear disease. Instead, we try to manage their problem to minimize the frequency of flare-ups and severity of symptoms.

We usually need to use multiple treatment options at the same time, and we often need to perform progress exams and change treatments to find an approach that is effective. For example, we may start by flushing the ears in the office, and dispensing an ear lotion and oral anti-inflammatory medication to be used at home. If this does not work as well as we hoped, we may change to a different lotion, continue the oral medication, and add in anti-inflammatory laser therapy. 

Effective treatment is almost always long-term. We typically start with a combination of treatments, and once there is a significant positive response we will then gradually taper them until we reach the lowest frequency and smallest number of treatments that works for the pet.