One veterinary practice's approach to diagnosing and treating otitis externa (ear inflammations or "ear infections"), including training your dog to allow ear treatments.

1. My Dog Has an
Ear Infection!
Now What?
By Jacquelyn H. Burns, DVM
Copyright © Jacquelyn H. Burns
2012
All rights reserved

2. Otitis Externa
aka “ear infections”
 A good many aren’t really infections!
 Otitis externa is an itchy inflammation of the external ear
canal. It is not like an earache (otitis media), which is on
the inside of the eardrum. Otitis externa involves the ear
canal outside of the eardrum.
◦ Inflammation and itch can occur without infection
 Itches and burns
 Does not always include infection, but can
◦ Yeast
◦ Bacteria
 Often results from allergies (Atopy or Food Allergy)
◦ Greater than 80% in this practice are caused by allergies
◦ Less than 20% other causes
 Mites
 Foreign bodies
 Trauma
 Tumors, polyps

3. Signs of Otitis Externa
 Shaking head
 Rubbing ears on floor or furniture
 Whining/crying when ears are rubbed
 Discharge from ears
 Odor from ears
◦ Sour most often means yeast infection
◦ Foul most often means bacterial infection
 Thickening or swelling of pinna (ear flap)
◦ Lichenification
◦ Aural hematoma

4. Tests to determine causes of
Otitis Externa
Oil Smear Ear Cytology
 Veterinarian looks at a  Veterinarian looks at a
sample of ear wax or stained slide of ear wax
discharge in mineral oil or discharge
under the microscope
 Seeing whether there
 Screening for ear mites
 Can be difficult to
are
interpret if you’ve used ◦ Yeast
an over-the-counter ear ◦ Bacteria
mite med prior to  Cocci
seeing your  Rods
veterinarian ◦ Neutrophils (pus cells) vs
simple epithelials

5. Management for Otitis Externa
 Hygiene
◦ Pluck hair from inside ears if present
◦ Clean with the veterinarian-recommended ear
cleaner
◦ One to two times weekly for about two weeks
◦ Weekly or every other week as ―maintenance‖
 Topical medications
◦ Ointments, drops, sprays
◦ Sometimes hunt and peck to see which works
best
 Symptomatic Care
◦ Antihistamines
◦ Fatty acid supplements

6. Cleaning the Ears

7. Ear Cleaners
 Some are contraindicated
◦ Especially if it is not known whether or not the ear
drum is intact
◦ In these cases, the veterinarian prefers that you use
saline solution
 Are not interchangeable
◦ Different ear conditions respond to different pH’s
 Some cleaners are low pH (acidic)
◦ Best for yeast
 Some cleaners are high pH (basic)
◦ Best for bacterial infections such as Pseudomonas

8. Vertical
Canal
Ear Drum
Understanding Ear Anatomy

9.  The only parts of
your dog’s ears you
are likely to see are
the Pinna and the top
portion of the vertical
canal.
Deepest  The ear drum
you can
reach (tympanic membrane
is very deep and
Ear protected around a
Drum nearly 90 degree
curve
Ears are difficult to damage!

10. How to clean your dog’s ears
 Outdoors or in shower/bathtub! It’s messy.
 Don’t wear anything you would mind being
spattered with ear goo and ear cleaner
 Hold the pinna up over the top of the dog’s head
 Fill the ear canal to overflowing with ear cleaning
solution
 Massage the base of the ear for 60 seconds
 Allow your dog to shake his head
◦ Don’t forget to duck! 
 Wipe away grime that comes to the top and
solution with a plain cotton ball
 Repeat
Never use Q-tips! They can pack wax and discharge
down deeper, and make the problem worse!

11. For everyday cleanups
 Grime in the top part of
the ear (pinna and into
vertical canal) is not
always an indicator of
what goes on deeper
within the canal
 Baby wipes or personal
cleansing moist towelettes
can be used as needed to
wipe away everyday dirt
around the pinna and into
the upper vertical canal
 We recommend unscented
towelettes

12. Ear Medications
 Topical drops or ointments are the
mainstay of therapy
 Many medications for dogs are in an oily
base, which is believed to be more difficult
for the dog to shake out of the ears
◦ These are a bit tricky for some owners to get into
the ears
◦ Can also leave the pet’s head greasy while being
treated
 Some are aqueous (water) based drops

13. Ear Ointments
 Have an applicator tip that can be inserted to
deposit the ointment deep into the vertical canal.
◦ Don’t be afraid to insert it as deep as it will reasonably
go!
 Contain a mixture of pharmaceuticals
◦ Anti-inflammatory/anti-itch
◦ Antifungaladdress yeasts
◦ Antibioticaddress bacteria
 Directions may say ―3 to 5 drops‖ but most of
the time we guesstimate since the applicator tip
is deep in the vertical canal when we squeeze the
tube.
 After squeezing the tube, massage the base of
the ear to work the ointment in deeper.

14. Ear Drops
 Are designed to be
dropped into the
vertical canal
 You will count drops
as directed on the
label, then massage
the base of the ear.
 Some have to be
refrigerated; some
don’t

15. • Odor – this ear
smells somewhat
sour
• Lichenification
• Thicker skin
• Roughened skin
• Hyperpigmenation
• Dark
discoloration of
the skin
An itchy ear!

16. • Raise pinna up
over the head
• Insert the
applicator tip into
the top of the
vertical canal
• Direct it downward
Inserting applicator tip of ear ointment
into the vertical canal

17. Advancing the applicator tip in deeper

18. • Fully insert the
applicator tip into
the vertical canal
• Gently squeeze the
tube to deposit
ointment into the
canal
• Ointment is usually
deposited about
where the
horizontal canal
meets the vertical
canal
• Massage the base
of the ear to work
ointment down
deeper
Applicator tip is fully inserted into the
vertical canal

19. Other Ear Therapies…
 Are much the same as dermatology therapies
◦ See ―My Dog Has Allergies! Now What?‖ by Dr. Burns
and review symptomatic care of itching under Atopy.
A majority of our otitis cases are caused by
Atopy and can be addressed in part by Atopica
 Antihistamines orally
 Anti-inflammatories (corticosteroids) orally
 Fatty Acid Supplements orally
 Weekly bathing & wipe off when coming in from outside
 No ear drop/ointment/cleanser will work
if you can’t administer it
◦ It may take training—of both you and your dog
◦ Confess to the vet if you can’t do it

20. Stubborn Cases
 There are many!
 May require
◦ Oral antibiotics
◦ Drops mixed up by the veterinarian with a
mixture of different drugs
(TrisEDTA+enrofloxacin+dexamethasone for
Pseudomonas bacterial infections)
◦ BNT, a lanolin-based
antibiotic/antifungal/steroid preparation that is
melted and poured into the ear canal under
sedation—can be repeated every 14 days.
◦ Oral corticosteroids (prednisone)

21. Realistic Expectations…
 Our goal of treatment is to make your dog
more comfortable
 We usually cannot stop all ear problems
―once and for all‖ because so many are
caused by allergies
◦ Allergies are not curable
◦ Allergies will come back
◦ Allergies may require ongoing care

22. Like all other allergies, allergies
affecting the ears have no magic
cure!
I've come to
cure your ear
allergies.
Yeah,
right!

23. What if I can’t do it?
No ear drop,
ointment,
cleanser or oral
medication will
work if you can’t
administer it.

24. Training…
 Ideally starts in puppyhood
 Set up for success rather than failure
◦ Waist high
◦ You set yourself up for failure attempting it on the
floor, couch, bed or chair
 Use Dr. Burns’ ―Special Place‖ concept
◦ A place you only put your pet when you are going to
do something (that may or may not be unpleasant)
to him…and he gets rewarded each time.
 Reward, reward, reward!
◦ Your dog knows every time he gets down, he is going
to get a reward

25. “Special Place” Training
 Put your dog in his special place
◦ Waist high with non-skid surface (bath mat)
◦ Top of a washing machine, clothes dryer or countertop
 Give a steadying command such as ―Still‖ or ―Whoa‖
 Handle him all over, including touching in the ears,
under tail, eyes, lips, mouth, privates, feet
 Release command, such as ―Okay!‖ or ―Alright!‖
 Reward!
◦ Should be a treat he goes wild over
◦ Can be a ―not your everyday treat‖ for training purposes
 Repeat often, until he is accustomed to and excited
over being put in the special place
 Advance to doing nail trims, ear ointment, tooth
brushing, administering oral medications or whatever

26. What about cats?
 Most common cause of otitis is ear mites
 Other causes
◦ Atopy
◦ Food Allergy
◦ Demodex mites
◦ Bacterial infections
◦ Polyps
 Inflammatory polyps!

27. Inflammatory Polyps
 Usually in young(er) cats
 Watery discharge that doesn’t respond to
topical or oral treatments
 Benign polyps can form in the Eustachian
tubes, tympanic bulla, ear canal, throat
 Problem won’t resolve until the polyp is
surgically removed
 Polyps high in the vertical canal may be
―pulled‖ out under sedation
 Deeper polyps require referral to a surgical
specialist

28. If you are frustrated beyond
belief…
 Ask yourself if you are
compliant with all of your
family veterinarian’s
prescriptions and advice.
 If you are not compliant,
ask yourself why…and try
to start doing EVERYTHING
your veterinarian
recommends
 If you are compliant and
things are not working out,
ask your veterinarian for a
referral to a board-certified
veterinary dermatologist

29. Slide presentation courtesy of
Jacquelyn H. Burns, DVM
 Holmes Veterinary Hospital
1001 Church Street
Laurens, SC 29360
www.holmesvethospital.com
Material in this slide presentation is intended to
help veterinary clients understand one practice’s
approach to ear disease. It is not intended to be a
substitute for assessment and treatment by your
pet’s veterinarian.
Copyright © Jacquelyn H. Burns
2012
All rights reserved