Those Pesky “Ear Infections” Part 2 – Treatment Options

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If you have read the first part of this series, you probably realize that not all ear diseases are from infection alone, and each individual may have multiple problems occurring at the same time. After performing my initial examination (which includes an examination of the rest of the body, otic cytology , +/- a culture of the ear, and hopefully an examination of the ear canal with an otoscope – if the patient allows it), a treatment plan is formulated and discussed with my client. It is important to note that in addition to the underlying medical problem, the temperament of the patient and the ability of the owner to administer treatment must be considered when deciding the best approach. However, for the sake of this discussion, let’s assume that the patient will allow therapy and the owner can administer treatment as directed.

If the extent of the presenting signs is confined to the ears, the first thing that I consider is whether or not both ears are affected. This is very important, because if both ears are affected – as is usually the case – the primary cause is not likely infectious, as developing infections in both ears at the same time is not common in dogs and cats. If infections or overgrowth of bacteria or yeast is present, it is likely secondary to another underlying disorder. Remember, when it comes to dermatologic (skin) diseases (Ears are many times included with these.), SYMMETRY = SYSTEMIC disease!  The most common systemic conditions that we see affecting the ears are hypersensitivities, such as environmental or food allergies. There are other conditions that can cause symmetrical ear disease, but they are less common, so I will save those for another discussion.

Okay….on to treatment.

If the ear canals are severely swollen to the point that cleaning would be difficult and painful for the patient, I may consider oral steroids for several days in order to make topical therapy easier. If yeast are noted on cytology I will use a cleanser with an antifungal such as ketoconazole. I will fill the ear canal with the cleanser, massage the ear canals and allow the dog to shake her head. I will not clean the ears out for 5-10 minutes in order to allow sufficient contact time for the antifungal to kill the yeast. Next I will apply a light coat of an ointment based medication that has an antifungal and a steroid. I will have the owners administer the therapy once daily and have them come back for a follow-up examination in a week or so. If there is improvement, I will continue the treatment for another week and then decrease therapy to every second or third day for another 1-2 weeks. If there is no improvement, I would consider either a diet trial with a hypoallergenic diet for at least 12 weeks and/or just discontinue the topical therapy, as some dogs may have a hypersensitivity reaction to the  topical medications. If there is bacterial overgrowth only, I will choose one of a few cleansers to apply based on what type of bacteria are found. I may or may not use topical steroids in these dogs initially. My priority in these cases is to treat the secondary infections first and follow up on the underlying conditions, such as allergies, once the overgrowth or infections are cleared. That approach should be taken with all dermatologic cases, not only otitis. If the otitis occurs for a few weeks during the height of allergy season, and the dog is normal the rest of the year, this is a very reasonable approach. If however, the signs occur during most or all of the year, a more aggressive approach is needed. This may include diet trials with a hypoallergenic diet, allergy testing, or other medications that would be safer for long-term use. In some cases, by the time these dogs are brought to us the changes in the ear canal are so severe that no medical approach will work. In these dogs, the pain is so severe and they cannot usually hear well at this point, that surgical procedures are recommended to provide comfort. The ability to hear may not return, but the dog (and the owner) are usually very happy due to the pain relief.

An important thing to note is that when there is a primary infection present, oral therapy used alone will not work! An strong topical antibiotic solution must be infused into the ear canal daily, sometimes for several weeks depending on the type of infection. In fact, I usually do not prescribe an oral antibiotic for these cases unless there are generalized skin infections present.

At our websites under the “Pet Care” tab, you can find a nice diagram of the ear canal and instructions on ear treatment as described above.

Go to eastmeadowvetclinic.com or sbvg.biz

Dr. Mike

 

 

Questions

Comments

  1. Abby says:

    Hi,

    I struggled with my dog’s chronic ear infections for a long time — I was extremely careful with her diet, cleaned her ears regularly, got prescriptions for otomax/tresaderm every other month or so and still my poor girl was always uncomfortable. Someone then told me about Zymox, an over the counter treatment that reportedly uses enzymes to cure the infection/inflammation. The problem didn’t go away completely, but my dog’s ear problems were significantly improved. Why did Zymox work where all other treatments failed? What does this tell me about the nature of my dog’s ear infections?

    Thanks,
    Abby

    • Angry Vet says:

      Not really sure why it worked. As I stated in the articles, if both ears are affected it is VERY unlikely that primary ear infections are the problem, although secondary overgrowth of bacteria or yeast is fairly common. If both ears are affected the most likely cause is a hypersensitivity of some sort. I have never had luck with zymox, and in fact, have had multiple cases from other vets trying to use it to treat ears with no luck. So, for whatever reason it worked well for your dog – that’s great – but I don’t know why it worked for you. As an aside – being careful with her diet does not constitute a hypoallergenic diet trial. There is a very specific method to a diet trial. If the ear problems continue, that is something that should be considered.

    • Jordan Pasos says:

      after years of ugly ear infections and very expensive vet visits we too discovered the $8.00 remedy zymox…no pre or post cleaning…medication gets dropped in the canal…no more painful cleaning…my question is why would a vet NOT try this widely successful INEXPENSIVE treatment first? After our girls ears cleared up (inside a week might I add) I took the tiny little wonder bottle back to the vet and tapped him on his noggin…I was not to happy hundreds later…no words were even needed

  2. Margaret says:

    My vet used a opti pac which he warmed and inserted into my dogs ears. This seemed to stop the itching and head shaking, but my dog can’t hear anything. Will this pass as the medicine disolves?

    • Angry Vet says:

      I am not familiar with this product. In general, I am not a fan of packing anything into the ears. It is not helpful in my experience, and most products will need to be cleaned out. I only carry a few ear cleansing solutions (to accomplish specific things based on the slides I make), one ointment that has an antibiotic, anti fungal, and a steroid, a mediation to treat ear mites, an injectable antibiotic that I will add to one of my cleaners in the event of a pseudomonas ear infection. That’s it. I have found that it’s less important to have MANY medications along with fancy equipment that is marketed to veterinarians, than it is to have a sound understanding of the primary and secondary causes of otitis and to be very familiar with the anatomy of the ear.

  3. I have a Springer Spaniel, Beau, who occasionaly gets a waxy, brownish flakey buildup on the inside flaps of both ears. He also has an ongoing issue with excesive dander. A friend of my parents, who is a vet, suggested trying Selsen Blue as the active ingredient would kill whatever bug was responsible for the dander. As of three days later, the dander is still persistent and Beau continues to suffer discomfort from his ears. When I hear “fungal infection”, I wonder if it is ok to use Tinactin cream or some other antifungal I can get over the counter. Any suggestions?

    • Angry Vet says:

      I wouldn’t use tinactin. This all could be allergy driven with secondary overgrowth or infections with bacteria or yeast. I would suggest bringing Beau to your vet so that cytology can be performed and the proper therapy can be instituted, rather than just guessing and applying over the counter medication.

      • Sasha says:

        Yeah I have had a pitbull for 5 years Samantha has developed ear infections and ear mites they gave me cream for it and went away now I got another pitbull that I rescued and Max has ear mites I don’t know if it’s an ear infection constant shaking your head I’m just trying to find out what can I do for it does this medication will zymox medication work for it and everytime I go to my vet vet wants to charge me $75 for the visit and $65 for the cream now I have to. Dogs do you know how much money that is every time I turn around

  4. Sharon says:

    I have a Yorkie that developed thyroid problems 2 yrs ago & is on meds. Within last year extreme ear problems. Currently has rod bacteria which diagnosed 30 days ago. Takes 1 10 mg atopica pill per day & special compound in ears twice a day(chloramphenicol/amikacin). He is miserable with scratching. Does seem to be improving but wondering how much longer or if ever will be cured? He is almost 13 yrs old & I hate to see him so uncomfortable.

    • Angry Vet says:

      If rods were noted on cytology, a culture and sensitivity would be indicated. If psuedomonas is found I use a different topical antibiotic to clear the infection than the chloro/amikacin. If the ears continue to be a problem topical and/or oral steroids can be used as well as a properly done food trial.

  5. Faith says:

    I have a 13 yr old Shih Tzu that has chronic ear infections. Took him to the vet again last week & he packed his ear with an antibiotic ointment. It is not any better. Is there something I can do at home for him?

  6. lisa says:

    Hello,
    I have 2 dogs that act like their ears are bothering them, they both went to the vet and the ears are clean. What can cause this to happen without any signs of a problem?

    • Angry Vet says:

      perhaps the middle ear is infected behind the eardrum…perhaps you are suffering from allergies which require no infection to become bothersome…perhaps there is another problem…difficult to say

  7. Susan says:

    I was hoping you could share your prefered topical treatment for a dogs ear infection with rods present on cytology.

  8. kimberly says:

    I took my dog to vet he is a razors edge blue pit bull with clipped ears. He’s was scratching his ears and having trouble hearing. They said he has a yeast infection. They prescribed him EasOtic daily. Its been 2 days and his hearing is still not back should I be concerned or will the medicine heal that?

  9. Maria says:

    Took my Boston Terrier to vet for his ears. Vet put a lanolin wax based Otic Pak 4 in his ears and in no time (hours later), he was deaf. It’s been 11 days since and he hears a bit but nothing like he did before. Before, you could whisper in another room and he was well aware but now, it’s very different. He can hear some, not much at all. Bottom line, what do you think happened here and do you think he will hear again? I will check back on your site for your answer. Thank you. Maria

  10. Sunita Singh says:

    My dog ,English spaniel, has been itching. Diet was changed from wheat to rice. But his ears itched. Seems may be moisture may have gone thru his ears during bath (not sure). After quite some time, his ears were reddish, was given a spray and seemed ok. One day suddenly, tilted his head on right ear side and just lost his balance too. He was treated by vet with oxytetracycline dose for 5 days. He was just ok for a month and now his ears do seem to be clean, but itches and his one hind leg is still weak. what can be the reason?

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  12. DJ says:

    My dog suffered chronic ear problems all the time and it seemed we were at the vet every couple months. Prescription ear drops given, antibiotics, allergy meds and intensive ear cleaning done but the ears still had issues. Seems like secondary infections from what you say here. Someone advised trying OTC formula called Dr Dogs Ear Oil and been using this for a few months now, keeping dogs ears cleared from the flareups she had. Wondering if some dogs just need regular treatment for ear problems to keep the issues away?

  13. Rich says:

    My dog (Peyton) is a 96lb staffordshire bull mix who cant control his urge to dive for rocks in our local lake. He developed a fungal/yeast infection in both ears this summer & our vet gave me conzol 1% drops to put in his ears but the treatment only succeeded in my dog developing a distrust for me to the point where he would rather shivver outside under the house in the dirt than come inside to sleep next to me on the bed. (I suppose my ultra positive, always with me approach to raising him &the fact hes never done anything worthy of scolding in his short 5 years makes him hypersensitive to my inflicting uncomfortable treatments)..three weeks after the treatment my aunt pointed out that whenever i exit the room Peyton tilts & twitches his ears & shakes his head…Reminiscant of myself breaking my colar bone as a child & hiding it to avoid going to the hospital. Anyway…at this point i realised his seeming indifference towards me was partly him hiding from treatments & partly partial hearing loss so we went back to the vet and she cleaned out his ears, inspected his eardrums & gave him “BCP BNT Amikacin Otic” in the form of a greasy goo in both ears..his hearing worsened by 10 fold immediately..i assumed it was the goo plugging his ears but its now been several days & Peyton is frightened & miserable & im feeling terrible about it all but whats worse is that the admistering vet hasnt been available to ease my worry which has driven me to the paranoid world of “online self doctoring” & the first thing i look up says Amikacin should NEVER be given to any patient who is experiencing hearing loss and that it is extremely ototoxic even from minimal initial dosing by any route!? I can find nothing in reference to this medication that doesnt mention this side effect within the first paragraph! My question is…Why on earth would this be the solution that a liscensed vet would choose as a solution to my boys ailing ears? If Amikacin rarely has this effect i think there would be mention of such a fact but theres not…just repeated warnings of ototoxicity with the words “permanent hearing loss” highlighted in some fashon followed by a list of drugs that interract to increase the liklihood of this particular symptom. (Which im afraid to read for fear of finding out that one or all of the drugs that make up the “BNT” is on that list.
    I know that im not a trained vet and that the internet isnt where people go to brag about how wonderful everything is so im praying that a second opinion (even from someone online) will reassure me that my vet wasnt being negligent or careless..Peyton goes everywhere with me and this includes work at an RV repair shop where his survival depends on him hearing the engine start on that vehicle hes lying under. If i have to leave him at home or with a sitter this would mean quitting my job..I made a pact with him from day one that he would never be left behind for more than the length of dinner and a movie and i owe it to him to be of my word. ..

    • Matilda says:

      Your an idiot. A “pact” you made with him has little to do with his ear issues. Additionally, you do a dog a HUGE injustice by NEVER leaving him or allowing him to experience ANYTHING without you! Just find a different vet!!!

      • rachel says:

        you’re mean matilda. your comment to this poor guy who is having problems with his dog (and who is obviously upset and worried about his dog) was cruel and unnecessary. It’s obviously Rich cares very much about his pittie (i too have two pits) and your mean comments just show you are immature. as an adult, couldn’t you have come up with anything else you could have said, in a different way then attacking him and being cruel? Rich- one of my pits has chronic ear infections and nothing the vets do work. i have put both dogs on Acana grain free limited ingredient dog food, we use essential oils for diffusion in the house, and i’m now going to try zymtox tomorrow for the ear infection since nothing (over the counter or by the vet) has helped the ear infection. my male is 90lbs and his chronic ear infection started after he was swimming all summer long. ear infections and skin infections and food allergies are very common in pits. our female pit is allergic to GRASS (per our vet).

  14. B says:

    I took my scottie in for ear infection one week ago. The vet had me use their concoction twice daily in her ears, the label says “T8 Keto, Baytril, & Dex ear mix” and to come back a week later for ear cleaning. They cleaned her ear & then packed it with Enroflaxacin/Baytril, Ketoconazole., Trimacinolone in an ointment. She is now totally deaf. They told me it would dissolve / dry up within 2 weeks and hearing would increase. It is now day 6 & she still cannot hear anything. Is this deafness going to be temporary or permanent? They said that I can wait & see as it dries up or they can flush it out with very warm / hot water. What should I do – wait or flush & do you think it will be permanent deafness? Thank you,

    • Judy Jones says:

      What did you do and did your dogs hear return? Vet applied BNT to our Jack for second time 6/08/16 and he is now totally deaf.

  15. Judy Jones says:

    Our vet applied BNT 3 weeks ago with no problems….then applied second dose 6/08/16 and Jack was instantly totally deaf. Took him back to vet today and vet said he had never heard of BNT causing deafness. He said he called pharmacy and they said they were unaware of BNT causing deafness. After searching net have several people that their dogs became deaf after using BNT as far back as 5 years. Upset was not made aware of this possible side effects

    • Valerie says:

      Hi Judy, My vet gave my dog BNT on Monday and he is now deaf. We went back today and they flushed his ears. I’m so upset I started researching and found your post. Val in Texas.

  16. CecilQNestel says:

    I don’t know whether it’s just me or if perhaps all others experiencing difficulties with your blog site.
    It appears just like a number of the written text on the posts are running away from the screen. Can somebody else please comment and let me know if this
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    Kudos

  17. Terry says:

    I also have (unexpectedly) had success with Zymox. However, I’m concerned about the issue of ototoxicity. Relative to other topical ear preparations, does anyone know of any research that rates the ototoxicity of Zymox? Since many ear infections reportedly involve a ruptured eardrum, it is likely that this medication will coat the middle ear cavity, and I would not want to harm my dog (especially the vestibular system) by using Zymox. Any input would appreciated.

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