Itchy Ear Management – The inside scoop on inside the ears

Itchy Ear Management (Otitis Externa)

Ear infections (also known as ‘Otitis externa’) are a very common condition among dogs and a common reason to bring them to the vet. The main signs owners see at home are dogs shaking their heads, scratching at their ears, rubbing their heads on things, and they often have red ears with excessive smelly discharge.

There are a number of factors that contribute to the development of an ear infection:

1. Breed – any dog breed with floppy ears, hairy ears, or small/squished ear canals is more at risk of an ear infection as the shape of the ear canal prevents moisture from escaping and provides nice nooks for bacteria and yeasts to grow. Some breeds in particular include the Pug, Frenchie, Sharpei, Cavaliers, Cocker spaniels, Dachshunds, Poodles & Golden retrievers to name a few.
2. Access to moisture – when dogs get their ears wet the excessive moisture is a common cause for an ear infection. Dogs that love to swim or get their ears wet after a bath can commonly get ear infections if their ears aren’t properly cleaned after the fact. Humid weather increases the ambient moisture in the air and works in the same way to promote ear infections.
3. Underlying allergies – sometimes the infection is just a side effect of an underlying allergy causing the ears to become red and warm, this creates an ideal environment for bacterial growth and causes a secondary ear infection. Allergies can be to anything, such as external parasites (fleas), food (chicken, beef, or wheat), or something in the environment (pollens, dust mites, or grass).
4. Changes to the ear canal – masses (most commonly ear polyps) can make cleaning ears difficult and can be the cause of recurrent ear infections.

Diagnosis of Otitis Externa

Generally the signs of an ear infection are pretty apparent on a physical exam – the vet will be able to identify redness, pain on palpation of the ear canal, and an excessive waxy discharge that varies from yellow to brown to black. However, there are a number of different infectious causes of otitis externa so it is very important to check an ear swab under the microscope to identify the bacteria or yeast and their numbers. This test helps us to select the most appropriate ear medication for your pets particular infection, and to confirm if the infection has been completely cleared at the end of the course.

Treatment – Short Term

After determining the type of ear infection present, the vet will prescribe an antimicrobial ear ointment that will treat the active infection. These preparations are often a combination of antifungals, antibiotics, and anti-inflammatories which reduce the pain and swelling whilst simultaneously treating the infection. They are designed to be put directly into the ear canal where they act locally.

If your pet has a very serious infection, we may consider other oral medications, such as –

• Oral anti-inflammatories e.g. steroids
• Oral antibiotics – only if the tympanic membrane (ear drum) is ruptured

Unfortunately oral medications are not as effective as an ear ointment, so if your dog does not like you handling their ears, please talk to your vet about long acting ear preparations. Generally it is ideal when giving your dog ear medication to do the following:

• Have an extra person on hand to help hold your pet still while you administer the ear ointment – sometimes less is more when it comes to handling, and having someone give their head a scratch or a pat can be enough to keep them still.
• Give them a high value treat during or after giving the ear ointment to make it a more pleasurable experience

Typically after starting an ear medication, your pet will improve within a few days – however, it is important to complete every course completely and return for a recheck to ensure the infection has been completely cleared. If not, partially treated infections regrow and you get a reoccurrence a few weeks later.

Leftover ear ointments being used ‘as needed’ and courses only being partially completed promotes the development of antibiotic resistant infections so it is important not to use these ear medications in this way.

Management – Long Term

If your pet is predisposed to ear infections and gets them regularly, there are a few things you can do at home to minimize their occurrence – and the need for frequent vet visits!

1. Ear cleaning – this is one of the most important and most underrated treatments that can easily be done at home. An ear cleaning liquid (such as Oticlean, Epiotic, or Otoflush) is applied to the ear canal and the ear massaged to break up any wax before cotton balls are used to wipe out the debris. Q-tips can also be used to get in between the small cartilages in the ear but care must be taken not to insert them too deep into the ear canal proper (though this is difficult due to the ‘L’ shaped structure of the dog ear – see picture on previous page). This should be done whenever the ears are dirty, usually every 1-2 weeks or up to a couple of times per week in severe cases.

2. Regular ear plucking – this helps some animals with particularly hairy ears that block the ear canal (though not all – if your pet seems to get worse after an ear pluck I wouldn’t recommend continued plucks). It can be done by your groomer or here at the vet every few months.

3. Management of underlying allergies – this is particularly important if your pet itches anywhere else on their body (e.g. foot licking). In these patients it is very important that they stay up to date with flea & tick prevention, and consider a diet trial with a hypoallergenic diet such as Hills z/d or Royal Canin Hypoallergenic as the sole diet for 8-12 weeks to rule out a food based allergy.

4. Anti-inflammatory medication – in patients with an underlying environmental allergy, regular medication with an anti-itching medication can be used to reduce the occurrence of ear infections. Some of these medications include:
   1. Compounded dexason flamazine ear drops – this is a preparation that is kept in the fridge and can be applied to the ears as needed every few days or during flare ups. It is particularly effective for patients with constantly itchy ears.
   2. Apoquel – this is a tablet that is targeted towards reducing itchiness throughout the whole body, it has few known side effects and may be suitable if your pet itches in multiple places other than just the ears.
   3. Cytopoint – this is an injection that lasts for a month to manage itchiness throughout the whole body similar to apoquel, for patients with chronic allergies.
   4. Steroids – these can be used in the short term but have a large amount of negative side effects associated with long term use, so we do not recommend these for more than intermittent short courses.