Hear Ye! Hear Ye! Facts about Ear Infections

I gave my spiel on ear infections so many times this week I can't help but write it down for posterity. 

1. Ear mites primarily cause infections in kittens or outside cats and are almost certainly not the reason your Cocker Spaniel is scratching her ears, so don't bother with the OTC ear mite remedy from the pet store.
2. Moisture is the enemy of ears, so don't clean those dirty ears with soapy water. Dogs who get a lot of baths or swim often (especially the floppy-eared variety like Labradors) should have their ears cleaned regularly with a veterinarian-approved cleanser. These products are specially formulated, pH balanced and may contain enzymes to improve the health of the ear canal. Please don't use straight alcohol, vinegar, or hydrogen peroxide. Also, I find OTC ear wipes are completely useless for this purpose. 
3. Another culprit behind itchy ears and infections is allergies. If your pet has a history of itchy ears at certain times of year you should discuss seasonal allergy management with your veterinarian. Finding a hypoallergenic food is tricky, and frequent diet changes without guidance from your veterinarian can lead to GI problems. Worse, over time, random exposure to many different foods may make your pet allergic to more and more ingredients!
4. Most early ear infections involve overpopulation by yeast. Yeast love moisture after all. Over time, ears that do not receive proper treatment and never fully resolve start growing bacteria. There are many types of bacterial ear infections, with the most difficult to treat infections involving rod-shaped bacteria. That's because these types of bacteria become resistant to antibiotics quickly. If your veterinarian suspects bacterial otitis she will want to look at some ear discharge under the microscope to get an idea how aggressive therapy must be. In fact, the presence of rod-shaped bacteria often warrants bacterial culture and sensitivity testing to ensure the most effective medicines are used.
5. The amount and type of microorganisms growing in the ear canal indicate how long treatment should be. Two weeks of treatment is a bare bones minimum!  I have seen bad bacterial otitis cases take over six weeks to clear up. For severe or chronic ear infections, rechecks by your veterinarian every two weeks is essential. I know it might seem expensive and time consuming, but if you don't follow up now you'll end up wasting a lot more money and energy on those problematic ears over time, your pet will have chronic pain and may even have diminished hearing. 

This week I gave a second opinion on Arnie, an adorable, good-natured pug whose previous veterinarian had given up hope that the chronic ear infection could be resolved and had discussed lateral ear resection with the owners. Lateral ear resection is a last ditch effort to clear up infection. The dog's ear canals are literally surgically removed! The problem is that I've treated "ear infections" in dogs who've had their ear canals removed, so it's not a sure cure. Arnie had a history of yeast otitis and microscopic evaluation of his ear gunk showed nothing but yeast. Turns out that over the course of Arnie's life the owners were prescribed one two-week ear treatment after another and the ears were never rechecked! After 10-14 days of medicine Arnie's ears felt better, the smelly brown gunk inside decreased, and the owners believed the infection was gone. I imagine Arnie's yeast enemies singing Chumbawumba's "I get knocked down, but I get up again" deep inside his ear canal about a week after the treatment stopped. 

We are currently treating Arnie with a leave-in ear treatment that eliminates the need for daily cleaning and treatment at home. Arnie's happy because he doesn't have to have his painfully inflamed ears messed with at home every day. The owners are happy because they don't have to do anything with Arnie's ears at all. I'm happy because I know the medicine is exactly where is should be and is assailing the yeast around the clock for two weeks straight (no skipped treatments, no inexpert medicating). We have a recheck appointment scheduled for two weeks, and the owners have been  prepared to expect 4-6 weeks of treatment if all goes well.  

While I fear Arnie has had a smoldering yeast otitis for years, I'm looking beyond simply killing resilient yeast to identify the underlying cause(s) of his original infection. Arnie is quite roly-poly and a breed that often suffers from allergies. He has dry skin and the fat in his face scrunches up his ears so they tend to trap moisture. I've started Arnie on a fish oil supplement, discussed weight management and questioned closely about possible food allergies. Treatment of severe, chronic ear infections and identification and management of the health conditions that cause them require patience, ingenuity and dedication. Luckily for Arnie, his family is motivated to resolve his ear problem once and for all.