Otitis Externa ( Ear Infections )

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1 Copyright Bilton Veterinary Centre All rights Reserved What is otitis externa? Otitis Externa ( Ear Infections ) Otitis externa is a term that describes either an inflammation and/or infection of the outer (external) ear canal. A dog s ear is quite different in anatomy to that of the human counterpart. The ear flap (called the pinna) can either be pricked (eg German Shepherd), floppy (eg Labrador) or pendulous (eg Cocker Spaniel). The tubular part of the ear carries sound from the pinna to the ear drum. This is separated into two distinct areas, called the vertical and horizontal canal. These canals are coated in a type of specialised skin called epithelium. The ear drum is a very thin and fragile membrane that separates the external ear canal from the middle ear, which is a spherical boney cavern filled with air. This also is coated with epithelium. Just above the middle ear is the inner ear and it is here that sound is processed as well as the apparatus that is responsible for balance. Otitis externa is used to describe ear disease affecting The base of the pinna The ear opening The vertical canal The horizontal canal Figure 1 - A Normal Healthy Dog Ear Otitis externa can affect any/some/all parts of the outer ear. This usually involves the pinna and ear opening as well as the vertical canal and the horizontal canal too. If the ear drum is damaged then it can progress to otitis media which describes infection of the middle ear, and otitis interna which describes an inner ear infection. These diseases can occur in their own right, but they may also be a cause/effect of otitis externa too. Figure 2 - A Dog Ear with otitis externa Page 1 of 7

2 Copyright Bilton Veterinary Centre All rights Reserved What causes otitis externa? Many factors can cause or contribute to the development of otitis externa. Parasites (ear mites, ticks). Foreign bodies (grass awns, dried medication, dried wax, displaced hairs). Allergic disease (canine atopic dermatitis, food allergy). Diseases causing abnormal skin renewal time (keratinization disorders). Hypothyroidism Primary bacterial/yeast infections (surprisingly rare). Structural abnormalities such as polyps or tumours. Figure 3 - Otodectes cynotis: The Ear Mite Other factors that may contribute to your pet developing otitis externa include: Ear structure (long floppy ears, heavily haired ears, long narrow ear canals). Errors in treating or cleaning ears (aggressive use of cotton buds deep in the ear canal). Environmental factors such as swimming, dusty conditions etc. Diseases that obstruct the ear canal (growths, swelling of the ear canal tissue). Sometimes pets with chronic otitis externa have problems beyond the ear drum (otitis media and/or interna), and so these problems also need to be aggressively treated. Many factors may come together in development of your pet s ear problem. Recognition and subsequent treatment of all factors are the keys to successful clinical management of the otitis externa. What are the symptoms of otitis externa? The symptoms of otitis externa can manifest from mild discomfort, to severe pain. Some animals with chronic (long-term) otitis can often have behavioral problems, particularly aggression, due to the discomfort being experienced. Generally, signs may include: Shaking of the head Pawing at ear Unusual/unpleasant smell from the ear Redness of the ear flap Thickening of the skin on or around the ear Narrowing of the ear canal opening Obvious abnormal discharge seen on the pinna (ear flap) or down side of face Yelping when head stroked Increase brown/dark wax secretion visible Page 2 of 7

3 Copyright Bilton Veterinary Centre All rights Reserved Figure 4 - Labrador with unilateral otitis externa. The picture on the LEFT is the normal ear, compared with the RIGHT picture which shows the affected ear What tests are needed? Often it will be obvious when your pet is suffering from otitis externa, but the following may be necessary to fully understand the nature of the problem: Examination of the ear with an auroscope to gauge the extent of the problem. This allows your vet to check for foreign bodies, growths etc. Also allows us to see if the eardrum is intact, and the severity of the problem. In some animals, the ear to too painful to allow a full examination straight away. If extremely painful, the dog may require sedation or sometimes a full anaesthetic to assess the extent of the problem. Full body examination, to check for the presence of other diseases, or predisposing factors, such as allergy or parasites. History taking, this lets us discover if anything has changed that may have triggered the problem, such as changing diet, moving house, building work, swimming etc. Cytology involves taking a small sample from the ear canal with a special cotton bud and then examining it under a microscope. We can check for evidence of yeasts, parasites and bacteria. Also can be useful for predicting the presence of pathological bacteria that may require further testing. Culture and Sensitivity. This is where a deep swab is taken from the ear and then the specific bacteria are cultures, identified and then subjected to a variety of antibiotics to find out which ones they are sensitive to and which ones they may be resistant to. Blood tests are occasionally warranted if underlying metabolic disease (such as hypothyroidism) is suspected that may be contributing to the infections. Xrays very occasionally need to be taken of the skull, if there is the suspicion of middle ear disease as well. Page 3 of 7

4 Copyright Bilton Veterinary Centre All rights Reserved What treatment is needed? The choice and nature of treatment depends on the diagnosis of the underlying cause. It is important to realise that very rarely are ear infections caused by a primary bacterial problem. In other words it is vitally important to try and establish why the ear infection occurred in the first place. If your pet has not had ear infections before and it is not a recurrent problem, then it is acceptable just to treat the problem as an isolated event. However it is recurrent ear infections that are more concerning. Ear disease tends to follow a set pattern. A normal, healthy ear is usually pretty resistant to any infection and so in order for problems to arise there needs to be an initial breakdown of the ears natural defenses. This usually starts of as inflammation caused by a variety of agents mites, foreign bodies, growths, allergies etc. As soon as the inflammation kicks in, a chain reaction occurs involving: The ear lining (the natural defence) being compromised The ability for a naturally occurring yeast called Malassezia to start to get a foot-hold and build up in numbers. This triggers further inflammation until eventually the ear canal is so damaged that the naturally occurring bacteria can start to get a better foot-hold too. Eventually the environment down the ear is so abnormal, that the nastier pathogenic bacteria can colonise the ear and then we have a severe otitis setting in. This vicious cycle of ear disease is illustrated on the next page. Treatment will therefore depend very much on what is causing the initial problem: Ear Mites need specific treatment with anti-parasite therapy. Foreign Bodies need to be removed. Sometimes under general anaesthetic. Tumours/Polyps usually need surgery to remove them. Poor ventilation needs to be addressed if the ears are particularly hairy or pendulous. Allergies need either identifying and avoided, or controlled with medication or desensitisation. If there is no obvious underlying cause for recurrent ear infections, then an allergy should always be strongly suspected. Animals that have an allergic otitis often show other subtle signs of allergic skin disease such as rubbing/licking/chewing/biting at their feet, muzzle, armpits, or groin, causing hair loss and reddening and thickening of the skin. Very commonly food intolerances are responsible for allergic ear disease and this may be one of the first things that we tackle when looking at possible causes. This may be the case in young animals in particular. Page 4 of 7

5 Copyright Bilton Veterinary Centre All rights Reserved Figure 5 - The "Vicious Cycle" of ear disease. Page 5 of 7

6 Copyright Bilton Veterinary Centre All rights Reserved What types of treatment are available? Treatment normally falls into two stages Acute treatment (rescue phase) This aims to correct the otitis and try to return the ear to a normal healthy state. This usually involves the application of certain topical medications and may also involve giving systemic medication as well via tablets. Antibiotics. These are usually given topically as ear drops. However occasionally we use systemic treatment in the form of tablets. The choice of antibiotic is important and often depends on the type of infection or based on cytology or swab results Anti-yeasts. These also usually given topically as they are most effective this way. They can be given orally but side effects are more likely. Usually drugs like Ketoconazole or Miconazole are used. Anti-inflammatories. These are vital as most otitis externa cases are extremely painful. Corticosteroids such as dexamethasone are most useful and effective. These are often given topically but in severe cases (or long term cases) may be given orally as well. Ear cleaning products. When using topical therapy it is often vital to use cleaners at the same time as these help remove unwanted debris, pus, wax etc from the ear which can reduce the effectiveness of the topical treatments. Ear Flush and Clean. This is sometimes required for really severe cases, and this is where we have the dog in for a day, and under general anaesthetic actually flush and clean the whole ear canal out. This has the advantage that we can be really thorough without hurting or upsetting the animal. Long term treatment (maintenance phase) This aims to try to keep the ear in a healthy state and try to reduce the chances of further flare ups. With simple cases of otitis due to ear mites, foreign bodies etc, there is generally not much else that needs to be done. In cases of allergic otitis however, this is by far the most important phase. Here we aim to try and control the underlying inflammation by: Trying to identify/eradicate the source of the allergy where possible. This is often not always possible! In which case we have to: Manage the inflammation by using some or all of the following: o Antihistamine tablets o Systemic steroid medication o Topical steroid medication o Regular ear cleaning Systemic medication has the advantage of being quite easy to administer and is often pretty potent and effective; however they often have the disadvantage of treating the whole animal, just to see the desired effects on the ears. This can be a problem when using medication such as steroids, which can have systemic side effects. Therefore where possible we try and use topical treatment wherever possible, and so a common regime that is used is: Weekly ear cleaning Twice weekly steroid application down the ear canals (we usually use hydrocortisone) Regular follow up checks to assess if current control is successful. Page 6 of 7

7 Copyright Bilton Veterinary Centre All rights Reserved One of the worst things that can be done when trying to manage a recurrent otitis externa is to have a bottle of antibiotic ear drops left-over from a previous occasion, and put some drops down whenever the ear seems to be a bit sore! This usually results in a more severe infection, and we often end up with multi drug-resistant bacterial infection that is then much harder to treat and resolve in the long run! In certain situations such as tumour/polyps or with severe chronic ear disease that has been poorly controlled over time leading to permanent damage a surgical solution may be advised. There are generally three types of surgeries performed on ears. 1. Lateral Wall Resection. This is where the Vertical canal is opened up and folded back on itself. This is a relatively simple operation but is only really useful in the case of polyps or tumours of the outer part of the vertical canal. 2. Vertical Canal Ablation. This is where the whole vertical canal is removed, and the normal top opening of the ear is closed. A new opening is created by joining the horizontal canal to the skin lower down the face. This can only be used if the horizontal canal is normal. 3. Total Ear Canal Ablation (TECA) This is where the vertical canal, the horizontal canal and the ear drum is removed. Often this procedure is performed with a Bulla Osteotomy (BO) as well which removes the lining of the middle ear. This TECA-BO is probably the most useful operation, but is unfortunately the most complex. The procedure will render the animal deaf in that ear (although by the time the surgery is performed, most dogs will be deaf anyway due to the chronic ear disease). There are also some risks involved with infection, swelling and facial nerve damage. If surgery is going to be considered with your dog, one of our vets will go through the whole procedure in a lot more detail with you. It is not a decision taken easily but often is the only way to prevent on-going and considerable problems and suffering. Page 7 of 7

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