Ear Infections 

Ear infections are typically caused by bacteria, yeast, or a combination of both. Ear mites can also be a source of infection (mainly in puppies and kittens). Factors that may predispose your dog to ear infections include moisture (which can create a prime growing environment for bacteria and yeast), foreign objects (eg grass seeds), anatomical problems with ear canals and any underlying allergies.

Causes of Otitis (Ear Infection)

Primary causes of ear infections are:

• The most common cause is an underlying allergy.
• Anatomical features such as floppy ears, narrow ear canals, hairy ear canals as they trap moisture (from swimming etc) and wax / debris in the ear canal.
• Environmental factors such as high humidity and moisture.
• Inappropriate cleaning interventions.
• Foreign objects like grass seeds and burrs.
• Puppies and kittens may get ear infections due to their immune system still developing.
• Keratinisation disorders.
• Endocrinopathies.
• Immune-mediated disease.
• Ear mites or parasites.
• Tumours.

Signs of an Ear Infection

• Musty or sour smell.
• Brown or creamy discharge from the ear.
• Red, thickened ear flaps that may be warm / hot to touch.
• Odd behaviour such as scratching at ears, shaking head, yelping or crying when ears are touched; some pets hide symptoms and become quieter, hide away or don't eat.

Why Your Pet Needs a Vet Appointment

It is very important to have an ear infection examined by the veterinarian. An untreated infection can lead to ear drum rupture and a much more severe inner ear infection. 

The veterinarian will use an ear scope (otoscope) to reveal the severity of infection, and to check for the presence of any foreign objects. A swab of both ears will be taken for cytology (examination under a microscope). Our vets will dispense the most appropriate medication based on the findings of the cytology. It's also essential to ensure that the eardrum is intact. Administration of certain medications can result in hearing loss or nerve damage if the eardrum is ruptured.

In certain cases (for example recurrent ear infections, those not responding to treatment, or where the swab reveals multiple bacterial infections), the veterinarian may submit the sample to an external veterinary laboratory for a culture and sensitivity to accurately identify the organism at fault and tell us which medication is the best to use for this individual case. 

Understanding this process means that treatment needs to be in two phases:

• Treat the infection until a resolution is confirmed both visibly by otoscope and cytologically - ‘treat till you beat’.

• Institute a maintenance program (initially weekly) with monitoring in the knowledge that a chronically damaged ear canal may NEVER regain normal self-cleaning function.

Management of a chronic ear problem will likely require more than three revisits.

Common Cytological Findings

Yeast 

Malassezia yeast species can be the cause of brown discharge and a musty smell. They look like a peanut while they are reproducing (see picture).

                                             

Cocci 

They can be a Staphylococcus bacteria or Streptococcus bacteria species. They appear like small individual dots, or in chains or clusters when they group together (see picture).

Rods

They can be E. coli, Pseudomonas or Proteus species. They appear like short, fat rods that can group together in chains (see picture).

Neutrophils

These are a type of white blood cell that is recruited to the ears to fight infection. They have lumpy, horseshoe shaped nuclei (see picture).

Treatment Plan

Your veterinarian will select an appropriate treatment for the ear infection, based on the cytological findings or culture results. 

The frequency of application may vary, depending on the type of medication required.

When giving the ear medication or cleaner, massage the ear canal gently afterwards to ensure that it travels all the way down the L-shaped canal to the ear drum. 

Recheck Appointments

Your pets recheck appointment is due two days after finishing the medication. It is important not to apply any ear drops or ear cleaning solution two days prior to attending the recheck appointment.

The recheck appointment is the most important step in treating any infection. 

Your veterinarian will take another sample from your pet's ears for cytology, to check whether the infection has cleared or not. If the organisms causing the infection are still present, then the treatment course will need to be extended. If treatment is stopped prematurely, the infection is highly likely to return and may set up a highly resistant infection. If the organisms are no longer present, your veterinarian will advise you on how to prevent future infections from occurring. 

Management of a chronic ear problem will require more than 3 revisits.

Costs

Possible costs associated with an ear infection appointment are:

• Consultation or Revisit (for subsequent checks) fee

• Ear cytology fee

• Ear medication

• Ear cleaning flush

• Severe cases may also require injectable and/or oral medication

Ear Care Maintenance

Ear Plucking
It used to be recommended to pluck the ears of dogs with hairy canals as a prevention against ear infections. However new evidence has shown that the process irritates the ear canal and can in fact lead to infection. It is now only recommended in ears that really need to be plucked due to stubborn, unresolving ear infections. 

After long-standing infection and inflammation, the ear canal can sometimes lose its self-cleaning function and possibly may never fully regain it. Long-term veterinary visits for close monitoring every few months is essential.

Routine Cleaning
Once the infection has cleared, it is important to maintain good external ear canal health, to prevent infections from recurring. 

If you have been given a cleaner to use, use this cleaner daily during the infection treatment program and ongoing weekly cleaning once the infection has cleared, to help reduce recurrence. If you have not been given a cleaner, perhaps discuss with your vet which product they think would be most beneficial. Ear cleaner should be done before applying medications.

The most commonly used cleaner is Epiotic. This cleaner is very effective at drying the ear canal and contains enzymes that help break down wax in the ears. Epiotic is a cleaner we regularly recommend to clients to assist with cleaning the ear before applying medication, as well as ongoing maintenance. However this cleaner can sting the ear if being used when the ear canal is inflamed or ulcerated, and can interfere with certain medications, so it is best to ask your veterinarian before using. 

Otoflush is a saline-based cleaner, is used to flush out heavily discharging infections and is often used in bacterial ear infections. This cleaner can be used with some medications, but please clarify with your veterinarian before using. 

How to Clean Your Dog's Ears

When cleaning a dog’s ear, it is critical not to use anything that would tend to push any debris further into the ear canal. Cotton-tipped applicators (such as Q-tips) should not be used.

Assemble cotton balls and the ear cleaning solution. Squirt enough cleaner into the ear to fill the canal. Massage the base of the ear until you hear the solution “squish.” Gently grasp the base of the ear and pull the pinna up and away from the head. Wad the cotton into a tubular shape and gently insert it into the canal as far as it will go. Again, gently massage the base of the ear to help work debris and cleaning solution toward the cotton and dry the canal. Wait a few minutes before using any medication in the affected ear(s) as instructed by your veterinarian.