Sore Ears – Dogs

One of the most common problems we see in dogs is sore or itchy ears. These can be frustrating recurrent problems so as an owner, it is useful to understand the problems that are going on in your dog’s ears.

Whatever the cause of the ear problem, once ears become inflamed:

• The skin down the long ear canal (which can be 100mm long), becomes swollen and red
• The canal diameter can shrink from 15mm to 5mm
• Increased heat and moisture from inflammation creates a great place for bacteria and yeasts to quickly multiply
• Pain and irritation causes your dog to itch and rub
• Eventually inflammatory cells (pus), flood the ear canal and create an infected airless soup
• A small problem quickly becomes an acute painful emergency, which can lead your pet to start traumatizing the skin around the ear, making it difficult to examine and treat

Emergency Treatment

Whatever the cause, it is important to treat the pain and inflammation

• Steroids can be useful to quickly decrease the inflammation, decreasing pain and opening the ear canal
  • Very acute cases respond well to steroid injections
  • Recurrent cases can be assisted with oral tablets
  • Topical creams used to treat inflamed ears often contain steroids
• Avoid further trauma
  • Some dogs will need to have an E-Collar applied to stop the dog itching and rubbing the ears
• Ear cleaning and assessment
  • Often assessment is impossible when ears are acutely painful
  • Reassessment when inflammation is settled a few days later can be helpful
  • General anaesthetic to clean and assess ears is useful to accelerate the treatment and look for any cause such as a polyp or foreign body in the ear

Investigation

To manage sore ears your veterinarian will investigate:

• • Is this only an ear problem, or is it an ear and skin problem
  • Previous ear problems and response to treatment
  • Are there other changes in the ear such as polyps or excessive hair
  • Microscopic appearance of the ear canal discharge
    • Are there yeast present such as malassezia
    • Are bacteria present – these can be divided into cocci or rods
    • Are there inflammatory cells – neutrophils – pus
  • The presence of ear mites – this is unusual except in young puppies

Treatment

Sore inflamed ears are treated by:

• • Settling any inflammation and pain to decrease the swelling and open up the ear canal
  • Medicate the ears to treat any overgrowth of microorganisms
  • Sometimes tablets or capsules maybe needed to treat the infection and inflammation
  • Removing excess discharge in ears to allow medications to work
  • Sometimes ear cleaning and examination under general anaesthetic is needed to remove excessive hair and discharge before the ear can start to improve
  • Treat for any underlying allergic causes

Management

Some sore ears are a single disease event, where after treatment, your pet will return to having healthy, non-itchy ears.

Many sore ears are secondary to allergic skin disease. Even when the ear infection is controlled and the ears kept clean, your pet still has itchy ears. The inflammation and swelling cycle can rapidly restart. This is where long-term management of inflamed ears becomes imperative.

There are many management medications which can be used, often in combination with each other, to make your pet more comfortable. These include

Ear Cleaners

• • • Some dogs ears benefit from the use of ear cleaners to break up thicker discharges and get them moving out of the ear canal
    • Wiping the ear canals with cotton balls following ear cleaner application will remove the debris from the top of the canal
    • Residual ear cleaner in the lower canal may dilute and soften debris and help it move out of the canal
    • Regular application of small quantities of ear cleaner can discourage the growth of organisms
    • Vigorous use of ear cleaners can make the ears more irritated and inflamed. Your veterinarian can guide you to the best ear cleaners and application methods

Antimicrobials

• • • Microscopic investigation of discharge in the ears will show your veterinarian if yeast or bacteria are overgrowing in the ears
    • Normal as well as abnormal ears are sampled and the results will vary over time
    • A positive smear will indicate bacteria or yeast. A follow up smear is needed to show that treatment with antimicrobials have been successful
    • If the organisms remain despite treatment, changes in treatment type or length are needed, or examination and cleaning under general anaesthetic may be useful
    • Sometimes the bacteria in your dog’s ears become resistant to antibiotics. Samples are then taken to identify the bacteria and assess it’s resistance or sensitivity to medication

Topical Steroids

• • • To treat underlying allergic disease, regular application of topical steroids can decrease inflammation. This avoids the itchiness, redness, swelling and pain that leads to sore ears.
    • Daily application is needed to settle inflammation followed by less frequent (perhaps weekly or fortnightly) application to maintain settled ears
    • When ears are not responding to topical treatment and are continuing to be painful and swollen, a veterinary assessment is needed

Anti-itching tablets

• • • Short courses of corticosteroids (prednisolone) can significantly decrease the itching and inflammation of sore ears. Longer courses are not ideal due to the whole of body effects these medications produce
    • Newer medications for dogs such as Apoquel® act to decrease the itching sensation with significantly less ongoing side effects. Some dogs with itchy ears and allergic skin disease respond very well to Apoquel®
    • Antihistamines are sadly rarely effective in allergic skin disease in dogs

Cytopoint

• • • CYTOPOINT is a long acting injection of a protein that works like your dog’s own immune system. The treatment acts to neutralize the main protein that triggers allergic itch
    • Treatment for dogs lasts for 4-8 weeks. It is safe from a very young age and with all other medications
    • Dogs with ongoing itchy ear problems with underlying allergies can often benefit from treatment with CYTOPOINT

Conclusion

Problems with sore or itchy ears can be frustrating and disturbing. With help from the veterinarians at Pittwater Animal Hospital these problems may be managed to make your pet more comfortable.

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or call us on 9913 7979