Examination of the Ear
In taking the first step towards addressing ear disease the doctor must first perform a thorough physical examination, while paying close attention to the quality of your pet’s skin and coat. Many times, the ability to detect these subtle hints upon complete examination may be crucial in providing the necessary clues to determine the primary cause of your pet’s ear disease. The next step is a thorough otoscopic examination of the ear. Without actually attaining complete visualization of the ear canal and ear drum, including microscopic evaluation of samples collected from deep within the ear, comprehensive and appropriate treatment of the ear disease cannot be effectively accomplished.
Complete examination of the ear canals and ear drums of both dogs and cats can often be extremely frustrating and provide a source of discomfort to any pet that is experiencing any form of ear disease. Simply manipulating the ear to aid insertion of the otoscope cone into the canal of a pet with a painful ear can often exacerbate the pain and often results in aggression toward the veterinarian or staff. It is often after experiences such as this that many pets become extremely reluctant to allow even their owners to treat their ears at home. This in turn, perpetuates the chronic ear disease that unfortunately extends the animal’s suffering while left untreated. Because appropriate corrective treatment of diseased ears can only be done after a complete examination and evaluation, the use of sedation or anesthesia is often required for patients experiencing discomfort
. Often in severe or chronic cases, the presence of swelling along with the accumulation of inflammatory material, such as mucus and pus within the canals may prevent complete examination. In these particular cases, very inflamed ears may need to be treated with topical or oral steroids for a week or two in an effort to gain better visualization of the ear at the following recheck exam.
Cytology and Culture
It is imperative to perform a microscopic evaluation of the secretions collected from deep within the ear canal when trying to identify a patient’s current condition, including underlying causes. Performing cytology of both ears each time your pet is presented for an exam due to possible ear disease is ideal and necessary so that we can identify what kind of infectious organisms are present, if any. With this information, we can tailor treatment to each individual patient to resolve the issue in an effective manner. It is also essential to recheck cytology of the ears during treatment so as to monitor progress. In doing so, we are able to ensure that no changes to the treatment protocol need to be made and assess response to the chosen treatment. It is important to monitor populations of organisms during treatment, as change can occur which may require the use of different medications. A culture of these organisms is also needed in some cases in order to determine susceptibility and resistance to drugs, if there is no favorable response to the previously chosen medication(s). In order to obtain these samples in painful pets, sedation or anesthesia may be necessary in some cases.
Flushing the Ears
After determining the underlying disease affecting the ears, a thorough ear cleaning must be performed. Adequate evaluation of the skin of the canals and the status of the ear drum can only be done after all the accumulated material has been evacuated. It is important that the medication(s) the pet is being treated with, actually be able to reach all affected tissue of the complete external canal and ear drum for resolution of infection, inflammation, or both. In most cases cleaning at home by owners can be initiated to begin with. If the material in the canals is persistent despite ear cleanings at home, or if the patient is too painful for this type of cleaning, then an ear flush under anesthesia with the use of an otoendoscope is necessary in order to completely remove the debris from the ears.
Evaluation of the Ear Drum
The ear drum is very thin, and is what separates the external ear from the middle ear. It is essential to evaluate the integrity of the ear drum, especially when managing ear disease. Middle ear disease can be quite serious, and the treatment approach implemented is entirely different from that taken with external ear disease.
Radiographs (x-rays) are often necessary to determine presence of middle ear disease. Because of the precise positioning needed to acquire these views, anesthesia is always necessary, even in the most cooperative of patients. Radiographs are often performed at the time of deep ear flushing to avoid an additional anesthetic procedure. Occasionally, advanced imaging such as computer tomography (CT) or magnetic resonance imaging (MRI) is needed in order to evaluate the severity of ear disease with regards to the skull and surrounding tissues.
One of the most critical aspects to the resolution of ear disease is regular re-evaluation, especially with patients that have perpetual triggers that lead to ear disease such as an overproduction of cerumen (wax) leading to build-up and eventually a foreign body. Multiple recheck examinations along with cytologic sampling are needed in every case of ear disease. The more complicated or chronic cases may require more than one deep flushing and follow-up radiographs.
Ear disease is complicated and can be frustrating for doctors, owners and patients. The key to successful treatment is teamwork, dedication and perseverance.