Ear Infections
Treating the Patient with Ear Disease
The
only way to resolve chronic or recurrent ear disease is to identify and address all of the
primary,
predisposing and
perpetuating factors. This means that in addition to direct medication of the ears, we need to treat any underlying causes such as allergies, parasites, endocrine disorders, immune mediated diseases or other conditions, as is determined for each specific patient. Allergy testing or a hypoallergenic diet trial may be needed to identify underlying allergies. Blood testing may help investigate hormonal abnormalities. Skin biopsies may be needed to determine any diseases such as an autoimmune disorder that could cause a skin abnormality affecting the ear. Skin scrapings may be needed to detect mites, tiny parasites that can infect the ears and cause skin diseases. X-rays of the skull or CT scan can be used to examine the middle and inner ear for signs of disease. In addition, cultures of an infected ear help determine the presence and type of bacteria, as well as antibiotics that are appropriate for treatment. Treatment of the secondary ear infections involves ear flushing and cleaning to remove exudate and wax, and topical +/- oral antibiotics to treat the infections.
Cleaning the Ears
Cleaning the external ear canal is absolutely imperative for two reasons. First, topical medications need to come into contact with the skin of the ear canal. If the lining of the ear canal is covered by inflammatory byproducts, wax, or old dried medications, this necessary medication contact cannot happen. Second, it is essential to evaluate the ear drum in order to successfully treat the disease. The ear drum is the only thing separating the external ear from the middle ear, and if it is not intact there will be middle ear disease as well. Because treating the middle ear involves different methods, we must know if middle ear disease is present. In addition, some medications we put into the external ear canal are not safe to use in the middle ear, therefore cannot be used if the integrity of the ear drum is unknown. But, if we are assured of an intact structure, we are able to use whichever drug best fits the external ear disease.
In mild cases of external ear disease, cleaning may be possible in the awake patient. Ear flushing may happen in the hospital during the appointment, and cleaning usually needs to happen at home as well. A specific cleaner will be prescribed based on the doctor’s findings, and there will be instructions as to the frequency required.
It is critical to use only the cleaner recommended by the doctor.
To clean the ears, lift the flap of the ear up firmly to straighten out the ear canal. Squeeze the liquid into the ear canal to fill it until it is overflowing. (Do not allow the tip of the ear cleaner bottle to contact the ear canal, as the bottle can become contaminated with bacteria. If the tip of the bottle touches the ear canal, then it is important in this case to clean the tip of the bottle well with rubbing alcohol after use). Still holding the ear flap, with your other hand massage the cartilage of the ear canal so that you hear squishing. Do this for at least 15-20 seconds. Then you may release the ear and let your pet shake his or her head. You may clean the inside of the ear with a tissue or cotton balls but
NEVER insert cotton swabs out of sight. Repeat as necessary so that after shaking there is no visible matter coming out of the ears. This is a messy process so prepare your house or do cleaning outside.
When using medication in conjunction with cleaning, medicate 20 minutes after cleaning.
In moderate or severe cases it is necessary to anesthetize the patient and perform a deep ear flushing. This is often the only way to remove tenacious inflammatory material, old medications, and clean the crevices made by inflamed tissues. See the
Video-otoscopy section of our “Services” website tab for pictures and videos of this procedure.
Medicating the Ears
Almost all cases of external ear disease require topical medication. The type used is prescribed based upon results of physical examination, cytology and/or culture. Commonly used medications include anti-inflammatories, antibacterial, and antifungal components. Depending on the case, topical medications are usually continued for 2-6 weeks.
If cleaning the ears is part of your pet’s treatment plan, it is important to instill the medication 20 minutes after cleaning.
Systemic Medications
Some patients with ear disease require systemic (oral or injectable) medications in conjunction with topical therapy. These may include steroids or nonsteroidal anti-inflammatories to reduce ear canal swelling and itching, antibacterial or antifungal drugs to address infections, or analgesics to manage pain. Animals with otitis media or otitis interna may need 1-3 months of systemic antibiotics
Surgery
There are some cases of ear disease that require surgical intervention. Some polyps and tumors can be removed with a simple surgical procedure. More complicated surgery is necessary for the more invasive growths, in cases of middle ear disease where proper application of medicine is not physically possible, or when irreversible changes within the ear are present secondary to longstanding disease. The decision to undergo surgery is made only after determining the inability to reverse changes within the ear and ear canal as a result of chronic inflammation and ear infection using less invasive therapies.
Re-evaluations
Regular and timely recheck examinations are crucial. The environment of the ear can change rapidly once treatment has been initiated, and as specific disease processes go through the transformation of healing, medications must be adjusted. It is only through diligent monitoring that we are able to maximize the chance of resolution.
Ear disease is complicated and can be frustrating for doctors, owners and patients. The key to successful treatment is teamwork, dedication and perseverance.
