dog ear infection treatment advice

Dog ear infections require close cooperation with your vet to treat successfully.

Handouts like this one help you understand the problem and the steps needed to fix it.  If not diagnosed early and treated correctly, dog ear infections often recur.

Dog ear vet

Read more about dog ear infection treatment

When your dog has sore, itchy ears.

272 MARCH 2004 Veterinary Medicine

Your veterinarian has just informed you that

your dog has otitis, or inflammation of the ear.

There are three stages of otitis. In the beginning,

the external ear canal is affected, and you may

notice that your dog is shaking its head or pawing at

its ear. Your dog might also have an ear discharge,

with or without odor. In the next stage, the disease

spreads to the middle ear, which includes the

eardrum. In the final stage, otitis spreads to the inner

ear, which houses your dog’s balance system.

In the more severe stages, dogs are reluctant to

open their mouths or chew and have a pronounced

head tilt, balance problems, and drooping lips or eyelids.

Luckily, most cases of otitis are caught during the

first stage, and, at this stage, the chances for getting

your dog’s ears back in tip-top shape are good.

How did the otitis develop?

Many things cause dogs’ ears to become

inflamed, including ear mites, a bacterial

or yeast infection, a foreign object or mass

within the ear, allergies, or medical conditions

that allow infection to develop within the

ear. Some breeds are more likely to develop

problems because of their ear structure. It

can take time and a variety of diagnostic

tests for your veterinarian to determine the

underlying cause. But this cause must be

identified, or the problem can worsen

and spread farther into the ear,

causing your dog intense pain and,

possibly, necessitating surgery to drain the

infected material and remove the affected tissues.

Even if bacterial or yeast infections aren’t the primary

cause, they often develop in affected ears. Your veterinarian

will likely prescribe medication to treat these

infections and show you how to administer it. Keep in

mind that frequent follow-up visits will be necessary to

monitor response to therapy.

Cleaning your dog’s ears

An important part of treating your dog’s otitis involves

frequent ear cleanings, which you can do at home.

Make sure you clean your dog’s ears either outdoors

or in an area such as a tiled bathroom where nothing

can be stained by debris from the ear canal. Use a

two-stage cleaning technique. First, flood the ear

canal with cleaning solution prescribed by your veterinarian.

Make sure you fill the canal—don’t just use

a few drops. Allow the solution to remain in contact

with the canal for at least 60 seconds, and gently massage

the entire canal during this time. Dry the canal

with a cotton ball. Use only real cotton balls, which

are less irritating than synthetic ones are. Never clean

your dog’s ears with a cotton swab. The

swab pushes debris farther into the ear

canal and puts the eardrum under pressure,

possibly causing it to rupture. The

second stage is a repeat of the first.

Again allow the solution to contact

the canal for a full 60 seconds or

more and massage the ear. Then

step back and let your dog shake

its head.

The frequency of cleaning

varies based on how severely

your dog’s ears are affected, but,

in general, perform this cleaning

process twice a day for the first one

or two weeks, once a day for the

next one or two weeks, and then

once or twice a week thereafter.

Communicate with your veterinarian

Follow your veterinarian’s instructions for cleaning

your dog’s ears and administering medications. Be

sure to bring your dog in for each recheck appointment

your veterinarian schedules, even after the

inflammation has subsided. Otitis often recurs in dogs,

and the medication that cleared it up the first time

may not work the next time because a different type

of infection may have developed. So be sure to see

your veterinarian if signs do recur. ■

Dog ear yeast infection

Dog ear infections are often caused by a yeast called MMalassezia Pachydermatitis.  Malasezzia yeasts live on normal dog skin, but some dogs get overgrowths of the yeast on their skin which causes symptoms such as thickening, scaliness, redness and itchiness of the skin.

Malasezzia infections are usually secondary to other problems such as injury, infection, poor hygeine, and environmental factors like the skin or ear being wet for long periods, humidity, and high temperature.  In many dogs yeast infections are secondary to allergies or other infections.

Dog ear vet

Read more about dog ear infections below:

Malassezia Yeast Infections in Dogs and Cats

Oct 9, 2010 Lorie Huston

Yeast Can Infect the Skin of Dogs - Chris Harriot

Malassezia yeast can infect the skin and/or ears of dogs and sometimes cats that have other types of skin disease. Infection is itchy and uncomfortable.

Yeast are, by definition, a spore-like form of fungi. Malassezia is a yeast organism that frequently populates the skin of the dog and cat. In fact, Malassezia are present even on the skin of healthy dogs and cats. However, when the skin becomes damaged, the changes in the skin give the yeast the opportunity to reproduce and infect the skin in higher numbers. The yeast organisms can infect the ears of the dog and cat as well.

Malassezia Yeast Infections in Dogs and Cats

Yeast infections involving Malassezia rarely occur in either dogs or cats without an underlying form of skin disease. Though the organisms are capable of causing disease in damaged skin, they are not particularly virulent in the absence of pathology.

Yeast infections due to Malassezia occur frequently in dogs and can occur in cats but are less common in the feline species.

Any type of skin disease can predispose a dog or cat to a Malassezia yeast infection. Some of the more common predisposing causes are:

• flea allergies
• food allergies
• inhalant allergies (also known as atopy)
• seborrhea

Other diseases that affect the skin can sometimes be responsible for causing Malassezia yeast infections also. These diseases include demodectic mange, autoimmune skin disease and other types of skin disease.

Symptoms of Canine and Feline Malassezia Yeast Infections

The most common and easily recognizable symptom of yeast infection in dogs and cats is intense itchiness.

Read on 

• Skin Allergies in Dogs
• Ear Mites in Dogs and Cats
• Diagnosing and Treating Ear Infections in Dogs

Malassezia can infect both the skin and the ears of the canine and feline. In dogs, yeast infection with Malassezia is an extremely common secondary infection. Yeast infection is less often diagnosed in cats but in either species, infection can be problematic. Without treatment of the yeast infection, the underlying disease is unlikely to respond well.

Commonly seen symptoms are those seen with many other skin diseases and include reddened or inflamed skin, open sores, scabs, hair loss and, in more chronic cases, thickened skin. Yeast infections often cause a foul skin odor as well.

In the ears, Malassezia yeast infection causes similar symptoms. The dog may shake his head, scratch at his ears or tilt his head. The ears may have a black to brown colored waxy discharge and may also have an odor.

Treatment of Malassezia Yeast Infections in Dogs and Cats

Yeast infection with Malassezia is treated in several different ways. Shampoos are frequently used although they may not be totally effective in and of themselves. Commonly used shampoos include benzoyl peroxide shampoos and those containing chlorhexidine. In addition, shampoos containing anti-fungal medications such as miconazole and ketoconazole may be used as well.

Topical medications used to treat small lesions include those containing acetic acid. A mixture of vinegar and water is often used to treat small areas of yeast infection also.

Antifungal medications such as ketoconazole given orally are usually the most effective means of treatment.

Any time a dog or cat develops a skin disease, secondary infection with Malassezia yeast is a possibility. When this occurs, your dog or cat may not improve until the yeast infection is controlled. Your veterinarian can perform simple skin tests to determine if your pet has a yeast infection.

Dog ear yeast infection

Dog ear infections are commonly caused by the budding yeast Malasezzia pachydermatitis.  Dog ear yeast infections are characterised by a yeasty smell, often with thickened skin, redness, scaling and a thick discharge inside the ears.  Dog ear yeast infections are usually long term problems and won't be painful initially.  While they can be hard to treat, they can be prevented by good ear hygeine and attention to your dogs overall health and other skin problems.

Check out this great electron microscope photo of the dog ears infection yeast from Vet blog.

Malassezia (yeast) infections: something extremely common in cats and dogs, especially during allergy season. These little buggers can cause nasty ear infections, and if you look for them properly, can be found anywhere on the skin. 
Incidentally, our microscope in the clinic is suberb, but not an electron microscope (as what has taken this image).

dog ear infection anatomy and physiology

Dog ear infections can be confusing because the dogs ear is actually mostly hidden.  Dog ear infections often occur deep within the ear, and dogs may have painful ears with pus or blood discharge for days before you notice any problems.

Learning the anatomy of the dogs ear and how this relates to infection, applying medication like ear drops and cleaning the ear is essential to successful treatment.

Dog Ear Vet

Read more about symptoms of dog ear infections

Read more about otitis externa anatomy

Otitis externa 

Introduction 
Otitis externa, or inflammation of the external ear canal, is a common condition in dogs. It is characterized by inflammation of the soft tissue components of the external ear canal and is particularly prevalent in dogs with long, floppy ears. Otitis externa may affect 20 percent of dogs. 

  
Left: as demonstrated by the above ear-model, the ear canal has a vertical and a horizontal component. This predisposes the dog to ear infections as debris must work its way upward rather than straight out. 
Right: otitis externa with brown exudate 

Anatomy of the ear 
The ear of the dog and the cat is composed of three parts: the external ear, the middle ear and the inner ear. Together these components allow the animal to locate a sound and the direction from which it emanates, to orientate the head in relation to gravity and to measure acceleration and rotation of the head. 
Selective breeding, of dogs in particular, has resulted in a wide variation in relative size and shape of the components of the external ear. Compare, for example, the French Bulldog, the Cocker Spaniel, the German Sheperd Dog, the St. Bernard and the Persian cat. The pinnal shape and carriage, the diameter of the external ear canal, the degree of hair and amount of soft tissue within the external ear canal, and the shape of the skull within which the middle and inner ear lie vary from one breed to another. 

The external ear canal 
An importrant difference between the tissues of healthy ears and infected ears is the appaerance and distribution of the glandular structures. In a healthy ear, sebaceous glands are usually numerous , large and actively secreting. In chronic otitis externa, they are less active and much smaller. The external ear canal may normally contain a small amount of wax that is yellowish-brown in color. 

Signs of ear disease
Every day we see dogs who have problems with their ears. Signs of these ear problems include: 
• Odor 
• Scratching or rubbing of ears and head 
• Discharge in the ears 
• Redness or swelling of the ear flap or canal 
• Shaking of the head or tilting it to one side 
• Pain around the ears 
• Changes in behavior such as depression or irritability 

Causes of ear disease 
• Allergies such as atopy or food allergies 
• Parasites - ear mites. Adult mites are large, white and free-moving. the life cycle of the ear mite is three weeks. Mites are characterized by thick, reddish-brown or darkbrown exsudate and crusts in the ear. Ear mites are the single most frequent cause of otitis externa in the cat. Mites are highly contagious. 
• Bacteria and Yeast infections. Staphylococcus or Streptococcus (Gram-positive bacteria) infections are most frequently associated with acute otitis externa. There is a light-brown, creamy exudate. Gram-negative organisms (Proteus, Pseudomonas, E.Coli) are most frequently observed in chronic otitis externa or recurrent ear disease. There is a yellow exudate. Malassezia canis is a budding yeast: a brown, waxy adherent exudate. 
• Ticks. The spinous ear tick is found in the external ear canal of dogs and cats. The ear canal become packed with immature ticks. Treatment involves mechanical removal, spraying or dipping the coat with an insecticide. 
• Foreign bodies, e.g., plant awns 
• Trauma 
• Hormonal abnormalities, e.g., hypothyroidism 
• The ear environment, e.g., excess moisture and ear anatomy 
• Hereditary or immune conditions 
• Tumors 

Treatment 
The first step in otitis externa is a thorough cleansing of the ear canal followed with irrigation of the canal with a warm antiseptic solution (chlorhexidine or betadine). A warm sterile solution should be used if there is any indication of ruptured membrane. 
Most topical ear medications are combinations containing one ore more antiparasitics, antibacterial, antimycotic, anti-inflammatory, local anesthetic, ceruminolytic and drying and cleaning agents. Oil or ointment bases help moisturize the skin and are effective in dry, scaly or crusty lesions. Solutions or lotions are most frequently used in exsudative ear lesions. 
Cotton applicator swabs can be used to clean the inside of the earflap and the part of the ear canal you can see. They should NOT be used farther down in the ear canal since that tends to pack debris in the ear canal, rather than removing it! 
Chronic otitis externa is usually associated with underlying skin conditions such as seborrhea, hypothyroidism or improperly or neglected ear disease.ar problems caused by a systemic disease such as a hormone abnormality or allergy must include a therapy that treats the whole dog, such as hormonal replacement or allergy testing and hyposensitization (immunotherapy). 

Surgical treatment
Depending on the severity of the problem, the vertical canal may need to be opened surgically. This enables debris to be removed more effectively. This is done to prevent severe scarring after prolonged specific medical therapy has been ineffective. This procedure is called a lateral ear resection, Zepp procedure, or LaCroix procedure.  
If the canal becomes so scarred that it is practically closed, ablation may be the final option. In this surgical procedure, the entire ear canal is removed and healthy tissue is allowed to grow in. This procedure is a last resort after severe infection has made effective medical treatment impossible. A specialist is called in for these cases and although surgery is expensive, dogs with chronic severe otitis usually require no further ear treatment for the rest of their lives.

 

 
Aural hematoma 

Complication of ear disease: aural hematoma 
When a dog with uncomfortable ears shakes and scratches vigorously, a blood vessel in the ear flap may rupture.  This leads to bleeding into the tissues of the pinna (see above illustration). The usual recommendation is to have the blood clots removed and the ear bandaged and cleaned under anesthesia. If the hematoma is not so big as to occlude the ear canal (thus preventing medication), the option to forgo surgery exists; but without surgery, the ear may scar down into an abnormal appearance. 

Preventing ear disease
The key to healthy ears is to keep them clean. Check your dog’s ears weekly. A slight amount of waxy buildup may be present in normal ears. If your dog swims a lot, has pendulous ears, or a history of ear disease, routine cleaning (often once to three times per week) is recommended. Use the same procedure as described above. Excess hair around the ear can be clipped to allow more air flow. Treat any underlying condition that predisposes your dog to ear problems. 
Remember, if your dog is showing severe discomfort, the ears have a bad smell, or the ear canals look very abnormal, do not delay in contacting your veterinarian. If your dog has a ruptured or weakened eardrum, some ear cleansers and medications could do more harm than good. 

Dog ear infection video

Dog ear infections need to be diagnosed by a vet.  The cause of the problem will influence the treatment, and the wrong treatment can delay recovery or even make the problem worse.

Cleaning the ear with a product like Epi-Otic can greatly improve the hygeine of the ear: helping to prevent problems and clearing up your dogs ear infection more quickly.

Dog Vet

Dog ear mite infections

Dog ear infections are very common.  Occasionally they are caused by ear mite infestations.  Ear mites are actually fairly rare problems in dogs these days, and dogs actually get the Cat Ear Mite, Otodectes cyanotis.  Dogs also get the cat flea Ctenocephalides felis: no wonder dogs and cats don't always get on!

Anyway, back to ear mites.  Mites are rarely the cause of dog ear problems, but people often think they are.  Many people spend a lot of money using ineffective ear mite drops in their dogs ears when their dog actually has a bacterial or yeast infection.  For this reason, its important to take your dog to the vet if their ear is is itchy and red, and especially if there is pain, smell and discharge (gunk or fluid in the ear).

Ear mites are little 8-legged critters that live in ears.  They are tiny, and you won't be able to see them just looking.  The vet will use and otoscope to look in your dog's ear and take a sample to look at under the microscope if they suspects ear mites.  In many cases the vet will rule out ear mites just by looking at the ear without taking a sample, as ear mites produce a very characteristic type of inflammation and discharge, which has been described as waxy and coffee-ground like.

If it is ear mites, thats actually good news as ear mites are very easy to treat..... but not with ear mite drops.

Drops often fail in treating ear mites as the mites can live on the head as well as in the ear, so the mites just return when you stop putting the drops in.

Far more effective are spot-on products like Advocate or Revolution: these both contain an ingredient which kills the mites with a single dose.  I reccommend pets use a course of 3 monthly doses to prevent reinfection, as the mites may survive in the environment.  Its vital that all in-contact pets, especially cats are treated as ear mites are highly contagious.

Ear drops are often still required as the ear may be very itchy and may have a secondary infection, which won't impove with the spot-on products.

More commonly, there are no mites, just a bacterial or yeast infection, and drops supported by a cleaning regime will be the best treatment.

Read more about Ear Mites below.

Ear Mites

Signs, Diagnosis and Treatment of Ear Mites

From Lianne McLeod, DVM, former About.com Contributing Writer

See More About:

• ear mites
• ear infections

Image (taken through microscope) of ear mites sampled from a cat's ear.

Credit: Wikimedia Commons / Caroldermoid

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Ear mites are tiny parasites that live out their life cycle mostly inside the ear canal. They are quite common, and can cause severe irritation and itchiness of the ears.

The most common ear mite of cats and dogs is Otodectes cynotis, and therefore an infestation with ear mites is sometimes called "otodectic mange."

Cause
Ear mites primarily live in the ear canal, where they feed on skin debris. Their presence causes inflammation, and can also lead to secondary ear infections.

Eggs are laid in the ear, and it takes about 3 weeks for eggs to hatch and develop into adult mites that can reproduce.

While ear mites are generally found in the ears, they can also wander out onto the body, causing irritation and itchiness of the skin as well.

Risk Factors
Cats are more commonly affected than dogs. Ear mites are spread mostly by direct contact with another animal that has ear mites (they are commonly seen in outdoor cats). They are especially common in young animals.

Signs and Symptoms of Ear Mites

• head shaking
• scratching at ears
• dark waxy or crusty discharge from the ears (looks a bit like coffee grounds)
• sometimes there will be scratching or irritation of other parts of body

Diagnosis of Ear Mites
The diagnosis of ear mites is confirmed when ear mites are found in a sample of the ear discharge examined under a microscope. Sometimes the mites can even be seen as little white specks moving around in the ear (when using a magnifying scope to examine the ear). Confirming the presence of the mites is necessary to distinguish ear mites from other ear infections.

Treating Ear Mites
There are several alternatives for treating ear mites, and your veterinarian will recommend a treatment protocol for your pet. Over the counter medications are often less effective or require extended treatment times compared to medications prescribed by your vet, especially the newer medications that require a single application to be effective.

First, a thorough cleaning of the ears can help clear the discharge to help calm the irritation and remove some of the mites. This can be followed up in several ways:

• one-time treatments applied to the ear: medications such as Acarexx® or Milbemite® (cats only)
• one time treatments applied to the skin: medications such as Revolution® or Advantage Multi® (these are typically used as monthly parasite control medications; a single dose usually takes care of an ear mite infection but you may consider using them monthly to prevent reinfection and control other pests)
• repeated treatments applied to the ear: e.g. Tresaderm®. It is important to strictly follow your vet's recommended dosage schedule for successful treatment of ear mites (usually twice daily treatments for a week or more). Though more time-consuming to apply (and can be difficult with uncooperative patients), Tresaderm® does have the advantage of containing medications to calm inflammation and treat secondary bacterial or yeast infections.
• injectable ivermectin can also be used (this is an off-label usage for ear mites, and care must be taken as some breeds of dogs are sensitive to ivermectin)

All pets in the home should be treated at the same time, even if they are not showing symptoms.

Ear mites do not survive for long on humans so do not cause long term infections in people. Rarely, however, they will transiently hang out on humans, and may cause a short-lived but very itchy rash.

Please note: this article has been provided for informational purposes only. If your pet is showing any signs of illness, please consult a veterinarian as quickly as possible.

 

Middle and inner dog ear infections

Dog ear infections can affect the external ear canal (otitis externa) the middle ear (otitis media) or the inner ear (otitis interna).  The vast majority of dog ear infections only affect the external ear, which is a good thing, because middle and ear infections are much more serious, are harder to treat and can result in very serious complications and often recur.

Most middle and inner ear infections start from severe or long term external ear infections, which is another reason (do you need more, other than your dog is in pain!!!) to check your dogs ears regularly and maintain a hygine regime, and see the vet immediately if there is signs of infection.

dog ear vet

Learn more about middle and inner ear infections in dogs by reading on below.

The middle and inner ear of dogs and cats is separated from the external ear by the ear drum. It is not possible to see the middle or the inner ear unless the eardrum has been ruptured. Infections or problems in the middle or inner ear require prompt diagnosis and treatment to prevent permanent damage and deafness. The middle and inner ear coordinate hearing and control balance. Therefore, problems in this area often show up as hearing loss or can include a loss of balance or other neurological problems. Fortunately, if caught early, most middle and inner ear infections can be treated successfully. What is the cause of middle ear infections? Most cases of middle and inner ear infections in dogs and cats are caused by an extension of an infection in the outer ear. Staph, Strep, and Pseudomonas bacteria or Malassezia or Candidayeast are often isolated as the infectious agents. Less commonly bacterial infections may ascend from the oral cavity through the auditory tube and into the ear. What are the symptoms? The symptoms for middle and inner ear infections are often similar to outer ear infections and include pain in the ear, head shaking, infected or bloody discharge, and scratching or pawing at the head or ear. As the infection in the middle ear progresses, the dog may also have facial paralysis on the infected side due to theinflammation of the facial nerve that runs adjacent to the middle ear. Signs of facial paralysis include difficulty swallowing, drooping eyelids and facial muscles, and a third eyelid that moves up and partially covers the eye. As the infection progresses to the inner ear, the symptoms will include a loss of balance, a downward head tilt, and even circling. How is it diagnosed? Middle and inner ear infections are diagnosed with a thorough otoscopic exam and x-rays of the head. Animals usually need to be anesthetized so that they can be properly examined and so that the ear can be flushed and treated. A ruptured eardrum or an eardrum that is discolored and bulging with fluid is an indicator of a middle and possibly inner ear infection. Most cases of middle and inner ear infections usually have signs of an outer ear infection as well, but not always. Treatment Treatment varies depending on the severity of the disease. In mild infections, oral or injectable antibiotics in combination with topical antibiotics and antifungal agents are often used. In more severe or chronic cases, the eardrum may need to be surgically incised and the middle ear flushed and treated. In some cases, more invasive surgery including removal of part of the bony covering of the ear (bulla) through a lateral or ventral bulla osteotomy may need to be performed. In very severe cases, complete removal and closure of the entire ear canal (total ear ablation) may be necessary. In cases where tumors, feline polyps, allergies, or other factors contribute to the cause of the infection, they must also be properly identified and treated for the entire treatment to be successful. Prevention While not all middle and inner ear problems can be prevented, the vast majority of them can. Early diagnosis and prompt treatment of the more common outer ear infections will prevent most middle and inner ear infections. Controlling ear mites and allergies, along with good routine ear cleaning and care are the key to preventing all ear infections.

References and Further Reading

Feldman, E; Ettinger, S. Textbook of Veterinary Internal Medicine. W.B. Saunders Co. Philadelphia, PA; 2000. Greene, C. Infectious Diseases of the Dog and Cat. W.B. Saunders Co. Philadelphia, PA; 1998.