Vetinfoindex
Vetinfo4cats
Catindex
Subscriber Area (members only)
Zoonotic disease
Becoming A Veterinarian
Your Turn
Search vetinfo4dogs
Support Vetinfo and Subscribe toVetinfo Digest
Ear problems in dogs
Ear cleaners and cleaning
Crusting on ear margins
Ear infection in Shih Tzu
Itchy ear margins - fly bites
Chronic ear problems
Chronic ear problems in
Chronic ear problem in Lab
Ear Infections
Ear polyp treatment
Ear problems
Chronic ear problems in Pug
Chronic ears problems - Welsh Terrier
Chronic otitis and demodex
Inhalant Allergies and itchy ears
Chronic ear infection - Shar Pei
Otitis in Cocker
Recurrent ear infections
Ear discomfort
Cleaning ears
Ear margin not healing
Ear infections - safe home cleaners
also see Ear Mites
also see Hematoma
also see allergy
also see Demodex
also see Parasites
also see Zoonotic disease
Ear cleaners and cleaning and feeding Yeast tabletsQuestion: Hi - haven't written to you in a while - Mileena my boxer who had the mast
cell surgery has an ear infection - staph - the vet says this is fairly
normal for dogs but it is our first. I have a question - I have been giving
them Yeast & Garlic wafers (supplements) - could the yeast have caused this
infection?Why is yeast good for them?
You talked about vinegar and water rinse for ears - how do you rinse the
dog's ears?
should I do this or just keep cleaning her ears with a commercial product?She is on medicine now and we have to take her back in 3 - 5 days so the vet
can look into her ear - it is just too tender for her to do it today.Thanks, Jane
Answer: Jane-
There are no particular benefits to yeast that have been proven. The yeast tablets do not
promote yeast infections in the body, either, though. Proponents of yeast tablets believe that
they help control fleas but this has been disproven in a number of studies. Yeast's are a source
of B vitamins but most dogs don't need the additional supplementation of this vitamin.We advise using a mixture of white vinegar and water, using either a 1:1 ratio or 1 part vinegar
to 2 parts of water (1:2 ratio). It is not a good idea to do this when the ears are sore or
ulcerated, as it will sting. In this case the commercial ear cleansers are better in most cases
because those products are usually manufactured to control stinging. The ear can be rinsed with
a bulb ear syringe, a turkey baster or just by pouring the vinegar/water mixture in from a
measuring cup. The commercial ear cleaners usually come in squeeze bottles and can be applied
directly from the bottle.The rechecks are important to be sure that the medications worked and your vet can tell you if
the ear looks comfortable enough to allow cleaning at home at the time of the recheck.Mike Richards, DVM
8/27/2001
Question: DR. Mikey-
Is the psoriasis-like slight, crusting around my
Sam's ear edges, something to be concerned about? Progressive? Treatment
suggested? Let it go? I know that the skin calcification thing,
flakiness, etc. is common with Cushing's. Don't want those cute little
ears to fall off, ya' know? <grin>Answer: H-
The most common causes of skin flakiness around the ear margins are
sarcoptic mange mites, seborrheic ear margin dermatitis (a condition that
occurs for no known reason, most commonly in dachshunds), vascular
disorders (cold hemaglutination, immune mediated disorders, insect bite
hypersensitivity) and hormonal disorders (hypothyroidism, diabetes mellitus
and hyperadrenocorticism). Normally ear margin dermatitis is not a major
problem for the ears themselves but the association with so many systemic
problems makes it worth checking for underlying causes. As you and your vet
work through the possible causes of the overall condition it is likely that
you will discover the cause of the ear margin dermatitis.Mike Richards, DVM
5/12/2001
Question: Dear Dr. Mike:
I am a new subscriber and I think your web site and advice is the best thing
I have seen for pet owners. Please do not change a thing. I do need your
advice regarding an ear problem with my 15 year old shih tzu. She has a bad
ear infection. She has cushions disease. She is being treated with Tresaderm
(in ear) and Cephalexin (oral antibiotics). I understand about the steroids
(re: Cushings). Could the Tresaderm harm her? We are using Anipryl for the
Cushings, but stopped the Anipryl because she will not take pills because she
is so weak from the ear infection. The vet told us that she has a tear in the
ear drum and an infection. I have looked everywhere in your Digest for info.
on ear infections. Can't find much. Please, please enlighten your readers on
ear infections with dogs. This is a common painful problem for dogs. My dog
is so weak from this problem that she is dizzy and acts as if she has
suffered from a small stroke. She can barely walk and refuses food and she
very weak. Please let me know what I can do. Thanks- James.
Answer: James-
Most ear infections in dogs affect the portion of the ear canal that lies
between the visible external ear and the ear drum. Infections in this
portion of the ear are referred to as otitis externa. Infections in this
region most commonly involve bacteria, with yeast being the next most
likely problem. This is also the region in which ear mites establish
themselves when they manage to infect a dog or cat. Otitis externa can be
very painful but it does not cause balance problems and only rarely affects
a dog or cat's appetite. There is usually an underlying cause for cases of
otitis externa, since a normally functioning ear canal resists infection
pretty well. The most common underlying cause is allergy, then probably
immunosuppressive disorders (Cushing's would fall in this category) and
then hormonal disorders, with hypothyroidism being the most common hormonal
disorder associated with persistent ear infections. Identifying and
treating an underlying cause can make it possible to manage ear infections
that would otherwise not respond to treatment. Identifying the infecting
organism is sometimes possible through examination of a smear of ear
contents under a microscope. Culture and sensitivity testing of the ear
canal can also be beneficial. Many cases of otitis externa can be treated
with topical medications. In the case of corticosteroids, which are found
in many ear medications, there is a systemic effect from topical
application in most instances, although it may be slight in many cases.
Tresaderm Otic (Rx) does contain a corticosteroid, in addition to an
antifungal agent and an antibiotic. It will usually kill ear mites, as
well. It is one of the more commonly used topical medications. Despite the
presence of Cushing's disease I usually opt for an ear medication
containing a corticosteroid, as the benefits are usually good and the risk
pretty minor.Otitis media is infection of the portion of the ear from the inside of the
ear drum to the beginning of the inner ear --- the portion often referred
to as the middle ear. It is not uncommon to have both otitis externa and
otitis media in the same patient. Estimates of the potential for both
infections to be present vary a lot but it is probably at least 25% and may
be as high as 50% or even more. The most common reason for this is rupture
of the ear drum due to chronic otitis externa. A few patients probably have
otitis media first. Otitis media can cause balance problems. Several of
the veterinary ear medications can potentially cause problems if they
penetrate to the level of the middle ear, so it is best, when possible, to
visualize the ear drum and make sure it is intact. This can be very
difficult in an infected, inflamed ear, though. Even though neomycin, the
antibiotic in Tresaderm Otic may cause toxicity problems (usually deafness,
less commonly balance problems) this is a rare problem in dogs and cats.Otitis interna is infection of the inner ear. It often occurs without
concurrent otitis media or otitis externa, although it is definitely
possible for otitis media to lead to otitis interna eventually. Deafness,
balance problems and facial paralysis are the signs most commonly
associated with otitis interna. This is usually a bacterial problem and
oral or injectable antibiotics are helpful.The most common cause of balance problems in a fifteen year old dog is
peripheral vestibular syndrome, which causes sudden loss of balance and
usually results in decreased appetite, either due to an inability of the
dog to eat effectively or due to nausea associated with the balance
problems. If this was part of the problem it should have improved a great
deal by now.There are some dogs with Cushing's disease who do develop neurolgic signs
or appetite problems (too much or too little appetite).I am really hopeful that the majority of the problem was peripheral
vestibular syndrome and that the Tresaderm is helping with the otitis
externa problem by now, too.Mike Richards, DVM
10/26/2000
Question: Dear Dr Richards:
I am a subscriber to VetInfo and find the info very useful. I wrote to you recently about my dog,
Dandi, who had a hemangioma taken out, and everything went well. My dog is an 11 year old mix
breed, and is never sick. After this I found two more small lumps on my Dandi one on his front left
leg and one on his hind leg. My vet said the one on front was probably just fatty tissue and the one
on the back was like a wart. That thrilled me. I did forget to mention he does have a couple of
these wart like things around his left eye (tiny little warts), and he once had like a little sty removed
from his right eye which grew back but does not seem to bother him.Anyway to get to the question, he recently has been itching a great deal all over to the extent I
thought he and my other dogs had fleas so I checked and they do not. He also started shaking and
itching both ears, When he would itch his ears he would cry so I took a look and in the outer ear
just a little patch of crusty scab in both ears exactly the same spot. He has never had an ear
infection or allergies in his life. I brought him to the vet and he does not have an ear infection but
she did give me tresaderm to put on the sores and also amoxicillian as well as allergy medicine.
She thinks (because we live in the northeast, and have had a ton of rain this summer) it is allergies.
She said all the dogs seem to have exaggerated symptoms this summer. Oh yes, before I brought
him to the vet for the hemangioma he did a couple weird things for him he urinated in the house
once (something he has never done since puppy hood), and would lick his bed (he is not a licker)I guess my question is I feel kind of silly calling my vet back about these small things and I don't
know if they mean anything. I don't want to sound like a hypochondriac. I would appreciate you
opinion. ThanksTina
Answer: Tina-
The sores on the outer aspect of the ear occur due to fly bite irritation in our area. Obviously, this
occurs most commonly in dogs that are outside and is worst in dogs that are penned or chained in the
yard, where they can't get away from the flies. These can also occur in dogs that are shaking their
heads, which can be a problem from allergies, flea bite irritation, mosquito bites and ear infections. If
fly bite irritation seems likely there are several products sold to repel biting flies that are approved for
use on dogs, such as VIP Fly Ointment (tm).Most of the time when dogs develop habits like licking objects it is not possible to discern why. I
think it is worthwhile to mention them to your vet, anyway, though. It can wait until a visit for
something else, though. Just bring a list so you can ask your questions early in the visit and your vet
shouldn't mind going over your concerns with you.Hope this helps.
Mike Richards, DVM
9/8/2000
Question: Dear Dr. Richards:
A word about our Weim: Had to take her in to the clinic Saturday morning. She had scratched her
right ear so badly that she was shaking blood everywhere. ONCE AGAIN, we cultured the
black/red, foul-smelling debris and drew another blood sample (the initial sample drawn for the
thyroid panel was lost in the mail). He flushed her ears out, checking each time with his otoscope
to ensure all was removed. Inserted a very small tube with a syringe on the end containing
Conofite cr. deep into her ear, next to the ear drum, and dispensed the medication. Any
suggestions??? Are oral/systemic antifungals ineffective in these cases? If it comes to it, is there a
specialist we might be referred to who might be able to help?Greg
Answer: Greg-
It is usually necessary to have a referral to see a specialist at one of the veterinary schools. Most vets
are willing to make referrals, but sometimes it is a touchy subject.Most cases of persistent ear infections are due to some underlying cause. The most common of
these is atopy, or inhalant allergies. This is also the most frustrating underlying cause, because it is a
lifelong problem that won't go away and which can be difficult to control.There are two approaches to allergic otitis. The first is to treat just the ear problem, whenever it is
necessary. The second is to treat the underlying allergy problem in an effort to make the ear problem
go away. I prefer the second approach but have a hard time convincing my clients to go for it due to
expense and the difficulty involved in treating allergies.To diagnose atopy, intradermal skin testing or blood testing for allergens is necessary. Skin testing
works better. These tests identify the things the dog is allergic to. Then a solution of very small
amounts of these allergens is made, which is used as an injection to "hyposensitize" the dog to the
allergens, hopefully stopping the reaction to them. Allergy testing and hyposensitizing works between
60 and 80% of the time, with blood testing producing results in the lower range and skin testing in
the upper range. We have had at least three or four patients whose ear infections were totally
controlled through hyposensitization, so it does work really well, sometimes.The other approach is to treat the ear problems whenever it is necessary. We usually use
combination products containing an antibiotic, a corticosteroid and an antifungal agent, such as
Otomax (Rx) or MalOtic (Rx). It is perfectly acceptable to do a smear of the ear's contents and try
to determine if an antibiotic or antifungal agent is better. Ear cultures are not very helpful in
determining what topical product to use, in my opinion, because most of the products contain the
same ingredients. However, cultures can be really useful for selecting an appropriate oral antibiotic
to use in conjunction with the topical product, when that seems necessary. Good ear cleaning can
help a great deal in preventing ear infections from recurring.I like to do some maintenance between infections, too. I think that rinsing the ears with vinegar
mixed half and half with water once or twice a week helps a lot in controlling recurrent ear infections.
While we do not routinely recommend it, some vets feel strongly that the ear should be rinsed out
after using this solution. Antihistamines, particularly clemastine (Tavist D tm) seem to help some
dogs, as do essential fatty acid supplements such as 3V caps (tm) or OmegaDerm (tm).There are other possible underlying causes, such as hypothyroidism and immune system disorders.
Trying to rule these out, especially if there atopy doesn't seem to be the problem, is also worthwhile.Hope this helps some.
Mike Richards, DVM
8/10/2000
Chronic ear problems in Weimaraner
Question: My wife and I have a 4 year-old Weimeraner, Sasha. Since she was about a year old, we have battled CHRONIC ext. ear infections. We have literally spent hundreds, perhaps over a thousand
dollars in attempting to give her some lasting relief. Her ears accumulate a dark, reddish-brown,
foul smelling matter.
To give you an idea on how fast this occurs, I thoroughly flushed and cleaned her ears yesterday.
WHen I got home from work today, the discharge was back. She shakes her head constantly and
violently, tilting her head as she walks when they are irritated. Her right ear appears to always be
worse than the left. Weve had the discharge cultured twice. A year or so ago, the culture showed
staph and some form of a yeast. The last culture, showed only a yeast. We have tried routine
flushings, Otomax, Monistat, cephalexin, and a combination of all of these. What to do for our girl?
We will do anythjing to bring her relief. Our vet did perform a thyroid function panel and showed
her levels to be only slightly low.Greg
Answer: Greg - . I don't think that you are going to find anything that will give a
lasting cure for your Weimaraner's ears. When dogs have repeated ear infections it is usually due to
an underlying cause. In Weimaraners, at least in our practice, the most common underlying cause is
allergies. Sometimes, treating the underlying allergic disease with hyposensitizing injections (allergy
shots) will control the ear infections, but you are still doing something chronically to help. Other times,
this doesn't help.In those dogs, we try to get our clients to clean the dog's ears on a regular basis, such as once or
twice a week, with dilute vinegar solution (1 part vinegar, 1 or 2 parts water) by rinsing the ear out
with the solution and then rinsing the ears a final time with plain water. This helps to prevent
secondary infections but doesn't always make the ears comfortable. For this, we try antihistamines to
see if they will help. I like to start with clemastine (Tavist or Tavist D Rx). We combine this with
topical treatment. I like the ointments that contain gentocin and a corticosteroid, such as Otomax Rx
or MalOtic Rx but we have had success with other products, too. Zymox Rx has worked in a few
dogs in which the other ointments weren't helpful. Finally, corticosteroids will usually provide enough
relief to suppress infections but due to the potential for side effects we try to keep oral
corticosteroids as a last resort. To put this in perspective, we probably use corticosteroids in several
hundred patients a year -- so it is a common last resort.
Mike Richards, DVM
8/4/2000
Question: Dr. Mike
Our 12 yr. old Lab. develops chronic ear problem every summer. He rolls
in the dirt and lately runs away from when I start reaching for his
ears.We have 4 dogs , two have ears problems however his seems to be
extremely dry ears where the dog with the other problem is with moist,
smelly ears.I have tried the peroxide mixture and I add panalog after cleansing. I
have also tried using aloe vera gel to the ear. Nothing seems to help.
He has had blood build up in the ear flap but none lately. There is a
small amount of either scar tissue closer to the inside of the ear. His
ear does not smell. The vet checked but the ears does not seem dirty
and he just suggested cleaning with peroxide mixture and panalog.. This
does not help. Have you any suggestions on this DRY ear problem.I have a handle on the problem on the dog with the moist ear. She seems
ok after treatment, but his will not improve.Thank You - Linda
Answer: Linda
Usually, ear inflammation and ear infection that is chronic or seasonal has
an underlying cause. Since this problem is seasonal, allergies are a very
likely underlying cause. This could be exacerbated by a problem like
hypothyroidism, which is not too unusual in older Labradors.Treating allergic ears can be really frustrating.
We usually try antihistamines first, just because they have the least side
effects. The antihistamine with the highest success rate in dogs is
supposed to be clemastine (Tavist tm). I personally like Tavist-D (tm),
which also contains a decongestant, since I think some dogs are bothered by
an inability to equalize the pressure in their ears when they have blocked
eustachian tubes from allergies. Clemastine is beneficial for about 25% of
our patients with ear inflammation. Often, we combine this therapy with
Synotic (Rx), a cortisone and DMSO ear drop that is pretty potent for
controlling inflammation. Since you don't see signs of infection (the ear
is inflamed but dry -- not inflamed with exudate which usually indicates
infection as well as inflammation). This combination works better than
either medication alone.If antihistamines and topical corticosteroid preparations don't work, then
we usually try prednisone. This medication works well in most cases but it
has a lot of side effects and should be used at as low a dose as possible
and on an every other day schedule, if it must be used long term. Some of
these dogs are so miserable that prednisone treatment is worth almost any
risk but it still should be used carefully. To put this in perspective, we
probably treat at least two hundred dogs a year in our practice with
prednisone for at least part of the year, we just wish we didn't have too!If there are any signs suggestive of hormonal disease, such as hair loss or
lethargy and testing for hypothyroidism seems worthwhile, it should be done
before starting prednisone.Hope this helps some.
Mike Richards, DVM
7/26/2000
Question: Dear Mike
Me again. Daisy's ears are again producing lots of back grit. What's the best treatment?
Many thanks. Kind regards. Raymond
Answer: Raymond-
For ears it is important to figure out whether there is an underlying cause leading to the recurrent
infections. This is usually the case. Allergies are the most common underlying cause. In this case,
antihistamines or corticosteroids used orally can help prevent recurrences of ear problems.
Vinegar mixed 1:1 with water is a good general ear rinse, as the acidity keeps bacterial
infections and yeast infections suppressed. Once an infection is present, it is often necessary to
use an antibiotic/antifungal/anti-inflammatory medication (components depend on what exactly is
present -- although there are a couple of medications, such as Otomax (Rx) that contain all
three. In many cases it is necessary to use an oral antibiotic, as well. Ear infections can be very
frustrating but using the vinegar/water mix on a regular basis (once a week) helps suppress them
and treating infections that occur right away can help keep them from becoming serious.Good luck with all of this.
Mike Richards, DVM
5/30/2000
Hearing range in dogsQ: Dear Sir/Madam
I am currently doing a A Level Biology course in England. I was hoping
that you would be genorous enough in helping me. I need to know the
frequency spectrum of of cats and dogs a rough idea will do.Example
Human spectrum (Theoretically) 20Hz-20khz
Actual 20Hz-17khzI thank you for your genorosity for even taking the time to read my
query.
Yours faithfullyAsjad M.
Answer: Asjad-
I can not find a range of hearing listed in the textbooks or databases that I have at home. I know
that dogs are reported to be able to hear sounds in the 30 KHz range and that cats are supposed to
be able to hear even higher frequencies than that but do not have exact figures.Mike Richards, DVM
Q: I have a 14 year old Mulitpoo that has polyps in one of her ears. The Vet
told me she was to old for an operation which would of been very costly.
At present I am putting drops in her ear twice daily which seems of make
her comfortable but then the ear wax comes out and she gets an infection.
More medication that I put in her food and that will last for about 2
weeks. and it is getting quite costly. And also the ear wax dries just out
side the ear canal and I have a hard time cleaning it up. At present I am
using olive oil to help soften the wax I would appreciate any help you can
give me. I forgot to mention that she has always been a very hyper dog even
as a pup. Thank. E. A
A: E.-
I think that you have to decide if the surgery is too costly, not your vet.
If it is possible to do surgery that will allow your dog to be comfortable
for whatever time she has left, which could easily be several years, and
you can afford to do it and want to, I see no reason to avoid surgery due
to age.If you don't want to do surgery for whatever reason, then continuing with
medical treatment may be necessary indefinitely. When a tumor or lump of
any kind blocks the ear canal it makes it really easy for infection to
develop. Sometimes nearly constant treatment is necessary to control this
situation. I'm sure your vet would work with you and dispense medications
as necessary with occasional rechecks of the ear, if this is the case.I like hydrogen peroxide mixed half and half with warm water when an
inexpensive ear cleaner is necessary. I also like white vinegar mixed half
and half or one-third vinegar, two-thirds water to rinse the ears and keep
bacterial and yeast infections to a minimum. Most of the time rinsing the
ears with the vinegar and water mixture two or three times a week will help
a lot. It is a good idea to ask your vet whether or not the ear canal was
ulcerated prior to using this rinse, though. It is pretty irritating when
the skin surface in the ear isn't intact.Mike Richards, DVM
Q: Hi again! Thanks for your advice about Madison (my sweet border collie mix with the histiocytoma on her foot). The vet removed it and you can't even tell anything was there. Now, she has another little problem: her ears. They are the flop-over kind and quite hairy and she loves to roll around in the grass and dirt. Ever since I got her, she has had occassional problems with infections - they get this brown gunk in them, get itchy and sensitive, and smell really bad. I get stuff from the vet that takes care of the problem, but I was curious about preventing the infections in the first place because I'm thinking it can't be too good for her. Any maintenance I could do to help keep her ears cleaner? Almost every time she goes to the vet, he flushes her ears out because she has big wax plugs in them. I heard of a cocker that actually died from recurrent ear infections - have you heard of this happening? Is it a real risk? Thanks again!! Leanne (Madison's best pal)
A: Leanne- I am glad to hear Madison had no problems with the surgery for histiocytoma.
I think that deaths from chronic external/middle ear infections are rare but that they almost certainly occur in some cases when the infection spreads internally. Even if this weren't a risk controlling the infections makes the dog so much happier that I would always recommend working hard to prevent infections and to clear up existing infections quickly.
The most common cause of recurrent ear infections, especially if they affect both ears, is allergic disease. Atopy (inhalant allergies) are the most common cause but ear infections have been associated with food allergies, flea allergies and even allergies to the dog's own anal sac secretions, in some cases. Swimming is another factor that seems to be produce bilateral recurrent ear infections in some dogs. Immune mediated disease, demodectic mange, susceptibility to yeast infections and hypothyroidism have also been implicated in some cases of chronic or recurrent ear infections. Sorting through these problems, even though it is a diagnostic challenge, is the best way of producing a plan to prevent future occurrences.
Keeping the ears clean does help a lot. There are commercial ear cleaners that have good ability to clear out wax and/or ingredients to keep the ear dry that are very helpful. Hydrogen peroxide (3%) diluted 1:1 with water is a reasonably good cleaning solution. White vinegar mixed 1:1 to 1:3 with water can be used to rinse the ears. The acidity makes it hard for the most common bacterial contaminants to grow and I think there is a slight astringent effect, as well.
Treating the underlying condition leading to the ear disease will help prevent recurrences. If this is not possible or if an underlying condition can not be identified then it may be necessary to use an appropriate topical ear medication at intervals to prevent recurrence or treat recurrence as soon as it appears.
Ask your vet about the possibility of an underlying cause for these ear infections and for his advice on preventing problems.
Mike Richards, DVM
Q: I have a 8 year old pug that has had ear problems since he was 2 years old. He obviously has ear damage and hearing loss in both ears. He recently developed another bad ear infection in his left ear. He was in alot of pain. Presently he is being treated with oral Baytril and Rimadyl (anti-inflammatory) and Synotic w/Baytril drops (twice daily in both ears). I have noticed a big difference in my dog's attitude. He seems much happier, left ear seems to not be as swollen as before, he doesn't shake or itch his ears as much. But, I noticed that when I clean his left ear, you can see a white-creamy substance that sounds like he has liquid in his ear. I don't think it is from the medication because that is a clear liquid. This substance in his ears has no smelling odor and doesn't seem to bother him in any way. He has been on the oral medication for 2-weeks and we plan on keeping him on it for approx. 1 month since many ear infections take that long to clear up. Could this white substance be from the middle ear? I've heard that if the ear drum has been damage, it could cause liquid to built-up in the ear. Will this eventually go away. What about getting a culture? Will this tell me anything. Your suggestions would be appreciated.
A: d- It would be possible for a ruptured ear drum to release pus that had previously been trapped by the ear drum so I can not say this is impossible but it is not as likely as two other possible problems. Bacterial infections often cause pus to form, even when the antibiotics are working. This is a very likely source of the white exudate you are seeing. Also, yeast or other fungal infections sometimes develop in sites where antibiotics are being used in heavy dosages. This probably happens because the normal bacteria of the skin are killed, opening up an opportunity for yeasts to take over their territory. Your vet may be able to distinguish between these possibilities by examining a smear of the exudate under a microscope. If it continues it would be a good idea to try.
Chronic ear infections often require really long term antibiotic therapy. We have used antibiotics for as long as a year to correct some really persistent ear infections, so don't give up early! Make sure you get the ears examined and make sure your vet thinks they are completely well before stopping the antibiotic. Then count on having to do regular ear maintenance to keep the problems from recurring.
Mike Richards, DVM
Chronic ear problems - Welsh Terrier
Q: Dear Dr. Mike: We have a 4 year old welsh terrier with a chronic ear infection in both ears. On the advice of our veterinarian, we tried a venison and potatoe diet in order to determine if she was experiencing some type of food allergy. Unfortunately, we are still experiencing the problem. A breeder suggested that we swab both ears with iodine to try to solve the problem. I clean her ears every other day and she is still miserable. Do you have any other suggestions?
A: Bill and Jennifer- The biggest mistake most people and many vets make in treating chronic ear infections is giving up and not continuing to work hard to find a treatment that will control the problem. It is a very good idea to try a food trial but it is just one step in the process of finding a solution to the problem. A thorough cleaning of the ear under anesthesia can help identify a problem like middle ear infection or a foreign body making clearing the infections difficult. When both ears are affected as in your dog, there is usually an underlying cause. Food allergies are one cause but inhalant allergies are much more likely to be the problem and hypothyroidism, immune mediated disease, demodecosis, ear mites and other problem have to be ruled out, too. Keep working with your vet to resolve this problem. If your vet is unable to resolve the problem ask about referral to a veterinary dermatologist. I wouldn't rush to take this step -- it really does take several tries to figure out the underlying cause in many cases of chronic ear infections but it is a good option before things get too bad if treatment efforts just aren't working.
Mike Richards, DVM
Chronic otitis and Demodex - Croation Sheepdog
Q: Dr. Mike, have a one year old Croatian sheepdog. In the past six months she has had 3 ear infections which were treated with Amoxicillin and Panorex. She also had demodectic mange, for this she was given Goodwinol ointment. The ointment did not work, so she was given three mitaban dips every two weeks. The dips seem to have worked so far, her fur is growing back. I was informed that both of these problems can recur. When I asked my veteranarian if there was anything I could do to prevent ear infections, she responded with,"The dog is young and she might have them for the rest of her life." She also could not tell me what was causing the ear infections. I know that my veteranarian can't predict the future, but I do want the best care for my dog, but it can become very expensive with chronic problems. My question is, is it appropriate to ask my veteranarian for a consultation to discuss my concerns so that I can be informed and prepared for what can be done in the future. Or do I continue to bring my dog in for every ear infection and deal with it as a case by case basis?
A: shr- As long as you understand that your vet can only give you an educated opinion about the long term prognosis of the problems you are seeing I think it is very appropriate to schedule an office visit to discuss these concerns. If your vet feels uncomfortable with this sort of prognosticating it may be worth asking for a referral to a veterinary dermatologist. Most are good about filling owners in on the long term prospects for diseases under their care.
It is possible that the ear infections could be a symptom of the demodecosis. Demodex will sometimes cause otitis. Overall, the chances of clearing up generalized demodecosis with persistent treatment is probably between 50 and 80% somewhere. It can be difficult to do and it is relatively expensive but the odds are good enough that I feel comfortable advising most clients to try for a cure.
Mike Richards, DVM
Inhalant allergies and itchy ears - English Setter
Q: I have a 2 year old english setter, hunting not show, that seems to have grass allergies. Last year, he developed a scratching problem on his belly causing his hair to thin. This occurs mainly during the spring/summer months and ends in fall. This year, I have not run him in the fields and he has not developed this problem. His litter mate didn't have the problem last year, but this year is hairless on his chest. He is run weekly in grass fields. I was just wondering what you thought.
Now, I have read some of the other replys regarding ear care and have a question of my own. My setter's ears are bothering him...scratching, shaking head etc. His ears have a dark, brown, waxy substance that builds up very quickly. I have heard that this is the residue left by mites, but others have said that it is a sign of a deeper ear infection. Please respond ASAP as hunting season is coming up and I need my friend in good health. Thanks, DAVE
A: Dave- Most allergies that appear to be grass allergies are actually inhalant allergies to various pollens --- which can include grass pollens. The pollens collect on the grass and dogs that are sensitive to them get exposed to high concentrations running through the grass. Allergies most commonly cause skin itchiness in dogs and that is the symptom you see. If keeping him out of the grass during allergy season works, that is great. If it doesn't you may need to use medications or consider hyposensitization to whatever he is allergic to. A veterinary dermatologist can usually do skin testing and prepare the allergy injections for you. Some general practitioners do this as well. It is not unusual for allergies to follow family lines and it does not surprise me that his brother has problems. Springers in my area seem very prone to allergies.
The ear problem you are seeing is probably also due to allergies, although ear mites or ear infection for other reasons is possible. Chronic ear infections are commonly caused by inhalant allergies (atopy). I am pretty sure that this is the most common cause of persistent ear infections in dogs. It is important to control these ear infections early and consistently. If this is not done the inflammation changes the structure of the ear canal and makes it harder to treat the infection and in many cases more difficult bacteria to kill eventually come to inhabit the ear. Please take your dog to your vet and find out if this is the problem and work with your vet to develop a plan to control this problem consistently. Not only is it the right thing to do just to keep him comfortable, he'll hunt a lot better if his ears don't bother him, probably.
Mike Richards, DVM
Chronic ear infections in Shar Pei
Q: Hi, I would like to find out if you have any suggestions for controlling ear infections in a Sharpai. I have a male name Tyler who is such a sweetheart, but I feel so bad for him because he gets cronic ear infections. The canals of his ears are very tiny so he tends them frequently. Everytime I take him to the vet it is $50 - $70. It is getting too much for me. He woke me up tonight shaking his head and licking his foot them putting it to his ear. I flush his ears out with the solution Nolvasan Otic (which by the way is 18.00 a bottle) .I am going to give him 1 asprin for the pain tonight, he is 54 lbs..but I was wondering if there is a less expensive way to control these than going to the vet all the time for him just to flush it out in the office and give me this solution (if there is something else I could use) also I get a tube of Otomax (will Monostat 7 work instead) a few times he has put him on an antibotic (will amoxicillin work?). I would appreciate it if you could help me try to help him without the high costs. .I wish I could put him on my medical insurance...Thanks so much..L.
A: I know this is too late to help you but shar pei dogs should never be purchased by anyone on a limited budget for continuous care. These dogs are horribly prone to skin disease (including ear disease) and it is very lucky to get one that doesn't cost a lot in maintenance.
Otomax contains an antibiotic, an antifungal ingredient and a corticosteroid. It is unlikely that Monistat 7 (which does contain the same antifungal ingredient, I think) would work. Amoxicillin is very unlikely to be useful in skin or ear problems in dogs due to the prevalence of resistant bacteria.
It is unfortunate, but you will need to continue to medicate his ears. It is sometimes possible to control ear infections with oral medications and it can be less expensive in some instances, but probably not many. Oral prednisone combined with a good antibiotic can be very helpful. It is important to be sure that demodecosis is not present before using cortisones, though.
Ear and skin disease in shar peis may have multiple underlying causes, such as demodectic mange, food allergy, inhalant allergy and bacterial infection as a primary or secondary problem. Yeast infections of the skin can also be found as a secondary problem in many shar peis. Mucinosis can contribute to the overall skin problems. A careful search for an underlying cause can sometimes lead to a reduction in the overall problem through elimination of one of the contributing problems.
Anything you can do to reduce over-all skin problems is worthwhile. Careful flea control, keeping your shar pei in an air conditioned environment, early and vigorous control of any problems you do find and elimination of food allergies can all help.
I know this isn't the answer you hoped for but a shar pei is just a high maintenance dog to own.
Mike Richards, DVM
Q: Hello, I'm writting to you hoping to have you inform me about my Cocker Spaniel and his ears. I know all about the problems of his ear not getting much air to help with the wax problems and infections that can start. My question to you is: Can I get a ear de-waxer from a store instead of a vet? The bills are getting expensive. I use Eptiotic for washing his ears. Can I buy that from a different source then the Vet? Tresaderm is what I use on his ears now. Is it OK to keep using this all the time? And get it over the Internet? Are you in the supply business? Thank You Mr. W.
A: TierCom, Inc. (the parent company for TierVet-Vetinfo) is just an information service. We may add a bookstore or some other information related services but I don't think we will ever branch out into selling veterinary supplies.
Tresaderm (Rx) is a prescription medication and it would be necessary to have a prescription from your vet to purchase it, if there is a source for it. There may be a source of EpiOtic somewhere (I am not familiar enough with this medication to be sure what the ingredients are).
It is hard to control otitis in a cocker with seborrhea or allergy problems. Usually it takes systemic medications such as prednisone and antibiotics in order to get the problem under control. It may then be necessary to use ear medications on and off on a continuous basis.
It is frustrating and expensive to treat a cocker with persistent ear disease from one of these underlying causes. An ear cleaner that removes sebum well helps a lot. I suspect that there are over-the-counter versions of these products that work but I am not familiar with them. There is no substitute that I am aware of for antibiotic/corticosteroid ear medications for this condition. I think it is less expensive and better for the dog to treat this condition systemically in most cases, at least until good control is established. If you are maintaining control with Tresaderm and it is working, I would recommend keeping it up. When you find something that works for this I'd stick with it until it doesn't work anymore.
Mike Richards, DVM
Recurrent ear infections -Shih Tzu
Q: Dr. Mike, I am writing to you about my 3 year old Shih Tzu, who constantly keeps getting yeast ear infections. I am always taking her to the vet and they keep giving me Panalog. They say it is because her ears are so hairy inside. I do not believe that the Panalog is working because she continuously has an infection. When I ask them what else they can do, they have no answer. My question is " what about Monistat 7 cream for women's yeast infections?" Would it help to rub some of the cream in the dogs ear? I live in a small town and do not have a choice of where to take her. Please HELP! My baby is miserable! K.
A: Recurrent ear infections that involve both ears almost always have an underlying cause that needs to be treated. In my practice area this is usually allergies but it can be hypothyroidism, immune mediated skin disease or parasites (Demodex or ear mites. Once in a while a bacterial or yeast infection does occur as the primary problem but this is not usually the case.
I do not know how frequently dogs have problems due to the presence of hair in the ear canals but this might cause problems in some dogs.
Once ear infections are well established it generally takes a two pronged approach to treatment. The ear must be treated and the underlying cause identified and controlled if at all possible.
A smear of the exudate in the ear canal may help to identify the organisms present. This is useful in identifying yeast infections in particular. Culturing the ear for bacteria is sometimes beneficial as well, although it is easy to miss the bacteria causing most of the problem with cultures. When a pathogenic bacteria is identified, sensitivity testing allows the veterinarian to choose the proper antibiotic with more certainty. The ear canal should be cleaned thoroughly. In some instances this will require anesthesia since the ears are often very sensitive when infected. Medications appropriate for the infectious organisms found should be used long enough to eliminate the problem. It often takes treatment of the ear topically and systemic treatment using oral antibiotics to eliminate a stubborn infection. It is sometimes necessary to clean the ear two or three times during the course of treatment. It may take several months of treatment to control an infection that has been present for some time.
Identifying the underlying cause will help to prevent recurrences of the ear disease. It can be difficult to do this in some dogs. In some dogs ear infections are the only visible sign of food allergy or inhalant allergy. It often seems like too much work or too much expense to try elimination diets for food allergy or skin testing for allergies when persistent ear infections are the only problem. It is worth it in many dogs, though. If your vet is not able to test for these problems he or she may be willing to refer you to a veterinary dermatologist who can. We are fortunate enough to practice close to a veterinary dermatologist, making this an easy choice for us to make. If clients will not consider allergy testing and hyposensitization (allergy shots) we often use corticosteroids to control the itching and inflammation that leads to the ear infections. In some dogs combinations of antihistamine and essential fatty acids will also work to control allergy symptoms.
If yeast infection was the only problem Monistat 7 would probably work but the odds are high that yeast is only part of the problem or even that it may not be present at all.
Sometimes you just have to tell your vet that you expect better treatment for your pet. As long as you are willing to pay for it, he or she should provide it or refer you to someone who will. It would be worth a trip to see a veterinary dermatologist, probably.
Mike Richards, DVM
Q: Dr. Mike We have a 3 yr old Boxer who has been constantly scratching at her ear. I suspected an infection or something, but started to use a cleaning solution from the local pet drugstore. The situation hasn't improved and she is still scratching. She will do this at 3 AM, waking us up from cries of what appears to be extreme discomfort. I've been told by non-vet people that she may have ear mites. If you suspect this, what course of action should we take?
A: You really should have your boxer examined by your veterinarian. It is entirely possible that earmites are the problem, or part of the problem, but it is actually much more likely that this is an infection of the ear. In that case, only appropriate antibiotic or anti-fungal therapy will help. If the ear infection is likely to have an underlying cause such as allergies, using an eardrop with a combination of an antibiotic and corticosteroid may be more beneficial. Your vet can make your dog much more comfortable, pretty quickly, in most cases of ear infection. Everyone will be happier, then!
Mike Richards, DVM
Q: Hello Dr. Mike, First let me say this is a wonderful site - especially for someone like me who lives in Arctic Canada with nary a vet in sight for a thousand miles! My question is a very basic one about routine maintanance. We have a 10 month old Black Lab, and the books I've looked at say that we should clean out her ears regularly. As a very first time ever dog owner, this advice is not very helpful. How do you clean a dog's ears? With what and how deep (seems to me they are pretty delicate things)? Finally, what does "regularly" mean? Thanks in advance, M.
A: Dogs ears are very different from human ears in their anatomy. The ear canal which appears to run straight down, parallel to the dog's head, actually does that for a centimeter or two. Then it takes a right angle turn straight towards the center of the dog's head, making it an "L" shape. It is usually another centimeter or so to the ear drum. This makes it much safer to clean a dog's ears with a cotton-tipped swab as long it is kept parallel to the dog's head (stays vertical, not horizontal). It is often easiest to use a cotton-tipped swab to remove big clumps of wax or visible foreign bodies like seeds. Really cleaning the ear well is hard to do with cotton-tipped swabs, though. For the same reason they are safer in dogs, they are not very effective ear cleaners once you get any big stuff out.
There are a number of commercial ear cleaning solutions, which break up the wax and allow the ear to be flushed efficiently afterwards. If these are inconvenient to get there are two recipes for ear cleaning solutions that work well. The first is to dilute 3% hydrogen peroxide with water in a 1:1 mixture and then use a bulb ear syringe (or even a basting syringe) to flush the solution into the ear. Repeating the flushing four or five times usually is sufficient. The second solution is white vinegar mix 1:1 to 1:3 with water. This is a mildly astringent solution that works reasonably well to prevent "swimmer's ear" if used after the dog swims. It will also help to remove debris from the ear if the ear is flushed with it.
Your vet will know of a good cleansing solution available in your area if the ear cleaning is a tough task (lots of wax or debris in the ears). These do seem to work better than the "homemade" solutions.
Mike Richards, DVM
Ear margin cut not healing - Rhodesian Ridgeback
Q: Hello Dr. Mike, My question is regarding a cut my 8.5 month old Rhodesian Ridgeback has sustained about 2.5 weeks ago. It is a quarter inch in length and is found on the inside tip of her left ear. It often looks like it will successfully heal, but when she "shakes herself down", (i.e. when she wakes up, or when she comes in from outside) she will sometimes have a little blood on the top of her head and on her neck. Afterwards, upon examination, it will have opened up slightly. Should we bring her in for 1 or 2 stitches? or is it too late? It does not appear to be infected and we have been applying antibiotic ointment. What do you recommend we do?
A: Ear margin cuts seem to have a very difficult time healing on their own and often persistently bleed, despite the fact that most of them seem to be very small, like the one your dog has. In fact, I have seen an Irish Setter with an ear margin cut approximately 1/4th inch deep that I am certain he would have bled to death from if it hadn't been sutured. The dog was actually nearly comatose on arrival at our hospital and this was the only cut we could find!
With persistent care and time, most of these will heal. They heal faster and more reliably with suturing, though. It doesn't seem to matter too much if there is a delay in repairing these, they usually heal fine with suturing, anyway. If this is still bleeding today I would recommend consulting with your vet about the necessity of surgical repair.
Mike Richards, DVM
Ear infections - safe "at home" cleansers - Golden
Q: Dear Mr. Mike: My Golden Retriever occasionally gets ear infections. I noticed this weekend that his ear was dirty and swollen. I periodically use EPI-OTIC in his ears to keep them clean. I have run out, so is there a home remedy I can use to clean his ears until I can get to the vet? Thanks.
A: Two solutions for cleaning ears that I think are helpful are:
Mix white vinegar with water in a 1:1 ration (half water, half white vinegar) The acidity makes it hard for some bacteria to grow and this has an astringent effect. It stings if there is any ulceration of the ear canal, though.
OR
Mix 3% hydrogen peroxide 1:1 with warm water. This is less antibacterial but is a little better at aiding in the removal of cerumen from the ears. It is not as likely to cause discomfort if the ear is inflamed.
There are advantages to the commercial ear washes and they are probably worthwhile to stick with if helpful. But these solutions are OK in a pinch.
Mike Richards, DVM
Last edited 01/31/05