Ear Infections: New Technology

By: Dr. Susan Wootten

New technology yields amazing results for pets with ear problems. Years ago it was commonplace for pets to have repetitive ear infections that just simply could not be cured. Pet owners, across the nation, returned to veterinarians month after month to obtain ear ointments that seemed to help but did not cure ear infections.

Dr. Wootten examining a patient’s ear with video otoscopy unit while under anesthesia.

Nine years ago, AHNA became one of a small number of hospitals to obtain the MedRx Video-Otoscopy equipment and instruments. This high-resolution video instrument allows detailed visualization of the outer ear canal, the eardrum and the middle ear. We felt that investing in this equipment was important because of the high number of chronic ear infections and the pain and discomfort caused by them. Prior to this technology, veterinarians did not realize that a high percentage of ear infections reoccurred because of untreated middle ear infections and polyps that could not be accurately diagnosed or treated. Because this equipment is not commonly available, we continue to see new patients presenting with frustrating, chronic ear disease that can now be treated and cured. Additionally, we make copies of the images we see for the client so that they have a better understanding of why their pet has been suffering from chronic ear disease. Instead of the 2x magnification of a typical exam room otoscope, this instrument achieves 100x magnification and displays it on a large screen. This scope has instruments that can be inserted into the scope and guided safely into the ear for flushing debris, dislodging wax balls, retrieving samples of discharge for testing, taking biopsy samples, and removing foreign objects, insects and ticks. Our years of continuing education, training and use of this instrument make this very effective.

One study showed that 80% of dogs with chronic outer ear infections were actually the result of infection of the middle ear (the bulla) as well. When not identified and treated, the middle ear infection typically re-infects the outer ear canal leading to continued pain and potential hearing loss.

Fancy is a cat that belongs to the mother of an AHNA staff member. She had vestibular symptoms (head tilt and dizziness) and with the MedRx we found one normal eardrum and one that is perforated. She responded to treatment and is doing well.

Fancy’s left ear – normal eardrum

Fancy’s right ear – hole in eardrum   

Frances is a little dog who was adopted from a shelter. She had terrible otitis externa when she was adopted. We tried a variety of cleaning solutions, medications (topical and oral) and treatments with minimal success. After more simple treatments failed to cure the ears, we anesthetized her and thoroughly examined and treated her ears with the MedRx system. We also removed some tissue at the base of her ear containing a MRSA infection which then was easily cured.

The right ear had a polyp that we weren't able to visualize until she was sedated and the MedRx was used, and behind it was a large amount of waxy debris that couldn't have been removed without the scope and polyp removal. The left ear had a large ceruminolith (imbedded wax) that we were able to break up and then discovered that she had a pre-existing tear in that eardrum. This procedure was about a year and a half ago, and she's been doing well with regular ear cleanings at home since then. We are so happy that this darling little Frances is now pain free!

Frances - Ear with Polyp

Frances - Ear with Lodged Wax

Below is more information about the causes and treatment of ear infections in dogs and cats.

Ear infections are a common problem in both dogs and cats. The ear canal has both a vertical and horizontal component. This structure predisposes to ear infections as debris and wax must work its way upward rather than straight out.  The outer ear is the part you can see. It includes the ear canal from the earflap, called the pinna, to the eardrum or tympanum. Ear disease usually stems from over-production of wax, which occurs in response to irritation. Bacteria and/or yeast can then flourish in this area and cause infection. 

There are multiple underlying factors responsible for chronic ear disease or infections. Floppy eared dogs like Cocker Spaniels and Labradors, or breeds that have hair naturally growing in the ear canal, like Poodles, are more prone to ear infections. Allergic skin disease (atopy or inhalant/seasonal allergens or food allergies) can make dogs and cats more prone to ear infections. Ear mites can be seen in both dogs (rarely) and cats that can lead to infections. Lastly, foreign bodies such as grass awns or foxtails may be present and lead to irritation.

Malodor and signs of pain are the most common symptoms we see with ear infections. The pet may scratch or dig at the ear, shake the head, or hold the head to one side. You may notice discharge (black, yellow, etc.) and/or odor to the ear when lifting the earflap up. In addition, the ear may appear red or have some dried blood from the pet scratching at it.  

Examining a patient’s ear with an otoscope.

Complications of an ear infection may include a middle ear infection. These can be more severe in that the pet may have a head tilt, lack of balance, or unusual back and forth eye movements called nystagmus. Another complication can be an aural hematoma where a blood vessel in the earflap ruptures and causes a collection of fluid in the dog’s or cat’s ear flap. This may require surgery.

Ear infections are a serious, potentially chronic health problem that needs to be seen and treated by a veterinarian. By examination of the ear and evaluating material collected from the ear under the microscope, your veterinarian can determine if the problem is due to ear mites, yeast, and/or bacteria and prescribe appropriate treatment. Most ear infections can be cleared up with simple disinfection and washing of the ear and then followed up by medication at home.  This may include both topical and oral medications. A reexamination is recommended after completion of the medication to make sure the infection is gone so that chronic disease does not develop.

In some cases, chronic ear problems may require more than the above treatment. An ear culture may be recommended to determine the precise bacterial organism and guide appropriate therapy. Some patients that have a lot of discomfort, swelling, or soreness with the ear infection may require sedation and/or anesthesia for a more thorough examination of the ear and deep ear flushing. Video otoscopy described below is a common procedure performed at Animal Hospital of North Asheville for this reason. Further testing may be in order to determine why the infections continue to recur (allergies, hormonal imbalances, etc.). In addition, home treatment with regular disinfecting ear washes may be discussed.

Ear infections that cannot be controlled with simple steps may require more aggressive management. We utilize a MedRx Video Otoscope to evaluate the patient’s vertical and horizontal ear canal as well as eardrum or tympanum. The area is brightly illuminated and magnified, allowing greater magnification. It may be necessary to anesthetize the patient for flushing or surgery once a problem is identified. There are many patients that can have wax, hair and debris very deep in the ear canal that cannot be removed or flushed with routine ear cleaning. Through the opening on the otoendoscope, the ears can be flushed; foreign objects, debris and hair may be retrieved with grasping forceps, biopsies obtained with biopsy forceps, and myringotomy performed with a catheter. With an attachable dual-port adapter, suction and saline may be used simultaneously to completely clean the ear.

After making an accurate diagnosis and selecting the appropriate therapy for your pet, most cases of otitis externa have a good prognosis and can be cured.  The important thing to remember is that if the problem recurs commonly, there may be other inciting conditions. A little prevention can go a long way in managing ear problems.

We do commonly recommend routine ear checks and ear cleaning for our patients at home. Vet Solutions is a commonly used ear cleaner that will clean, dry and disinfect the ear canal. In dogs that swim often, this alcohol-based ear cleaner is useful to clean, disinfect, and dry the ear after swimming. To clean the ears, first lift the earflap and fill the canal as if it were a funnel. Massage the ears gently from the base up to loosen any debris. Take a tissue or cotton balls and wipe the canal with your fingers. Repeat the procedure until the solution you pick up on the tissue or cotton is free of wax and debris. (See pictures below.) Never use q-tips to clean the ears at home. If your pet has a bad odor coming from the ears, shows discharge or debris in the ear canal or is shaking his head, scratching his ears or  seems painful, the please call Animal Hospital of North Asheville for an appointment with your veterinarian. 

The Right Way to Clean Ears at Home