Treating the Patient with Ear Disease

The only way to resolve ear disease is to identify and address all of the primary, predisposing and perpetuating factors.  This means that in addition to medicating the ears directly, we may need to treat for endocrine disorders, allergies, parasites, inflammation or other conditions, as is determined for each specific patient.  Because external and internal parasites are such a common problem, and their presence can never be completely ruled out, the doctor may treat for parasites even though none have been seen.  Environmental issues may also need to be addressed, such as bedding, diet, or the presence of smoke in the house.

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 skin is covered by inflammatory byproducts, wax, or old dried medications, this necessary contact can not 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, most 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.  In order to adequately fill the canal, you may need to put the tip of the bottle down into the canal (the bottle tip will not be long enough to cause harm).  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 so that you hear squishing.  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 soft cloth but NEVER put 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.  Going through this process once may be adequate for moderate cases, but more severe situations may require four or five weekly procedures.

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 culture.  Commonly used medications include antiinflammatories, antibacterial and antifungal drugs.  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.  These may be steroids or nonsteroidal anti-inflammatories to reduce swelling and itching, antibacterial or antifungal drugs to address infection, or anti-inflammatories or opioids to manage pain.

Surgery

There are some cases of ear disease that require surgical intervention.  Some polyps and tumors may be removed with a simple surgical procedure.  More complicated surgery is necessary for the more invasive growths, in cases of middle ear disease, in cases where proper application of medicine is not possible, or when there are irreversible changes within the ear because of longstanding disease.  The decision to undergo surgery is made only after determining it is absolute necessity, and will involve extensive conversation.

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.