Ear infections are a common problem in the dog, but can vary in severity and rate of occurrence dependent on the breed. In many cases, it seems like the condition appears 2-3 times per year, if not more often. The more often the ear infection condition arises in your dog, not only does this signal potential underlying health concerns, but it increases damage to the ear canal. This ongoing damage creates pain and discomfort for your dog, but also raises the occurrence of future ear infections. Management can be challenging in some cases, but if you address the overall health of your pet, along with predisposing factors, then the infections can become easier to manage.
Ear infections in the dog are likely in the top 5 reasons for a pet owner to visit their veterinarian. These conditions are common and expected in the acute form, but sadly, many pets suffer chronic ear infections. In another article, we discussed causes and contributors to ear infections, which can be addressed as part of the overall therapy process. This therapy process is what we hope to address in the article today.
Evaluation for Ear Infection in the Dog
Ear infections occur in the dog for a variety of reasons, but there are predisposing factors that greatly add to the problem. Those factors include ear position, diet, excessive moisture, digestive health, and immune status. In most cases, the ears are red, inflamed, and overall irritated with moderate scratching or rubbing of the head. Some of these pets have other health issues, including skin allergies, paw licking or digestive complaints.
During the examination, your veterinarian will use an otoscope to evaluate the inside of the ear and the ear canal. What they are evaluating for is the overall status of the ear canal, the extent of redness, the swelling, the presence of a discharge, and if the ear drum is intact. If a discharge is noted, they will usually make a notation regarding the odor and color, as this can be helpful to determine the bacteria or yeast involved. In some cases, a swab will be used to gather a sample of the discharge for culture or plain evaluation under a microscope. During this evaluation, a special stain can be applied to the sample to determine whether if there are bacteria present, yeast present, or both. There are many different types of bacteria that can create ear infections, but in many there is also a yeast present, Malassezia, which can create an obvious odor to the ear.
The presence of bacteria or yeast can be confirmed in a short period by viewing the sample under a microscope, but in some cases of ongoing infections, the sample may be sent to the laboratory for a culture and sensitivity. This is where the lab will culture out the specific strains of bacteria present and challenge them to various antibiotics. These results then guide your veterinarian to proper choices regarding therapy and antimicrobial options.
Common Therapy Options for Dogs with Ear Infections
In most cases of ear infections, it is common for the veterinarian to clean the ears using a properly balanced pH solution to aid in removing debris and discharge. Then, after cleaning, a topical antibiotic cream is usually prescribed, maybe along with an oral antibiotic, to aid in clearing the infection. In most cases the medications are continued 1-2 times per day for about 10 days.
Many of those cases have significant ear canal swelling and pain, thus it is common to have a topical corticosteroid included within that cream to aid in reducing inflammation. This is generally sufficient to benefit the patient, but in higher levels of discomfort, other pain medications may be prescribed.
When it comes to yeast infections in this ear, this is extremely common. Yeast are secondary invaders to the ear and skin, really being present in the normal dog but in low levels not high enough to create health concerns. When the levels are high, creating problems, this is usually a result of changing conditions within the ear, the skin, or the overall health of the dog. Most of these yeast infections are easily managed using an anti-fungal medication which is conveniently included in most topical ear medications that are prescribed.
Topical ear medications and oral medications are the most common first line therapies for dogs with ear infections. However, the dog that has recurrent ear infections is often prescribed the same therapies time and time again. This creates resistance and is often not very helpful in the long term. Some dogs will develop narrowed or stenotic ear canals due to the chronic ear infections and inflammation. This condition then further reduced air flow and circulation to the ear and can make matters worse. Other dogs, due to shaking of the head, develop and aural hematoma, which is a pocket of blood that develops on the outer ear. This is due to blood vessel rupture as the ear hits the skull, during head shaking. These hematomas can be managed conservatively or aggressively with surgery, dependent on the severity. However, in order to resolve the hematoma, you also have to resolve the ear infection, which is the cause.
This is not always easy and in the long-term, chronic ear infections can be a challenge in the dog.
Options for Better Management of Ear Infections in the Dog
Despite them being a challenge, there are options for better management!
The first thing you need to do is look at the list of predisposing contributors that aid in creating the infections. Two on the list that are very easy to manage are excess moisture exposure and hair removal. If you bathe your dog frequently or they swim a lot, you would be well served to keep those ear canals as dry as possible. There are two ways to do this. First, you can put a large ball of cotton into each ear during bathing to gather excess moisture, but make sure you leave enough out to retrieve it. The second thing you can do is instill a small amount of rubbing alcohol into the ear post bath or swimming. The alcohol will aid in drying up any moisture. This can burn to a degree, and you do not want to instill rubbing alcohol if the ear drum is ruptured. Please keep that in mind. There are some ‘drying’ ear products on the market, but I personally feel that these products can disrupt the normal environment and bacterial populations, contributing to more infections.
When it comes to hair accumulation, this is often restricted to smaller breed dogs. This hair can be removed during routine grooming or by making an appointment with your veterinarian. If the hair is not adequately removed, it will impede airflow and allow for discharge accumulation. This then predisposes to more frequent ear infections.
Another factor to strongly evaluate is your dog’s diet. If they are continuing to battle ear infections, often there is a link to the diet which impacts the digestive health and even the immune status. Personally, in those dogs with recurrent ear infections, I always advised our owners to either home cook for their pet or use a high quality, whole food type of food product. I am not against grains, but am against the incorporation of dyes, preservatives, chemicals, and artificial nutrients. Therefore, in most of my patients, I generally recommended whole-food diets and home cooking.
When looking at the diet, one question that is often raised is regarding the ‘raw” diets. I personally did not utilize these diets as a veterinarian as I do have some concerns. The first is that most raw diets are cold in nature, which can benefit an already ‘hot’ patient, but can pose a digestive challenge for others. So they are not suited for every dog. Other concerns are bacterial contamination and risk to both dog and owner, especially if there are immune related concerns. In most of our patients, we simply recommended a home cooked, whole-food meal, that was warmed up, or at least to room temperature. Some pets did better with heated meals, while others did better when their meal was cold.
The diet is paramount in these cases, as the diet not only impacts nutrition and cell function, but also impacts digestive health. When the GI tract is out of balance, it is common to see gas, bloating, loose stools, diarrhea, and even constipation. Many of these dogs will also have allergies and anal gland concerns. This is all reflective of and influenced by the diet. Again, there is no one diet that is best suited for every dog, but the bottom line is that if there are health issues, the diet needs to be evaluated.
Digestive influences are often made worse by the diet, but can also accompany stress and inflammation. Some dogs are more predisposed to GI upset, which then can influence their overall health. Addressing and correcting dietary influences is key, and can assist many dogs, but in other cases this step is not enough. In those cases, the inflammatory pathways and immune dysfunction have proceeded to a high level and more help is needed.
In those cases of ongoing digestive dysfunction, aside from the diet, we can incorporate many herbs to assist with the immune function, inflammation, and overall digestive health.
Some helpful herbs include:
- T. bellerica
- T. chebula
- P. emblica
- Dandelion root
- Mushrooms (many types)
- and many others.
Almost all of these herbs have immune and anti-inflammatory benefits, but some of them can demonstrate mild laxative properties dependent on their dose. This is not a bad thing, and helps to keep the GI tract moving properly and lessen the accumulation of potentially damaging toxins.
In many cases of chronic ear infections in the dog, there are other health ailments impacting that patient. You or your veterinarian may recognize the ear infections, but likewise there are often skin allergies, paw licking, digestive upset, and potentially anal gland concerns. These conditions are all tied into one another and have the root problem of ongoing inflammatory problems.
When it comes to using herbs to benefit their health it is helpful to look at them from a Chinese or Ayurvedic medicine perspective. Each dog has their own constitution and with that, there are imbalances that take place that contribute to health problems. As an example, many of these dogs afflicted with chronic ear infections are perceived as being ‘hot’ in nature. This can be reflective in their personality or in the skin or ears, as being red, hot and inflamed. This would be referred to as ‘internal’ heat accumulation. When we then couple it with a discharge, or oily, flaky skin, this is then termed ‘damp-heat’ and is often connected back to digestive concerns.
Many of the herbs mentioned before can assist us with managing these damp and heat influences, and once they are re-balanced, then the health is improved. Through the mitigation of inflammation, the herbs help to reduce heat. Some are more digestive tonics, which aid in that spectrum additionally. The diet can then play a major role, either being cooling or heating, and contributing to dampness or helping to resolve it.
When we look at the chronic ear infection in the dog, we can hopefully see that it is not a localized problem just to the ear. Most cases reflect a deeper problem in that patient, reaching back to uncontrolled inflammation and immune dysfunction. This can then be tied back to hereditary factors, diet, digestive health, and even stress. When we address all aspects, to the best of our abilities, then the conditions become easier to manage. The sooner you take steps to prevent or control the ear infections in your dog, the better the outcome. The longer the infections are present in your dog, the more damage that can occur on a local and systemic level, which makes matters even more challenging.
Author: Tom Schell, D.V.M, CVCH, CHN