CVC highlight: Relieving the itch and pain of ear infections
Ear infections can be a pet owner’s worst nightmare—the constant head shaking and ear-scratching, foul-smelling discharge, and inflamed ears all add up to one miserable pet and one almost equally miserable pet owner. But the right diagnostic and treatment strategy can make all the difference in easing both the pet’s and the client’s pain.
Discovering the cause
A thorough otoscopic examination is key to making a diagnosis. In fact, to get a truly good look at the pathology in the ear canal, it may be necessary to sedate the patient. It’s important to examine any exudative material grossly, noting the color and consistency. If there is no exudate in the ear canal, it may be that you’ve caught the infection early thanks to an observant owner or that the patient has an underlying primary cause, such as an allergic condition, and a secondary ear infection hasn’t manifested yet.
During the otoscopic examination, it’s also critical to take samples of the exudative material for cytologic examination and bacterial culture and sensitivity testing. Yeast and bacteria are the most common culprits for ear infections, but yeast can be difficult to culture. If a pure population of bacterial rods is found on cytologic examination, always perform a bacterial culture and sensitivity on the sample.
Video otoscopy can also be a helpful diagnostic tool and allows pet owners to visualize the pathology in the ear canal along with you.
Eliminating the discomfort
Therapy should be based on the type of exudate and the type of organism found on cytologic examination:
> If the exudate has a waxy consistency, a ceruminolytic ear cleaner is recommended.
> If the exudate is purulent, Tris-EDTA can be used, especially for rod bacteria.
> If the exudate is found to be in the Staphylococcus species family, thiabendazole-dexamethasone-neomycin sulfate (Tresaderm—Merial) can be used.
Saline solution can be used as an ear cleaner in sensitive animals.
Many topical antibacterial agents are inactivated in the presence of organic material, which further emphasizes the importance of thoroughly cleaning the ears before introducing treatment. Corticosteroids can also be used to treat inflammation, but it’s best to use one that is low in potency and that won’t be absorbed systemically. Hydrocortisone aceponate (EasOtic Otic Suspension for Dogs—Virbac) is not absorbed systemically and works well if there is little inflammation.
Home care tips
A critical step in the resolution of ear infections is giving the right recommendations to clients for home care, especially when it comes to cleaning their pets’ ears. In the examination room, take the time to clean one of the pet’s ears to demonstrate the process and watch the owner clean the other.
Using an ample amount of cleaner is key to thoroughly cleansing the ear canal; often clients use too little. And be sure to tell clients that cotton swabs should never be used because it can cause impaction and tympanic rupture. The pet will do the work of emptying its ear canals itself as it vigorously shakes its head after cleaning. If the patient is resistant to having its ears cleaned, an indirect method such as using a solution-filled syringe or squeezing the solution out of soaked cotton balls can be used. Advise the client to warm the solution to body temperature (e.g. have the client warm up the syringe in his or her hand) to make it less irritating.