Gladys from Modesto wrote in about Buffy, her 9-year-old cocker spaniel with ear problems. Buffy has had ear infections on and off for most of her life and is being treated with some type of ointment in the ears without apparent success. Buffy appears to be in pain and her activity level is way down.
It sounds to me as though Buffy is suffering from chronic ear disease, something we term chronic otitis.
This occurs when an ear infection is allowed to progress over a long period of time, leading to secondary changes in the ear canal that are often irreversible. Gladys shared that she has treated Buffy many times in her life for ear infections and, I suspect, there has never been true resolution of Buffy’s otitis.
Otitis in dogs is a fairly common disease. In uncomplicated cases, it involves the outer canal of the ear, which in dogs is quite deep. There are contributing factors that can lead to ear infections in canines, some external and some inherent. External factors include foreign material getting into the ear canal such as water or plant material (think foxtail) which can disallow proper air circulation and drying of the canal, leading to a perfect, moist, warm environment for the development of infection. Inherent factors include anatomic issues such as narrowing of the ear canal and/or an increase in the number of wax/sebum producing glands, which lead to decreased air circulation in the ear canal along with increased secretions. Some dogs have heavy ears that hang down over the canal openings, further decreasing good air circulation. Cocker spaniels such as Buffy can have all of these mentioned inherent factors and, as a result, this breed shows a very high incidence for the development of ear disease.
When a dog is presented for otitis, it is important to identify what is causing the infection. Is it a bacterial infection? Is it a fungal (yeast) infection? Is it a combination of both? This is very important, as it allows us to focus our therapy specifically against the offending disease organisms. This diagnostic step is done quite simply by swabbing the ear canals, culturing the material obtained for bacteria, and examining a slide of the material under the microscope to see what is involved. The next step is to thoroughly flush the ear canals to remove debris and as much of the offending disease agents as possible. This often involves a general anesthetic to allow for thorough flushing without discomfort and pain.
Treatment then involves some combination of topical medication specific to the organisms involved and often a flushing agent to be used at home. In the past few years, we have had success using ear packs that are put into the ear canals after they are flushed at the hospital. These packs can last a week and keep caretakers from having to treat their companions once or twice daily at home. The patients are rechecked in a week and retreated if necessary, with resolution usually occurring in one or two treatments. There are cases that require systemic treatments as well as topical, depending on the severity of the case. These might include antibiotics in the case of bacterial otitis and anti-inflammatory medication.
Buffy is in a different league when it comes to her otitis. If left uncured, otitis, as mentioned, leads to chronic changes which can include further narrowing of the ear canal, destruction of the ear drum, and then invasion into the middle and inner ear canals. Further progression causes mineralization of the tympanic bulla, which is the boney chamber of the inner ear that houses part of the balance system. This can lead to head tilts and abnormal postures, along with worsening pain. These cases can lead to total shutdown of the ear canal, to the point at which the patients need surgical intervention.
The surgery in chronic severe otitis cases in dogs involves removal of the entire ear canal, a surgery termed total ear canal ablation. These patients are no longer able to hear, though many cannot hear very well presurgically due to severe disease of the canal(s). The surgery allows these patients to return to a good quality of life without pain and it shows in their demeanor after recovery. Patients on which I have performed this surgery act like puppies, according to their caretakers, as a result of no longer living with chronic pain.
Hopefully, Buffy has not reached the point of needing ear canal ablation surgery. She is likely at the point where she needs a major ear canal workup, and treatment at the very least. Hopefully, with proper care, she can be relieved of her otitis.
Jeff Kahler is a veterinarian in Modesto. Questions can be submitted to Your Pet in care of LifeStyles, The Modesto Bee, P.O. Box 5256, Modesto 95352.