In veterinary medicine, dermatologists have the role of managing ear diseases. This is because many skin diseases in pets manifest with ear issues. Dr. Eisenschenk has extensive training in procedures to remove ear canal masses, manage infections in the middle ear, and correct chronic inflammation and infection of the ear canals. Most of the anesthetized procedures we perform in our clinic involve the ears. We have elongated grasping tools, specialized scopes, and precise techniques to insert tools into and take samples from the middle ear for cultures and cleaning. This often involves a myringotomy, a technique to make a hole in the eardrum to pass instruments through, usually to flush infection or pus that has built up behind the ear drum.
Why does my dog or cat keep getting ear infections?
The short answer to this question is that the underlying problem is not controlled. If an underlying problem cannot be found, then long term therapy is likely needed or the infection will come back. There are 3 main types of underlying problems that cause ear infections to keep coming back (or not go away) when they are treated: allergies, an object in the canal (mites, tumors, foreign material), and a middle ear infection.
Ear infections can be very painful for the dog or cat and should be treated right away. Routine care of the ears and management of the underlying problem will help prevent the problem from coming back. Veterinary dermatologists specialize in the treatment of ear diseases and the underlying causes of most infections and can perform specialized procedures to help treat these problems.
When some dogs (especially cocker spaniels) have infections in the ear for a long time, the ear canal swells closed. If the canal cannot be opened with aggressive treatment, the infections can be very difficult to manage. Ear infections are painful. If left untreated, severe or long term ear infections can cause a head tilt, paralysis of that side of the face, calcium deposits in the ear canal, and dry eye.
The ear canal is commonly affected when dogs and cats have allergies. Allergies cause the skin to be inflamed, which allows overgrowth of otherwise normal yeast and/or bacteria. This overgrowth causes itchiness and pain, and scratching and rubbing contribute to making the infection and inflammation worse. Because it is inflamed, the ear canal secretes large amounts of wax. The ears may develop an odor from the infection.
Pseudomonas aeruginosa is a type of bacteria that is found all over in the environment. Normal animals do not develop infections when this organism gets on the skin or in the ears. When a pet has damage to the ears because of chronic recurrent ear infections, pseudomonas happily starts growing. Then the ear infection takes on a new appearance. The canals become very sore with pus exuding or moisture can be heard deep within the ear. A strong smell may develop, and the pet may be lethargic with pain. The ear drum often ruptures and the bacteria contaminate the middle ear. Strong oral and topical ear medications must be used aggressively to control this infection.
Middle Ear Infections
With long term infections of the ear (from any cause), the bacteria can move past the ear drum and get into the middle ear. These infections are more difficult to treat and require long term medications. Often, pseudomonas bacteria are involved.
Sometimes ear infections need to be treated with a special procedure to clean out and infuse treatments directly into the middle ear while the pet is under anesthesia.
Primary Secretory Otitis Media
Primary Secretory Otitis Media (PSOM) is an ear disease caused by buildup of usually sterile gluey mucus in the middle ear. This causes the ear drum to bulge outward. This mucus plug can cause no symptoms, pain worsening with pressure change, hearing loss, head tilt, or scratching at the air. This disease is most common in Cavalier King Charles Spaniels, but is also seen in dogs with short noses (brachycephalic). The condition is often recurrent after flushing out the mucus, and multiple procedures need to be done, but sometimes long term remission is achieved. Middle ear flushings alleviate symptoms if caught early enough, but sometimes nerve damage or deafness are permanent. There are other conditions in the Cavalier that can cause similar symptoms, including Chiari malformation of the skull and syringomyelia in the spinal cord. It may be impossible to know which issue is causing symptoms without performing a middle ear flush.