As dogs and cats grow older it is common for them to develop chronic ear infections. Often only one ear is involved, with a history of problems in the past. To keep their ears healthy, pets need regular ear exams at home.
Dogs, especially floppy eared dogs, need their ears cleaned weekly with a proprietary cleansing solution. Veterinary attention is necessary if ears appeared waxy, smelly, or if pets shake their heads or scratch their ears a lot.
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Anatomy is the key to understanding the problem. The ear is divided into external, middle, and inner components. The external ear includes the ear flap or pinna & the ear canal. The middle ear, inside the drum is enclosed within a bony chamber, the tympanic bulla. It connects with the throat via the Eustachian tube & connects to the inner ear by 2 small membranous windows. The middle ear is traversed by three small bones that connect the ear drum to one of these windows. The inner ear consists of a fluid filled coil and three semi-circular sound and balance organs.
The chronic ear infection involves disease of the ear canal that is not readily observed without an otoscope. Over time, the ear canal lining responds to infection by thickening and becoming rough. These changes are irreversible & cause narrowing of the canal, sometimes almost obliterating it. In cats, chronic ear infections may be associated with polyps within the ear canal.
Ear infections should not be confused with hematoma formation where a burst blood vessel fills the ear up with blood. This is a sudden, acute problem and if untreated may progress to a chronic infection. Treatment of hematoma involves surgery to the ear flap, or pinna. Surgery for chronic ear infections involves the ear canal.
When treating a dog for an ear infection, the aim is to get a complete cure, so that there is no persistent irritation and no progression to chronic change. There are 3 parts to the treatment and they are all equally important. First, Dr. Lugten will thoroughly clean all the discharge out of the ear. This may require sedation in some cases. Secondly, topical ear ointments to kill bacteria and yeast are dispensed for the owner to use twice a day at home for the next 10 days. Thirdly, it is important to keep the recheck appointment in 10 days so that the result of the treatment can be assessed and all residual wax and discharge can be removed. We then use an ear cleaning solution on a weekly basis to minimize the risk of re-infection. Careful attention to your pet’s ears will reduce the risk that it will need surgery later for chronic disease.
Before considering surgery for chronic ears, we evaluate the results of medical therapy. In conditions limited to the external ear, vigorous therapy with powerful ear medications and repeated veterinary exams can be successful. However, in the case of treatment failure or relapse or middle ear infection, surgery is indicated. A middle ear infection can be recognized as, in addition to all the other chronic signs, there may be a head tilt. In cats, polyp formation may originate in the middle ear and grow out through the ear drum or in through the Eustachian Tube. X-rays are used to diagnose middle ear infection.
The basic principle of surgery is to open up the confined space of the ear canal to permit effective drainage. In two procedures knows as Lateral Canal Resection and Vertical canal Ablation, the parts of the ear canal that are chronically thickened and heavily folded are cut away to leave a more accessible opening for a healthy ear canal. In the Lateral Canal Resection, we cut away the outer wall of the ear canal in such a way that it can be folded downwards, so that instead of being a barrier to drainage of the ear, it becomes more like a draining board. In Vertical Canal Ablation the entire vertical canal is removed so the horizontal canal opens as a small hole right under the ear-flap. These surgeries are free of complications other than minor problems with structure breakdown. I strongly recommend a Lateral procedure for any dog that suffers ear infections 3x a year or more. When the entire ear canal plus the middle ear are badly infected, a more radical surgery is required. Results are usually successful in eliminating recurrent ear infections. It s important to correctly match the type of surgery to the severity of the condition. For pets accustomed to long-standing pain, surgery is expected to bring relief.