Caring for dogs with otitis externa calls for a gentle approach. Patients with ear disease may shy away from ear handling. Forced ear handling can make future treatment more difficult and have long-term effects on the dog’s emotional health. Look for products with soft-tipped applicators, which help to decrease discomfort or pain in dogs receiving medication. BigStock Image Canine otitis externa: It’s the third most common medical condition treated by veterinarians, based on 2025 statistics from Nationwide (skin allergies rank number one).1 Reported prevalence ranges from five to 20 percent in the canine population and up to 30 to 40 percent in tropical climates and regions, according to some studies.2 Certain regions may have a higher prevalence because breeds that are more prone to otitis are more prevalent there. The good news for dogs, clients, and veterinarians is the advent of longer-acting medications that reduce the frequency of administration and have improved ingredients, as well as advances in diagnostics. All have enhanced the treatment of ear infections for the patient, the owner, and the practitioner. How products have changed Back in the day, compounded lanolin-based packs were what you reached for if you needed a long-acting product. They lasted about a week and treated most infections. However, there were drawbacks, according to Julia Miller, DVM, DACVD, at Animal Dermatology Clinic in Louisville, Ky. “Some animals had reactions to them, and there wasn’t a lot of variety in the ingredients that made up the pack, so they had limited application.” Now there are gel-based non-compounded ear packs. They do not create the potential foreign body effect of the lanolin; they contain more potent antibiotics, antifungals, and steroids; and fewer dogs have reactions to them, according to Dr. Miller. New products include Osurnia Otic Gel, a long-acting combination therapy that requires two in-clinic doses, seven days apart; Claro, a single-dose otic solution that lasts up to 30 days, administered in the clinic; and Simplera, another long-lasting single-dose product. “We also now have Mometamax Single, which came out on the market recently and is also a long-acting gel-based product,” Miller says. Also new on the market is DuOtic. It contains only antifungal and steroids, making it a good choice for antimicrobial stewardship when dealing with Malassezia unaccompanied by bacteria, Miller says. With all these products, there is no need for the client to instill topical ear medication at home. While there is no one-size-fits-all treatment protocol for ear infections, Miller says the new products are good to have, especially in cases where it is unlikely the client will complete the treatment. However, traditional daily-use products still have a place. They can be more effective than long-acting medications in many patients, especially those with resistant-type bacterial involvement, says Jangi Bajwa, BVSc AH, ACVD, who practices at Veterinary Dermatology & Ear Referral Medical Clinic in Surrey, B.C., Canada. Diagnostic advances For Dr. Bajwa, otoscopic exams are an area where real progress can be seen. Video-based otoscopic examination tools have improved visualization of ear canals and are available at different price points. More advanced video-otoscopy equipment has significantly enhanced and magnified imaging of the ear, he says, although better technology does not reduce the need for good technique when it comes to handling and examining sensitive canine ears. Bajwa adds that head CT scans, including deep-ear imaging, are becoming more mainstream—at least among veterinary dermatologists, surgeons, and neurologists. “That helps to diagnose more complicated deep-ear conditions, such as otitis media and ear masses, or to help rule them out.” AI has also made its way into ear diagnostics. Zoetis Reference Laboratories allows practitioners to take and stain a sample and then upload it to an AI microscope, where it is screened for rods, cocci, white blood cells, and Malassezia, Miller says. “Then it will read out the cytology for you and quantify what it sees. If you’re not confident with your cytology interpretations, there are some AI cytologies on the market that can help you get a definitive answer, which is pretty cool.” If you or your technicians are already proficient at reading ear slides, however, then using AI may take longer, with only a slight increase in accuracy. Another potential downside is that AI does not read the entire slide. “You select an area for the AI to interpret,” Miller says. “So, if you selected an area that wasn’t representative, you would not get the right answer, but that could be true of you reading the slide. I always recommend if people are doing AI cytologies, [they] do a good scan of the slide and try to select the most representative samples. There can be two samples on one slide. You might need two interpretations.” Addressing allergies Frequently, canine otitis externa goes hand-in-hand with environmental or food allergies. When dogs have recurrent otitis, it is often allergies that are the underlying problem. A thorough allergy workup is the first step, but a detailed history can help you determine the best course of action. If otitis is not seasonal or if it begins at an early age—a three-month-old puppy, for instance—Miller says a food allergy should be the top suspect. She notes that food allergies can occur at any age, so just because a dog has not had them previously doesn’t mean that they don’t have one. “I think a lot of people forget recurrent otitis externa can be the only clinical sign of a food allergy, so I do a lot of diet trials when they have recurrent otitis externa. Now, if they recur in June and only in June, that fits much more with environmental allergies.” For seasonal environmental allergies, she advises considering whether a dog needs to stay on oclacitinib consistently during that time to help calm the inflammation. Managing inflammation can help keep infections away. “A trick I really like for preventing otitis if I think they are an allergic dog is to have them use a topical as maintenance therapy, plus an ear cleaner spiked with a little bit of steroid so they get inflammation management and cleaning,” Miller says. “Or I’ll use a product that has a low-potency steroid like hydrocortisone in it. There are a lot of nice products out there, and I might use that as a maintenance product for that dog’s ears over the summer, like maybe he gets a small squeeze in both ears once a week.” Biofilm management tips When a patient has severe exudative otitis externa, with ears oozing thick mucus and pus, potentially accompanied by underlying allergies, it can be challenging to clear the infection. Biofilm management is key, Miller says. “Adding in different options for biofilm management as part of your treatment plan is, I think, an underutilized aspect of managing those ears,” she says. “You need specific ingredients. There are a number of different products out there designed to break down the biofilm, such as Zymox Plus, TrizEDTA, and n-acetylcysteine. Get those ears cleaned out and treat the biofilm along with the infection and inflammation.” When to refer Ear infections are one of the primary conditions that dermatologists treat, but many clients may not realize this because, for their own ear problems, they see an ear, nose, and throat specialist instead. If you are struggling to clear an ear infection, it may be time for a referral to a specialist. “The earlier we can get to these ears, the better, as far as the prognosis for the pet and the less likely we are to have to go all the way to something like a TECA (total ear canal ablation) surgery,” Miller says. “I usually tell people that if you haven’t cleared the ear infection in three months, you should start recommending a referral.” Even if clients wait until the ears have been a problem for six months, there is still a window of opportunity for successful management, using such tools and techniques as deep video; otoscopic ear flush for removing debris deep in the ear, masses, and foreign bodies; and allergy management methods. Don’t wait until the case becomes complicated. Ear problems in dogs can be severe, and referral has the potential to alleviate their pain and discomfort, as well as improve their quality of life. Hear, hear Bajwa emphasizes that ear disease is rarely a primary problem, and ear infection is never a primary disease. Factors that contribute to the development of canine otitis externa can be a grass seed in the ear as a foreign body, an ear mass, a condition, such as primary secretory otitis media—most commonly seen in Cavalier King Charles Spaniels— and allergies, both environmental and dietary. Other causes include hormonal conditions, such as thyroid problems; skin disorders, such as sebaceous adenitis, and improper ear care, to name only a few. If the primary problem is not diagnosed or corrected, he says, ear problems will persist or recur often. That leads to complications of chronic ear disease, such as ruptured eardrums, ear masses, patient pain, negative effects on quality of life, client frustration, and cost of care. “Clients do not know of these impacts, and we need to educate our clients to get buy-in,” Bajwa says. “Pet owners may often think of and treat ear issues as ‘just an ear infection,’ but it’s in our hands to educate while treating.” Take the time to properly work up ear problems and do ear cytology testing and otoscopic exams, even when ears have improved and the pet is comfortable. “That is the time to consider if we have adequate improvements,” he says. “Then implement a maintenance plan for the pet, which may involve ongoing ear flushes or drops in the ears.” Miller agrees: “Getting to the root cause is so important. With the invention of these long-acting ear meds, it’s becoming more and more easy to just put ear medication in and call it a day, but it still is really important for the veterinarian to have the conversation with the client that there is always a reason that the dog developed the ear infection.” Kim Campbell Thornton has been writing about dogs, cats, wildlife, and marine life since 1985, and is a recipient of multiple awards for her articles and books from the Cat Writers Association, Dog Writers Association of America, and American Society of Journalists and Authors. Reference https://news.nationwide.com/chronic-vs-acute-the-most-frequent-diagnoses-and-their-costs/https://news.nationwide.com/chronic-vs-acute-the-most-frequent-diagnoses-and-their-costs/ Srashty Singh, Amita Tiwari, G Das, DK Gupta, Ashutosh Mishra and Pooja Dawar. Epidemiological studies on otitis externa in dogs. Int. J. Adv. Biochem. Res. 2024;8(7):48-52. DOI: 10.33545/26174693.2024.v8.i7a.1432
