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What Do You Do When Ear Drops and Oral Antibiotics Don’t Work?
February 24, 2017 (published)

dog with hat over ears BigStock

It’s a problem many of us dog owners have experienced, especially someone like myself who is in love with the Labrador Retriever.  You wake up to find that Fido is dragging his ear along the ground as if trying to pick up a radio signal from China.  You lift that floppy ear up only to find it’s Elmo red and it looks like someone dumped your left-over coffee grounds in there.  Yep, it’s another ear infection!  Well, yes, for the most part.  What many people don’t understand is that it’s not just an infection and that continually dumping antibiotics into the ear or popping pills won't resolve the problem. These recurrent infections are secondary to other underlying issues that will continue to repeat themselves if we don’t get to the bottom of why they happen. Continually just asking your veterinarian for more antibiotics will not fix your problem!

You see, most of these infections involve bacteria or yeast that normally live in your dog’s ear.  They have their own niche or ecosystem that under normal circumstances, allows them to survive in the ear canal and the dog’s body (immunity) keeps them in check.  When there is damage to this normal environment or ecosystem, such as allergic disease, tumors, or foreign bodies, these bugs can then overgrow and create an infection. This is just the tip of the iceberg as they say. Killing these opportunistic bugs only gets rid of the secondary infection for a time because there is an abnormality with the environment of the ear they live in, such as caused by those pesky allergies.  If we just treat the bugs without dealing with the true reason for the alteration in the ear’s ecosystem/environment, we will never have a chance to resolve these infections for good.

If we don’t address that bigger issue beyond the infection, it will return.  The bacteria will then be more resistant to previously used medication, the ear canal will start to get narrow from the chronic inflammation that results from these infections, and your dog will run and hide from you anytime they see a Q-tip!  In the worst-case scenario, your dog could build up so much scar tissue from these repeated infections that the ear canal becomes completely closed off to the world, locking in a nasty, resistant infection that only surgery can address!!  No bueno! 

If your dog experiences one or two infections a year, then you’re going to be okay with treatment guided by your veterinarian.  But if these infections occur more frequently than you check your Facebook page, you’re going to have to look for the underlying cause.  You will not be able to continuously just give antibiotics or anti-yeast medications as these bugs will develop resistance causing this treatment to fail! 

otitis Carol Foil

Ouch! This infected ear has the added bonus of a yeast called Malassezia. Photo by Dr. Carol Foil.

There can be many reasons your dog continues to get recurrent ear infections.  The most common cause is allergies, which are usually caused by food or environmental allergies.  But we’ll focus on those later.

Endocrine (hormonal) disease can also be a trigger for recurrent otitis.  The two most common endocrine diseases that can result in recurrent ear infections and inflammation are hypothyroidism and hyperadrenocorticism.  Hypothyroidism is when your dog’s thyroid gland no longer makes appropriate amounts of thyroid hormone.  Lack of this hormone can affect a multitude of body systems and in this instance, predispose your dog to recurrent ear infections.  Other signs include gaining weight simply by looking at cheesecake in the display at Cheesecake Factory. (Oh wait…sorry, that’s me!)  Joking aside, uncontrolled weight gain, seeking out warm places, lethargy, hair loss, and recurrent skin and ear infections can all be due to reduced production of thyroid hormone.  Your veterinarian can run specific blood tests to see if this may be a cause.

Hyperadrenocorticism (aka Cushing’s disease) is when your dog’s adrenal glands produce excess amounts of the stress hormone cortisol.  Excess cortisol reduces the body’s ability to fight off infection.  Kind of a no-brainer here.  Obviously if you can’t defend yourself from infection, you’re going to get them more frequently.  Other common signs include increased appetite, increased thirst and urination, panting, hair loss and possibly an enlarged belly.  Again, your veterinarian can run a series of tests to help figure out whether this might be a problem.  Diagnosing and treating hypothyroidism or hyperadrenocorticism effectively will help reduce the recurrence rate of these infections.

Sometimes your dog may get foreign material stuck down in the ear canal.  A blade of grass or foxtail could get lodged down in the ear canal and result in repeated infections if not removed.  Occasionally, your dog may develop a benign growth of tissue called a polyp deep in the ear canal that might cause recurrent infections. Your veterinarian can do a thorough ear examination, with or without sedation to see if any of these might be present.  Also on occasion, parasites such as certain mites can predispose to ear infection.  The good news here is that if one of these are found and addressed, your dog may be cured from these recurrent infections faster than you can deposit your check on payday!

But by far the most common reason for recurrent ear infections as alluded to above is ALLERGIES. That’s right folks, just like you and I, your dog is susceptible to allergic disease as well. In most instances this is either an allergy to a component in their food or an over-response of the immune system to some sort of grass, mold, weed, or fungus out in the environment (aka atopy or atopic dermatitis).  But instead of sneezing their heads off during ragweed season, it may manifest as recurrent ear infections!  With the help of your veterinarian, or better yet a veterinary dermatologist, you can devise a plan to figure out what allergy your dog might have and when addressed properly, reduce or eliminate the recurrence of these ear infections.  A simple food trial should help aid in figuring out whether these infections might be triggered by a particular food component.  Incorporating a hypoallergenic diet might be all that is needed to get rid of those pesky ear infections once and for all.

But if a food trial doesn’t do the trick, then a veterinary dermatologist can do a procedure called skin testing (intradermal skin testing) where a series of allergens are injected under your dog’s skin to see what he's allergic to.  Once these are discovered, then a series of injections can be give under the skin with a needle to help reduce your dog’s response to these allergens.  Alternatively, oral drops can be prepared and placed directly under the tongue to begin to dampen your dog’s immune response to these allergens.  This is a nice option for owners who get queasy thinking they have to give their pet an injection! 

Although injections, or these specially formulated under-the-tongue drops, remain the gold-standard treatment for allergies, many other therapies such as antihistamines, fish oils/fatty acids and drugs that suppress the immune-system directly (prednisone or cyclosporine) can help aid in the fight against allergies.  Although some of these drugs, such as the glucocorticoid prednisone, are effective at controlling the inflammation and itch associated with allergic disease, they can have unpleasant long-term effects such as causing diabetes mellitus if overused and abused. Cyclosporine can be effective but is expensive and many dogs get gastrointestinal distress when given this medication. 

Only by pursuing, eliminating, or treating these underlying factors can we help rid Fido of these recurrent infections.  Continuous, repeated antibiotic administration is not the answer.  In the words of my late grandfather, "That’s like peeing in a lake trying to raise the water level!"  It’s not going to work, and all involved will get frustrated, particularly Fido and his Elmo-red ear!

1 Comment

Lowen Russell
February 28, 2019

My miniature Dachshund has had an ear infection for about 6 months. And he has been treated with antibiotics and ear drops nothing seams to work. what next?

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