What Do You Do When Ear Drops and Oral Antibiotics Don’t Work?

Continually dumping antibiotics in won't resolve chronic ear infections

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!


Amber Littleton
September 6, 2020

My dog, a pit mix, has had chronic ear infections for about 2 years now. The vet she has now, basically just shrugs it off as she has small ear canals so I'm just going to have to deal with it. I would like to get to the root cause, maybe try something to use as a preventative. She got a strong dose of an antibiotic in the office so they could give it, the monday beforelast, by the following monday she was starting to shake her head and do the head tilt again so I checked her ears and they were starting to get puffy red. Went to have her checked,they said the ear swabbed came back neither yeast or bacterial but she only noticed a little inflammation. She told me to continue giving her zyrtec as she prescribed the previous week. By thursday her right ear was bright red and I could see swelling inside. Called again to speak to vet and she didnt even ask to see her just told me I could either do the strong antibiotic again in office or try zymox, which is an enzyme she said would work good for her. This was friday, I started zymox. Tonight is sunday, both ears are super swelled, puffy, red and shes even caused some bleeding from scratching them. I am calling first thing in the morning to figure out what to do. We paid for a package deal to include her yearly shots and free check ups for a year. So we mainly pay for the ear swabs and antibiotics. I have worried that she is becoming resistant to antibiotics and am not sure what else to do. We've spent hundreds of dollars each month for meds and it is really digging deep in our pockets. We are a family of five so, of course money is tight. I do not want to get rid of her, shes part of the family. I would just like answers!

Suzanne Jiracek
August 30, 2020

My dog is a pit bull 9years old she has had both ear conals removed she has no drainage or infections any more this surgery was life or death but now she wants to sleep a lot.

August 7, 2020

We have a German shepard who has had chronic ear infections on and off for years. We were heartbroken and Frustrated! So was our vet. Nothing worked long term. The ointment..nope...the antibiotic pills..nope..nothing. But then we, or our great vet used a treatment called c.l.a.r.o. otic solution (had to put periods in the name-autocorrect). It is applied at the vet (after a thorough, sedated cleaning) it stays active in ears for three weeks. You do not touch them. You do not allow them to get wet. Our boy had a severe infection so we did have to repeat once (not sedated because less pain), and NO infection!!! It has been five months and he is so happy! We finally feel like we have a handle on this years long saga and it still seems like a miracle. Hope this helps someone out there.

Dana Monte
July 29, 2020

So my pit mix has been diagnosed with environmental allergies (grass, trees, dust mites). I gave him allergy shots for about a year; expensive and I honestly did not see much of a change.He gets ear infections and skin infections. He was on apoquel, responded to first cytopoint injection but not the second because an infection was bewing. Currently on a very high does of cephalexin for a week and I am not seeing much of a change where in the past I saw a change immediately. Called vet...waiting for a call back tomorrow. I give him weekly baths with a medicated shampoo.....I feel so bad for my buddy as it is apparent that he is not feeling well. I also give him omega 3 capsules and a probiotic daily. I am puzzled and frustrated for him at this point.......

Christine Satterthwaite
July 13, 2020

My dog is 14 she is a Yorkshire terrier and has had ear infections twice this year. Ear drops and antibiotics seem to work then about a week after the course finishes it reoccurs.  She had ear drop 2 months ago and there is still a smell coming from her ear even though I clean them out. 

jen oaks
July 7, 2020

i have a 12 year old dachshund Ive tried everything but he has constant ear infections not sure what else to do

June 10, 2020

Hi my 9 year old German shepherd has been suffering from ear infections for quite a few years he's had antibiotics steroids been under sedation and ended up with a floppy ear he's still having the same problem keeps shaking his ear and it's red and scabby inside vets don't seem to no what it is could it be an allergy since the operation he dribbles more and does the reverse sneeze all the time I don't no what else to do could u give me some advice please

June 8, 2020

Another thing I put cotton balls in my dogs ear when ever my dog is around water I do not let water get into my dogs here. Another thing I have read with having a purebred. Is it can be hereditary.  Check Dam/Sire health records. Some dogs have a different shaped ear inside or big an floppy on outside. Read Read Read that’s what I have done. Just think if you’re miserable �� How does your dog feel. If you ever had an ear infection it is painful. Dogs ear infection was so bad when I bought him he ran in circles rested his head up against the wall, loss of balance and became very aggressive.I have spent over $3000. Anybody is thinking about vet insurance. I would highly recommend it.�� Good luck

June 8, 2020

I had a culture done on my German Shepherd he was resistant to 12 anabiotic’s. Florfenicol was the susceptible antibiotic that could only be used on cows. Finally a product with Florfenicol was made with this ingredient in it I found many places that sell this product U can request the prescription from your vet sent to Chewy’s. Chewy’s Is by far the cheapest. This has to be shipped on ice. Other companies charge $30 shipping Because it needs to be shipped separately. Chewy’s charges a flat rate of $4.50. Also my veterinarian made a drop with the Epi-Otic,Dexamethasone SP, Miconazole... (That’s a cleaner a steroid and an anti-fungal) If your dog has an antibiotic susceptible that can be added. Another thing depending where you live you can Request your veterinarian record. Just like you would request your own records. State statues:With a written informed consent signed by you,you can request your dogs records from your veterinarian. Also can you get prescriptions for your dog as long as you’d like if you request them. Make sure your records are correct it can cost money especially if you’re switching vets veterinarian records cannot be sent to another veterinarian without your signed consent. Just found out another medication is Clairo.

Juanita LaBorde
May 3, 2020

Thank u for information.   I rescue 15 yr old dachshund and its been  $250 like every month at season change. But this yr its been 4 trips to vet and 3 shots and antibiotic on top of antibiotics.   Special  med drops for his food and it's a nightmare.   He is bath 1 per week in special shampoo.   But now I have moved so time for new vet.

April 10, 2020

My ten year old pit has had infections since she was three, and all the vets do is charge charge charge! Thank you for such a great article, I’m going to switch vets and get some testing done. I feel so bad for my baby

February 10, 2020

The best idea was getting a culture of the bacteria then having a compound pharmacy compound the medication since it was mono culture and only sensitive to one antibiotic.- this was advice from a friend

January 28, 2020

My dog has been battling ear issues for 4 years now, many visits to the vet, cleaning drops, antibiotics, diet change and money. The poor dog is still miserable. Vet now suggest the surgery for lateral ear resection.

William Lee
December 17, 2019

So glad i found this read.  my dog has been struggling for a solid year, and my vet has just shrugged his shoulders every time. going to a new clinic and running test asap! thank you for your insight.

Chelsea MacPhail
November 29, 2019

Our 8 year old Golden has had many ear infections over the years. Her current infection is in both ears, and is anti-biotic resistant. The vet has told us that after the second dose of meds which she is finishing now, they won’t have anything else to treat the infection and they’ll have to do surgery to remove her ear canals. We’re interested in learning about any other options available. Would allergy testing at this point help with the current infection??? Also would love to hear more about essential oils used. We’re seeking out a specialist as well.

November 11, 2019

We have an older Welsh Terrier rescue who has severe ear issues. Her ears look like cauliflower inside and it's difficult to clean or put drops in because the opening is so small. She has been on all types of antiobiotics, prednisone and washes. We have had her tested for allergies and recently had a swab test where they found 5 different organisms. The baytril drops seem to help but it's a daily battle. We feel helpless at times and wish we could just cure her. She has been on different types of foods but according to the allergy test by Dr. Jean Dodds, she really isn't allergic to most foods. We are now giving her Cytopoint shots which do help somewhat but doesn't solve the problem. We don't know what else to do for this poor girl.

LaRae McGahuey
October 29, 2019

We have a 13 year old carine terrier. He has had a yeast infection for many years.  His skin in areas is black and flaky. We have tried everything. Diet changes, low carb foods, anti fungal shampoos with vinegar rinses. He got better for awhile but it's back 10 times worse and is now attacking the ears.  We have been on meds 3 times now. But it continually comes back. He's only been off the last dose 2 weeks and already his itching at his ears again.  I don't know what else to do with him. We have spent over $1000.00 dollars.  We love our little man, and feel terrible for him, he's miserable. 

Kelly Jennings
October 29, 2019

Please before putting down, we have been dealing with our smallest dog having ear infection for months. Our vet is using some essential oils mixed with Manuka Honey. Talk to vet first. Our guys infection became resistant to all antibiotics. We have also added pre and probiotics, vitamin c, and echinacea/goldenseal. He’s doing better. He’s not in pain anymore.

October 9, 2019

We have tried everything and I mean everything. I am calling the vet yet again to have her thyroid checked. My husband feels so bad about her being in pain. He’s considering having her put down. She has had this problem since she was a pup. She is 5. She also has kidney disease.

September 23, 2019

I have an elderly chocolate lab that has had ear infections literally for years. He was my mom's dog and she never took him to the vet, so once I was able to afford to take him out of there and get him to the vet, I did so. He had also been diagnosed with hypothyroidism five years ago, but he was never treated. (Yes, this was a horrible situation for him, and I wish I could've helped him sooner) I took him to the vet, and he was missing tons of hair, had skin infection, eye infection, and a massive ear infection. His thyroid levels were rechecked, and he was started on various antibiotics, oral, eardrums, and eyedrops as well as 0.6mg of levothyroxine. He finished the eyedrops and the oral antibiotic last week, one ear was infection free, so I was just to continue the eardrops in his other ear. The past two days, the infection appears a little worse, with a return of the telltale odor. He has been on the thyroid medication now since Aug. 31st. Is this long enough for the thyroid medication to help keep the ear infection from getting worse? He will be getting the levels rechecked next week, and I do plan to call my vet tomorrow to see what they recommend, but I would like to hear another vet's opinion. Thanks so much!

Christy Corp-Minamiji, DVM
September 12, 2019

Hi Kristen,  unfortunately, immune systems being what they are, it's certainly possible to develop an allergy to another protein (such as fish) over time.  If he is receiving anything else (treats, chewable medications, the occasional human food), that could also play a role.  I'd suggest going back to your veterinarian and reviewing diet options as well as other diagnostics.

Kristen Duquette
September 9, 2019

Hi! I have a 5 year old Labradoodle and I’m having the exact same issues as Andy! I’m mentally exhausted with the situation, broke and, most importantly, feel just awful for my Fur Baby! My question is this - When he first had the issue, about 4 years ago, it resolved when we changed his food to a fish protein rather than a meat protein. Is it possible that he has now developed an allergy to THIS food?!? He has no other symptoms that you mentioned in your article... just a nasty ear infection that won’t go away, no matter the treatment. Thank you for your time!

Dr. Nathan Mueller
August 28, 2019

Hi Andy,  It's hard to say exactly because each pet is different and food trials take patience.  In general, it may take 12-16 weeks before you know if it will help.

August 28, 2019

our golden doodle has a chronic infection in his right ear only for about 5 years. we have seen multiple vets and tried many abx, prednisone and ear washes and sedation flushing at the vet. about $10K in total. we are now trying Royal Canin hypoallergenic food. IF this works, how long before we MAY see improvement ? any other thoughts ???? thanks

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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