I Can’t Sleep With All That Shaking!

In this episode, Dogtor S will focus on ear infections of the dog. Ear infections are among the most commonly encountered conditions in general veterinary practice, and if you’ve owned a dog for any length of time you have likely experienced these.

Picture this: It’s finally time to go to sleep after a long day at work and just as you turn off the lights, Marley your Golden Retriever shakes her head. It’s so loud… ugh you think, well that’s okay it was one time. Until it continues, and over and over throughout the night, Marley wakes up and incessantly shakes her head. You can hear her ears as they flap back and forth… Guess you’re going to be tired tomorrow! She continues to scratch and now is pawing at her ears throughout the night, you even had to move her out of your room for the first time since she was a puppy so that you could sleep!

First thing in the morning you look at her ears and realize that they are very red and she whimpers when you move them. “Well, I suppose I should call the vet” you decide. So you give them a call and they sneak you in to the first available appointment, right around lunch. Perfect! Now you don’t have to take any time off work. So you take Marley into the clinic and are loaded into an exam room. “She keeps itching and shaking at her head and her ears, they are super red today and she is really in pain it seems.” You tell the technician getting the history. The technician takes your information and moments later comes back in with your doctor holding a strange instrument called an otoscope. Basically a light with a cone on it to look down into the ear canals. Dogs and cats both have longer ear canals than people do, so an otoscope is actually required to see down into these and gauge the full extent of what is going on deeper in the ears. The ear drum is absolutely not visible without one.

Welcome everyone to episode 5 of this six part podcast series, “I can’t sleep with all that shaking!” We aim to explore many of the maladies that our favorite furry friends seem to encounter frequently as well as take a deeper look into the veterinary profession as a whole. In this episode we are going to focus on ear infections which are very common in our canine patients. Cats tend to be less frequently affected with these so I will do a separate episode on some of the more relevant ear issues in cats. I hope you find this one informative as this is one of the most commonly seen diseases in general practice! So sit back, paws and press play.

After looking into Marley’s ears, the doctor pulls back and notes, wow they are really inflamed. She grabs a swab and takes a sample out of each ear and puts it onto a slide and tells you she will be right back in with you. You pet Marley’s head while the doctor steps out, but what are they doing?

In most clinics there will be an in house laboratory set up with limited supplies, like blood work machines, microscopes, and various other objects depending on what the clinic does the most. Using a series of stains commonly called a diff quick stain the slide will be ready to examine. The veterinarian is trying to see what microorganisms if any are present in Marley’s ears. The most common things to find on these swabs are yeast and bacteria. The yeast are frequently going to be of a species called malassezia, which is commensal to the skin. Commensal meaning that they are present in an ordinarily healthy pet in small numbers. The bacterial organisms are usually cocci, meaning they are circular in shape and are frequently staph or if the issue is more chronic they can lead to pseudomonas (which is a rod shaped bacteria). In many cases whichever organism is overgrown is normally present on the skin or in the ear canals in very small numbers. In a vast majority of dogs there is an underlying allergy or irritant that predisposes to ear infections and the irritation caused by itching or shaking of the head leads to a more favorable environment for them to grow.

“Marley has a ton of yeast in her ear” your doctor says as she comes back into the room. Poor thing needs some help so I’m going to give you some ear drops that I want you to do daily until a recheck. At this point a technician may come in and give Marley’s ears a thorough cleaning using a flush inserted into the ear canal and filling it with fluid. This helps clean out a lot of the waxy debris that accumulates in infections and this debris can make healing take even longer! After the flushing a drop or ointment will be brought into the room for Marley. Some of the most frequently used drugs in my experience are Entederm, Posatex, Tresaderm, and Mometamax. These are all brand names which include a combination of drugs that include anti-fungal, anti-bacterial and steroid medications which are all three helpful in curing ear infections in dogs. I prefer to recheck all ears in 10-14 days, and repeat another cytology, ideally we want the cytology to be free from the above mentioned organisms before we stop treating completely.

Ear infections can be very difficult to treat, and there are three reasons that come to mind first and foremost as to why treatment fails.

Number 1: failure to address the underlying disease. Since allergies are very commonly the underlying issue, if these are not adequately controlled, ear infections may never be completely resolved, or the patient may have recurrent issues with their ears. Allergies are frustrating to manage in and of themselves (listen to episode 2 for more information).

Number 2: is inadequate therapy administration. We are often very hesitant administering medications into our pets’ ears as we worry about damaging anything. This is of course a very valid concern. Fortunately; however, dogs have very long ear canals, the entrance that you can see from the outside is called the external pinna, and the initial hole leading into the head is called the vertical canal. There is then a fold of cartilage that separates this canal from the horizontal canal. Then at the very end of the horizontal canal, the tympanic membrane or the ear drum is located. If medication is being administered too superficially in the ear canal it won’t completely resolve the infection and may create a longer treatment protocol. Be sure to check with your vet what the best way to administer this is!

Number 3: Inadequate length of treatment. Cytology of the ears are very important as to determining whether the infection has resolved, is improving, or is not changing. This is very critical to deciding whether another round of treatment is needed and for how long. Stopping treatment too early can be frustrating for everybody involved. Your dog, you and your veterinarian all want the ears to be clear from infection as quickly as possible, and so that is why the recheck evaluations are critical. 

Fortunately for you and Marley after two weeks of giving the drops you were prescribed into the ears every day you head back into the veterinarian and she reports that the ears are clear both during the otoscopic exam and on the cytology prep! Awesome, treatment is complete, now just keep a close eye on your girl for any recurring signs of irritation in the ears. As we now know these are frequently going to recur once patients have already had them.

Now there a whole variety of conditions that can affect the ears beyond these simple infections discussed here; however, these are likely the most common you will encounter with your furry friends. I hope you found this episode informative and useful. Please feel free to request additional episodes to cover more specific diseases and keep in mind that an episode on cats will be coming soon! Don’t forget to leave us some feedback, suggest topics, or donate as you wish.