The Ear Ache That Just Never Went Away

My friend, (and fellow veterinarian), and I complain that we see endless cases of skin and ears. It is our bread and butter, but goodness it can get frustrating.

Yes, it is frustrating for us, and I know that it is frustrating to my clients., but it is painful, persistent, and a palatial PIA to our pets.

Here is my hope, that if these ailments are so common, and frequent, that I can educate my clients with all of the tricks of the trade to avoid these frequent recurrent problems.

I know that most people don't look for more reasons to visit my office nor do they want their pet to be ill or in pain and not know how to relieve this. So here is my first piece of advice; if your pet has had one ear infection, bout of allergies, or other skin problem, it is very likely to have it again. Talk to your vet about how to identify the problem in its fledgling stages, how to prevent it, and what you can do to minimize any future episodes. 

Today's story is about Tootsie. A cuddle-bug kissing rotund little Yorkie. Her charm is instant and lasting. But, alas, she is a dog with allergies. Tootsie, like many of my patients with allergies, starts to show her first signs of impending irritation via her ears flaring up.

Truth is that in many cases what my clients perceive as an "ear infection" is in some cases just ear 'inflammation." Whether that ear is infected or inflamed the long term consequences of both are the same. 

Chronic irritation creates chronic inflammation. Think of it like a wound that never heals. That wound will become raised and the tissue that makes up that wound will get larger as a scar starts to form. Scar tissue has an irregular raised almost cauliflower look to it. If scar tissue forms around the tunnel of the ear canal then the only place it has to grow is into the tube. The ear canal tube thus gets narrower and narrower. A narrowed ear canal is called stenotic. Unfortunately, over time and repeated inflammation the canal closes off from the outside world. 

Ears benefit from a few key things. 

• Ideally, the ear should be open to air flow. Dogs with erect open ears have fewer ear problems than those dogs with big floppy pendulous ear flaps. Like for instance the difference between shepherd and a spaniel. The erect ears get to breathe because an floppy ear flap shuts out sunlight, keeps in moisture and keeps in dirt and debris. I call this the "fire triangle." Remember when we were in elementary school and we were taught that a fire needs fuel (debris, wax, and dirt), oxygen (darkness), and a source of the heat (inflammation or allergies). With some dogs their ears remind me of the fire triangle.
• The size of the ear canal should be large and open. The brachycephalic dogs have short narrow tortuous tubes..much harder to let air flow through. 
• Excessive ear hair is commonly seen in smaller breed dogs, like poodles. The hair keeps humidity, dirt, debris, and wax in the ear and precludes it from leaving the ear. 
• A dirty, waxy, or parasite filled ear is an invitation to a problem.

One last note. Many pets with allergies have ear problems. You will have a difficult time keeping the ears under control if you cannot keep the allergies under control.

In an effort to keep ears happy and healthy basic ear maintenance and intervention is key. I advice any dog with excessive hair around and in the ears be removed, (remember never use scissors, either pluck or clip), ask your groomer or veterinarian for tips to keep the ears clean and hair-free. Any ear that is red and itchy should be kept impeccably clean with a good veterinary recommended ear cleaner, (read the directions for use, NEVER stick q-tips or swabs in the ear!). Also see your vet about how to distinguish inflammation from infection. If you do have an infection use the appropriate bug specific medication.

Tootsie has had allergies and ear problems for most of her 4 years. She finally has her allergies (mostly) under control. But that right ear, well, it shut its doors to company (medical or otherwise) a long time ago. We have tried every possible concoction to get medicine to the inside of her ear. All with no luck. That right ear was a closed brewing vat of inflammation and infection that was unable to let any kind of medication penetrate into the closed canal of chronic disease.

When Tootsie came to see me I tried once again to treat her proliferative stenotic ear. For weeks we tried to get her infection back under control. With reluctance, and bit of optimism for resolve, we decided it was finally time to surgically open up Tootsies' ear canal. We hoped that this surgery would hopefully provide her the ability to still hear but no longer suffer from infection. For any real chance of keeping a functioning hearing ear we had to re-open her ear canal.

Here are the pictures of Tootsie's ear surgery.  This could only be achieved through surgery.

The first incisions to open the vertical ear canal.
The nerves that innervate the face live here.
Facial paralysis (often only temporary) is not uncommon after this surgery.

Normal post-op swelling.
But a beautiful and finally opened ear canal.

Three days post-op. Still swollen and draining but healing.
These are painful surgeries.
Tootsie has a morphine time-release pain patch and oral opioids to keep her pain free.

Tootsie has had allergies and ear problems for most of her 4 years. She finally has her allergies (mostly) under control. But that right ear, well it shut its doors to company (medical or otherwise) a long time ago. We have tried every possible concoction to get medicine to the inside of her ear. No such luck. That right ear was a closed brewing unable to get to canal of chronic disease.

With reluctance and optimism for resolve we surgically opened up the canal. This surgery will hopefully provide her the ability to still hear but no longer suffer from infection.

If your pet has recurrent chronic ear infections, or an inability to treat any longer please see your veterinarian, a veterinary dermatologist, or a veterinary surgeon to treat this painful debilitating condition.

There is much that you can do, but of paramount importance is keeping your pet disease, pain and discomfort free.

For more information on how to clean ears please see: http://kmdvm.blogspot.com/search/label/Ear%20cleaning

Ears are a common ailment for our pets but in almost all cases being correct with your diagnosis, specific in your treatment plan, and thorough in your ability to prevent any of the predisposing factors that predispose your pet to ear problems.

One week post-op and the ear is healing beautifully!

All healed!! Now back to keeping the chronic skin allergies under control..

Tootsie and her mom.
Every single living creature should have a family that loves them even an ounce as much as Tootsies does!
She is one happy girl!
And her family says she is even happier without her chronic ear problems.
Very best of luck to all of them, and we will always be here to help her with any of her ear, skin, or waistline bumps in the road ahead..