DISEASES OF THE PINNA (EAR FLAP)
It is not uncommon for bacterial or fungal infections of the pinna (earflap) to occur. Scrapes and scratches to the pinna can allow bacteria to invade the skin. Often damage is done when the dog scratches at the ear as ear canal problems are present. This allows resident bacteria, often staphylococcus, to invade and start an infection. These bacterial infections of the earflap present signs of local areas of hair loss, small bumps where infection is present called pustules and crusts or scabs in areas where the infection is trying to heal. Sometimes similar patches of infection are present on other areas of the body. (Pyoderma)
Fungi can also invade the earflap. Although not very common, ringworm infections cause local areas of hair loss, sometimes in a ring or circular pattern and occasionally crusts on the pinna. As with bacterial infections, lesions on other parts of the body may be present. Diagnosis of these infections is based on examination, woods light screening, examination of hair samples or special cultures.
Young pups with poorly developed immunity can have severe, sterile inflammatory disease of the face and ears known as puppy strangles, properly called Juvenile Cellulitis. In these cases, the face, eyes and/or ears are very red, swollen and often discharge oozing pus. The pup may also have a fever and nodes in the neck will swell and sometimes rupture. The cause of this condition is unknown. ((Juvenile Cellulitis))
TREATMENT OF INFECTIONS OF THE PINNA
Bacterial and fungal infections of the pinna are treated using oral antibiotics or antifungal medications, medicated creams and shampoos to disinfect and cleanse the ear. If ear canal disease is present, that too must be treated accordingly. With severe infections, clipping and scrubbing the area with antiseptic preparations often helps quicken the recovery. Puppies that have Juvenile Cellulitis are treated with prednisolone, antibiotics and astringent topically.
Demodicosis will show lesions of localized, circular areas of hair loss, itching (prorates) and crusting of the skin. Lesions on the face and legs are usually present. Sarcoptic Mange will produce a very pruritic (itchy) and crusting dermatitis along the edges of the earflap as well as other areas of the body. This parasite causes such an intense itching that simply rubbing the edge of the pinna will cause the dog to try to scratch with the hindleg. Diagnosis of these parasites is based on physical exam and positive skin scrapings.
Dogs left outside in areas where flies are present, particularly around horses, often suffer from Fly Bite Dermatitis as these insects attack the edge of the pinna. The flies bite and ulcerate the skin, which bleeds, then black crusts will form in the area. The pet may scratch the ears or shake the head to relieve the local irritation. Repellents may help prevent this problem.
TREATMENT OF PARASITES OF THE PINNA
Treatment for Sarcoptes or Demodex is the same as per these problems generally. Clipping hair from the ears and scrubbing scabs and crusts away with medicated shampoos is very helpful. Antibiotic treatment is also needed if secondary infections have occurred. Fly Bite Dermatitis is treated by cleaning the earflap, applying medicated ointments and using repellents to prevent further damage.
Loss of hair from the pinna without inflammation, crusting, or other symptoms is known as Idiopathic Pinnal Alopecia. This most often occurs in male Dachshunds and is considered to be a hereditary disorder similar to human male pattern baldness. Sometimes Endocrine Disease may be involved. Miniature Poodles may suffer from a related form of this problem but the hair will usually regrow several months later while the Dachshund may never regrow the hair. Treatment is usually not needed or effectual.
Seborrhea is a disorder of keratinization that most often occurs in breeds with pendulous ears such as the Dachshund or the Cocker Spaniel. Seborrhea will usually affect other parts of the body, but when the ears are involved signs include scales, crusts and loss of hair will occur along the margins of the ear, especially near the tip. Itching is uncommon, but the problem may become quite unsightly. Diagnosis is based on clinical signs, skin scrapings and skin biopsy.
TREATMENT OF EAR MARGIN SEBORRHEA
Rarely is there a cure for Seborrheic diseases, so treatment often centers on controlling the symptoms which includes the buildup of scales, crusts, plugs and excess oil on the ears and other body areas. Medicated shampoos such as Allerseb, T-lux or benzoyl-peroxide based products among others are very good at cleansing the skin. Antibiotics and cortisone are used in cases where infection and inflammation has become apparent. Retin-A, Vitamin A, Zinc, Fatty Acid supplements and several other drugs may have applications in various forms and secondary problems of the disease that occur.
An aural hematoma is a blood and fluid filled swelling of the pinna. It most often occurs secondary to head shaking and scratching of the ear from any problem which causes the ear to itch. Some studies indicate that immune-mediated disease may be present causing a spontaneous bleeding between ear layers. The swelling may be localized or encompass the entire area of the flap; diagnosis should include a search for the initiating cause. Otherwise diagnosis is based on physical examination. ((Hematoma))
TREATMENT FOR AURAL HEMATOMA
First, an attempt to determine and treat the initiating cause of a hematoma is very important. If a hematoma was secondary to a foxtail in the ear for instance, and that was left untreated, the problem would not be solved. Rarely will a hematoma resolve by itself and if so, the ear is often left grossly deformed. Drainage with a syringe or test tube may produce results if repeated frequently or left in place for long periods of time, but most often, the ear will refill with blood after such treatment.
The best recognized therapy is to surgically open the skin of the ear on the inside surface, remove a small flap of tissue, place numerous regular sutures along the line of the incision and bandage the ear in some fashion for 1-3 weeks to help encourage smooth healing. The goal is that the layers of skin and cartilage will "weld" together to form a permanent bonding of the pinna tissues. Surgery is usually successful and permanent. ((Hematoma Surgery))
Sunburn of the earflap is uncommon but can occur in areas of high sun exposure on dogs with white or light colored ears. The earflap will show signs of localized hair loss and redness, followed by crusting and possibly ulceration. Frostbite can occur when the dog is exposed to subzero temperatures for prolonged periods of time. Damaged areas may be whitish or blue and will later slough. Diagnosis is based on the history of exposure and physical examination.
Immune-Mediated Diseases, Endocrine Diseases and Allergies can all affect the pinna. Signs may range from redness and itching of the flap, to hair loss, ulceration, severe infection and crusting of the area. Most often other signs of illness are present and treatment of the primary problem will return the pinna to normal. Diagnosis is based on history, physical examination, blood counts, serum chemistry and hormonal analysis as indicated.
INFECTIONS OF THE EAR CANAL (OTITIS EXTERNA)
It is important to understand that most infections of the ear canal have some initiating cause; rarely do these infections simply erupt on their own. Bacteria, yeast's and fungi reside in and around the ear canal and under normal circumstances do little more. Parasites, moisture, diseases of the pinna and allergies can all initiate ear canal disease.
The usual signs of ear canal disease are head shaking, scratching the ear, rubbing the face and/or ear, soreness when touched, a sharp fetid odor and possibly some type of exudate or discharge coming from the ear canal. Many people quickly and erroneously conclude that most dogs with these symptoms have ear mites, which is not the usual case. The type, color or consistency of the discharge does not always reveal the cause of the problem. Again, as ear canal problems are often secondary to other disease processes, the dog may be showing signs of skin disease or other problems that must to be taken into account.
Your veterinarian will make a diagnosis by examining the ear, including a deep otoscopic exam and perform cytology or possibly a culture to determine the cause of the problem and the best course of therapy. Often cleaning the ear under sedation may be needed to reveal the initial cause if deeper ear problems are present. In cases where the ear disease has kept returning after treatment, or fails to respond to therapy, middle or inner ear problems may be present.
Signs of Middle Ear and/or Inner Ear Disease include head shaking, rubbing the face and ear, scratching, discharge and pain. Poor appetite, fever, dry eye, drooling, a head tilt, facial nerve paralysis, trouble walking or balancing and circling to one side or direction may additionally occur. Diagnosis is made by otoscopic exam, which may reveal a ruptured eardrum in many cases. Cultures and X-rays are also important to establish a diagnosis and prepare a treatment plan.
Dogs that have heavy, pendulous ears, such as the Cocker Spaniel, seem to be more prone to ear problems, although the German Shepherd is a notable exception, being a dog with upright ears but also an increased risk for infections. Dogs that swim or live and play in a moist environment are also at increased risk. Dogs that have keratinization disorders or produce excess wax in the ears for any reason will have more trouble with ear canal disease. Breeds such as the Poodle or Schnauzer, which tend to have heavy hair growth in the ears, are also prone to frequent ear infections.
Another problem commonly seen in dogs which have had repeated and/or uncontrolled ear infections is that of sclerosis of the ear canal; a thickening and narrowing of the canal itself. Given enough time, an infection can cause scar tissue to build up. This may become a permanent change and require surgery to reopen the ear so that air may dry the canal and medication to be administered regularly. Dogs like the Shar Pei are often born with a small, twisted ear canal, predisposing even the youngest of puppies to infections.
TREATMENT OF DISEASE OF THE EAR CANAL
While the causes and exacerbating causes of ear canal disease may vary, basic principles of treatment are consistent:
1. Cleanse the ear of any debris and exudates. Wash solutions may be used daily at home in minor cases, while more advanced cases require sedation and flushing of the ear with medicated solutions. Ceruminous otitis is also treated this way as to cleanse the ear of the waxy buildups.
2. Physically remove any foreign objects; again, sedation will most likely be needed. Excess hair should also be removed from the ear.
3. Bacterial infections will be treated with antibiotic drops (or ointments) and oral medication; Yeast infections with antifungal drops and oral medications. Mites will be treated with topical drops and possibly injections of ivermectin. It is also advisable to treat dogs that have ear mites with a flea powder around the ear, neck and rump areas.
PREVENTION AND CONTROL OF EAR CANAL DISEASE
Not only is treatment for ear canal disease important, but as many dogs are prone to recurrent attacks of ear infections, preventative measures are very important. Dog owners can take a few simple steps to control this problem. Three basic principles can be employed:
1. Keep excess hair pulled and clipped from the ear canal to aid air circulation.
2. If your dog gets wet, swims or after a bath apply a few drops of rubbing alcohol to the ears to speed drying and follow a few hours later with a preventative wash.
3. Use a preventative wash solution weekly (or more often) and as advised above to clean debris from the ear and disinfect the internal environment. Avoid the concoctions sold in pet supply stores as these often contain ingredients that can promote or exacerbate ear canal disease.
TREATMENT FOR MIDDLE, INNER AND CHRONIC EAR PROBLEMS
As many chronic infections result in damage and narrowing of the ear canal, treatment and preventative care can become difficult if not impossible. For this reason a Zepp procedure is often performed, which in short, is removal of part of the vertical portion of the ear canal to open the ear for ventilation. It is not always a perfect cure, especially if grossly scared tissue is present. Some ear canals may become so badly damaged and infected as to necessitate complete removal (Alblation) of the ear canal. While such a procedure may sound radical, the alternative to it is often chronic suffering.
Middle and inner ear infections are treated with antibiotic medications, like other ear canal infections and by establishing drainage for exudates produced during the infection. This may necessitate the performance of a Bulla Osteotomy that involves opening part of a bone in the skull where fluids from these types of infections can collect and flushing out the material therein. A drainage tube may be installed. Sometimes, simply rupturing the eardrum and flushing and aspirating the material from this area may be effective. Cultures are very important to determine the type of infection and help insure the best possible chance for cure.
EAR MITES (Otodectes species)
Ear mites are probably the most over diagnosed problem of the ear. Mites cause signs including a buildup of black crusty debris in the ear and intense itching; every time a dog owner notes these symptoms the diagnosis seems automatic. Most commonly, ear canal infections that produce similar exudates are present.
Ear mites are caused by the mite Otodectes cynotis that is common to both the dog and cat, but does not attack humans. The mites burrow and feed within the ear canal, which in itself can cause intense itching, but as time goes on and the mites multiply, infection of the ear canal and allergic reactions to the mites can occur, compounding the problem all the more so. ((Ear Mite))
The mites can easily move between animals with even minimal contact but cannot live for long without a host. They also lay eggs in the ear canal, which hatch and molt into adult mites about every 19 days. Diagnosis is based on clinical signs and visualization of the mites under the microscope; a procedure called ear cytology.
TREATMENT OF EAR MITES
Mites are easily killed with good quality mite drops, but these will need to be used for about 21 consecutive days. Ivermectin injections have been used with good success with and without the drops. If the ears are full of secondary debris, cleaning or flushing of the ear canals should be performed first. The use of flea powders on the neck and rump of the dog will also hasten the death of these mites.
Foreign body otitis is quite common. Ticks and grass awns, called "foxtails" can easily and quickly make their way deep into the canal. At first, they may simply cause head shaking and itching of the ear, but as these invaders rupture the ear drum and damage the lining to the ear canal, infections generally occur and exudates may hide the object as they accumulate. Pain may also occur, often in proportion to the damage being done by the foreign object. Damage to the pinna and surrounding skin may occur as the dog tries to scratch the ear.
Tumors and polyps that often occur in the ear canal are mentioned here as they most commonly manifest as a foreign object will. Masses in the ear can plug the canal and set up an infection therein. Surgery to open the ear canal and remove the mass may be the only option to stop the infections that then occur.
TREATMENT OF EAR CANAL FOREIGN OBJECTS
Most times, with the help of sedation, the veterinarian will be able to capture and remove foreign objects and then medication will be useful to heal the ear. Plugs and other masses may require some degree of surgery to remove them.
Ceruminous Otitis is an increased production and accumulation of waxy debris in the ear canal and can become quite irritating for the dog. Owners often mistake it as a primary ear infection. Yellow oily or waxy material is often seen coming from the ear canal. Bacteria and yeast in some cases may cause a secondary infection. Many of these dogs have generalized Seborrhea, a disorder of keratinization that most often occurs in breeds with pendulous ears such as the Dachshund or Cocker Spaniel.
Seborrhea will usually affect other parts of the body, but when the ears are involved symptoms include scales, crusts and loss of hair will occur along the margins of the ear, especially near the tip, often with the buildup of the waxy secretions in the ear canal. Itching is common as increased accumulation or secondary infection begins and the problem may become quite unsightly. Diagnosis is based on clinical signs, skin scrapings and skin biopsy. ((Ceruminous Otitis))
TREATMENT OF CERUMINOUS OTITIS
While there is currently no cure for this condition, your veterinarian will have several products available that when used on a regular basis will help dissolve and keep the ear clean of these exudates.
Allergies to airborne irritants, foods or contact with certain objects can lead to inflammation of the ear, as well as other areas of the skin. The earliest clinical signs include redness and itching to the ear canal and the pinna. Sometimes the ear may appear normal, yet be very itchy. Fleas, mites and drugs can also cause these allergic reactions and need to be considered by your veterinarian. Autoimmune disease can also cause eruptions of the earflap and canal and should not be overlooked. Diagnosis is based on history, physical examination, blood tests, skin scraping and skin biopsy in some cases.
By definition, deafness is a partial or complete inability to hear. Deafness may occur in one or both ears. Some animals may be born deaf, most times due to genetic defects. These defects are often hereditary so affected dogs and their parents should not be bred.
Other causes of deafness include middle and inner ear disease, foreign objects of the ear canal, ear infections, excessive wax buildup, neoplasia of the ear, trauma to the head or ear(s), poisons and toxins and hypothyroidism. Many older dogs, like many older people, suffer from simple degeneration of the organs of the inner ear which perceive sound. This too produces an often gradual but noticeable loss of hearing in the geriatric dog.
TREATMENT OF DEAFNESS
Dogs with congenital or genetic deafness most often cannot be treated. Dogs with deafness secondary to some other ear disease will often regain most if not all of their hearing once the primary condition is resolved. Age-related hearing loss is usually permanent although adapting human hearing aids to them has helped some patients. In general, most dogs can survive and live happy normal lives with partial or complete hearing loss as long as they are kept away from busy roads and other dangers.