Treatment of otitis externa has two facets. The treatment of the original cause of the infection and to create an ear environment that is resistant to future ear infections.
1. Bacterial Ear Infections: In the majority of basic cases, a topical antibiotic will be prescribed. In severe infections a topical and oral antibiotic such as Clavamox® will be prescribed. At the same time a culture is taken for the lab to grow.
2. Yeast (Malassezzia) Ear Infections: Can be treated with topical antifungals with or without oral ketoconazole.
3. Food Allergy Ear Infections: These are often treated with antihistamines such as hydroxyzine plus a food trial is offered.
4. Ear Mites External Ear Infections: There are many preparations such as Tresaderm®, pyrethrins and Acarexx® (ivermectins) that will do the job. Treatment for ear mites takes a minimum of three weeks.
In many animals the ear pain and head shaking is intense. If you do not stop the head shaking, an auricular hematoma will be the usual result. Topical and or injectable corticosteroids will often be used on a short term basis to control inflammation hence head shaking.
The ear canal needs to stay dry and acidic. These are normally bad conditions for yeast and bacteria to grow. Most veterinarians will send home a suitable preparation wash that is squirt in the ear, massaged in and removed with cotton balls. One of my favorites is EpiOtic®. Never use Q-Tips® to clean the ears. Animals may jerk and the cotton swab will penetrate the tympanic membrane causing intense pain and possible hearing loss. I have had to sedate numerous animals to remove the offending object. In cats, NEVER use ear cleaning products that contain salicylates! Salicylic acid is an astringent and is present in many canine ear cleaners. Cats are ultra sensitive to salicylates. For that reason, avoid the use of aspirin (acetylsalicylic acid) in cats. Use ear cleaning preparations that are made for dogs and cats or just cats.
The ear canal should be cleaned out first with a cleaner before the antibiotic drops are applied. Once the ear infection is cleared, use the cleaner at least once a week. For dogs that love to swim in the summer, clean the ears after each romp in the water.
It is crucial to keep acute ear infections under control. If they continue, a chronic ear infection develops. They cause a stenosis (narrowing) of the ear canal making ear infections even worse. Chronic cases are almost impossible to cure but possible to control.