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Clinical Suite: Otitis Externa

Louis Norman Gotthelf, DVM, Animal Hospital of Montgomery, Montgomery, Alabama

Jessica Goodman Lee, CVPM, Veterinary Credit Plans, Irvine, California

July / August 2013|Peer Reviewed

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Otitis Externa in Dogs & Cats

Louis N. Gotthelf, DVM, Animal Hospital of Montgomery & Montgomery Pet Skin & Ear Clinic, Montgomery, Alabama

The Figures

Ear problems affect more than 20% of dogs (upward of 50% in warm, humid climates).1,2 In cats, this figure is almost 10%,1,2 with potential causes including mites, ruptured eardrums from sneezing, or nasopharyngeal polyps that allow middle-ear secretions to fill the external ear canal.

The Signs

Otitis externa can result in:

  • Significant ear itching and head shaking
  • Self-trauma and matted hair behind the pinnae (from excessive scratching)
  • Aural hematoma
  • Dried or crusty exudate at the ear canal opening
  • Odor
  • Apparent severe pain and head shyness
  • Neurologic signs (eg, facial nerve palsy, Horner syndrome, head tilt, nystagmus), suggesting a problem in the bulla.

The 4-Step Approach


History & Examination: For dogs, dermatologic history and examination for allergic skin disease should be done initially, as most ear conditions result from allergies. For cats, history of respiratory disease is important, as many cases of feline ear disease result from ascending middle-ear infection (if ear mites are not identified).


Ear Cytology: Characterizing the relative numbers and types of microorganisms, if present, helps decide the best treatment. Otic cytology identifies bacterial and/or yeast infection and ceruminous problems; neutrophils, if present, give a prognostic indicator.


Ear Cleaning: An ear canal cleansed of cellular debris, purulent material, wax, and other material aids examination and should be done with good-quality otoscopic equipment (eg, video otoscope) in a sedated or anesthetized patient. Ear cleaning also enhances medication efficacy, allowing medicine to reach inflamed, ulcerated, swollen, and infected skin. After cleaning (and drying) the ear, reexamine to find potential wax-covered growths, cerumen-gland hyperplasia, ulcerated areas, and fissures in the hyperplastic epithelium. After the horizontal ear canal is cleaned, the eardrum may be visible for evaluation.


Treatment: Treatment protocols should be based on all information gathered from history, examination, cytology, and the status of the ear canal epithelium (determined after ear cleaning). Decisions as to corticosteroids, antibiotics, yeast treatments, growth removal, and eardrum status are all factors in individualizing treatment regimens.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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