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A normal ear does not require cleaning to remain healthy. A healthy ear canal has a self-cleaning mechanism. This process is accomplished by the migration and desquamation of epithelial cells, which combine with secretions from apocrine and sebaceous glands to form cerumen. Anything that disrupts this process may lead to excessive cerumen accumulation and ear pathology. Common causes that disrupt the process include allergies, endocrine disease, foreign bodies, sebaceous gland hyper- or hypoplasia, microorganisms, parasites, and immune-mediated diseases.
In addition to mechanically interfering with effective application of topical otic preparations to the ear canal, excessive debris may also neutralize the active ingredients in those treatments. Proper examination of the entire canal to the level of the tympanic membrane is also very difficult if the debris is not adequately removed.
For cases in which the ear canal is either significantly swollen or ulcerated, pretreatment with a systemic steroid and antibiotic and/or antifungal medication for a time may be necessary to allow for optimal ear examination and flushing. Such therapy will also be helpful in providing the patient relief before the ear flush procedure.
General anesthesia is advised to provide the most efficient and thorough evaluation of the ear canal. A surgical plane of anesthesia provides for the best opportunity for visualization as well as patient comfort. Additionally, head shaking and subsequent damage to the ear canal can be avoided with general anesthesia.
Commonly used items for ear flushing include an otoscope, bulb syringes, red rubber feeding tubes, tomcat catheters, a 3-way stopcock, syringes, alligator forceps to retrieve foreign bodies, and culturettes plus plain cotton-tipped applicators for collecting samples for microbiology and cytology. Saline or distilled water is typically used to initially clean the ear canal when the integrity of the tympanic membrane is unknown.
The ear canal should not be occluded during flushing to avoid excessive pressure that may extend an infection to the middle ear canal or inadvertently rupture the tympanic membrane. Gentle handling during the procedure will help avoid potential harmful side effects and delayed healing.
Consideration for the individual performing the ear flush should also be made. Eye protection, a face mask, and gloves should be worn to avoid infection from organisms that are aerosolized during the procedure.
III. Types of Ear Cleansers
The veterinary practitioner has a wide variety of ear cleanser products available to choose from. Two main considerations for deciding which product to use are the type of organisms found on ear cytology plus the integrity of the tympanic membrane. Ceruminolytic cleaners featuring ingredients such as dioctyl sodium sulfosuccinate (DSS) are primarily used for dissolving excess wax accumulations. Cleaners with drying agents help to keep the ear canal dry and free of debris. Some cleansing products have ingredients such as aloe vera to help soothe the ear. Other products contain weak acids such as salicylic, benzoic, boric or acetic acid that will lower the pH within the canal and thus inhibit microbial growth. In cases where the tympanic membrane is known to be ruptured, extreme caution should be used.
An ear cytology result consisting primarily of rod-shaped bacteria is generally indicative of a Pseudomonas infection. An ear cleanser with tris-EDTA is a good choice when this organism is suspected. Tris-EDTA is a chelating agent that damages the bacterial cell walls and enhances the effectiveness of the antibiotic used. Tris-EDTA is effective against many Gram-negative organisms. Ketoconazole or other antifungal medications are often added to ear cleaners.
IV. Potential Complications
As with any medical or surgical procedure, informed consent from the owner should be obtained before ear flushing is performed. Complications, although infrequent, may occur from either mechanical trauma or use of ototoxic agents. Horner’s syndrome, ruptured tympanic membrane, vestibular signs, extension of the infection from the external to the internal ear, or hearing loss are the most frequent adverse events. These complications occur more often in cats than dogs.
V. Ear Cleaning at Home
It is often necessary for an owner to follow up with some form of ear cleaning as part of the treatment or long-term maintenance plan. There are several breeds of dogs that are genetically predisposed to ear disease and active participation of the owner is essential for maintaining ear health. It is essential that owners receive the proper instructions for ear cleaning. Typically, an owner is instructed to fill the ear canal with an appropriate ear cleanser, gently massage at the base of the ear, and gently remove the excess fluid from the external ear canal by use of either a soft paper towel or gauze sponges. The use of cotton-tipped swabs by an owner is discouraged due to the potential for damage to the ear. As some pediatricians have simply instructed parents to avoid putting “anything smaller than your elbow” down a child’s ear canal, clear instructions for the owner will help avoid problems with their pets.
The maintenance of a pet’s ear health should be a priority for the owner and a part of the conversation with the owner during the office visit. Unfortunately, there are animals that live with the pain and discomfort of chronic otitis for the majority of their lives.
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- Thompson LA. Otitis externa: Which ear cleanser should I choose? NAVC Conference Proc. Orlando, Fla. 2015.
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