December 2016
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Quiz: Otitis Management in Dogs

According to case files of more than 550,000 pets insured by a major pet insurance carrier, ear infection was the second most common claim filed in 2015.1 Otitis externa can be discovered during an examination of an animal presented for routine care or may be discovered when presented for a nondermatologic problem.2 Common presenting signs include head shaking, otic discharge, otic pruritus, odor from the ear, rubbing of affected ears, and crying out when an affected ear is touched. Of note, as based on clinical observation, otitis externa typically is present, but affected dogs may not exhibit clinical signs or their owners may fail to appreciate the early clinical signs of otitis.Performing an otoscopic examination on all nonemergent patients is, therefore, advisable, especially in patients with a history of otitis externa or allergic skin disease, as 80% or more of dogs with food or environmentally triggered atopic dermatitis (AD) have otitis externa.3,4 If the patient’s ears are painful, sedation may be necessary prior to otoscopic examination.

Diagnosis of otitis externa is only part of the puzzle, however; the second puzzle piece involves identifying the primary cause. Although the primary differential typically is AD, other differentials can involve5-9:

  • Parasitic infection (eg, Demodex spp, Otodectes spp, Sarcoptes spp)
  • Foreign body
  • Allergic or irritant contact dermatitis
  • Autoimmune or immune-mediated disease (eg, pemphigus complex, vasculitis [note that these diseases involve the pinna more commonly than the ear canals])
  • Juvenile cellulitis
  • Neoplasia (eg, adenoma, adenocarcinoma)

Long-term management relies on identifying and treating (or controlling) the primary cause, addressing secondary microbial overgrowth (eg, bacteria, Malassezia spp) and treating the associated inflammation. Treatment for otitis therefore will include appropriate antimicrobial agent(s) and steroids (topical, with or without systemic treatment, depending on severity of otitis), and providing analgesics for pain relief.10,11

Although a commonly taught premise involves ear cleaning as essential in controlling and preventing otitis externa, clinical data2 do not necessarily support this and, to the author’s knowledge, neither do clinical studies. Of note, research has shown that adding twice-weekly topical steroidal therapy to once weekly ear cleaning can more effectively prevent otitis externa, as compared with ear cleaning alone.12 This would suggest that controlling inflammation with a topical steroid is more effective than ear cleaning in preventing episodes of otitis externa.

Quiz: Otitis Management in Dogs

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References and author information Show
  1. Nationwide Pet (formerly Veterinary Pet Insurance). Identification of 10 most common medical conditions in dogs; based on database of more than 550,000 insured pets, as recorded 2015 veterinary visits. Brea, CA: Media release; March 24, 2016.
  2. Bloom P. Unpublished observations and clinical data; accumulated clinical records and knowledge from 1984 to 2016. Livonia, MI: Allergy Skin and Ear Clinic for Pets; 1984-2016. 
  3. Rosser EJ Jr. Causes of otitis externa. Vet Clin North Am Small Anim Pract. 2004;34(2):459-468.
  4. Muse R, Griffin CE, Rosenkrantz WS, et al. The prevalence of otic manifestations and otitis externa in allergic dogs (abstract). Proceedings of the American Academy of Veterinary Dermatology/American College of Veterinary Dermatology. Las Vegas, NV: AAVD/ACVD; 1996;23.
  5. Scott DW, Miller WH, Griffin CE. Parasitic skin disease. In: Scott DW, Miller WH, Griffin CE, eds. Muller & Kirk’s Small Animal Dermatology. 6th ed. Philadelphia, PA: WB Saunders; 2001:423-518.
  6. Griffin CE. Otitis externa and media. In: Griffin CE, Kwochka KW, MacDonald HM, eds. Current Veterinary Dermatology: The Art of Science and Therapy. St. Louis, MO: Mosby Year Book; 1993”244-262.
  7. Rosser EJ Jr. Causes of otitis externa. Vet Clin North Am Small Anim Pract. 2004;34(2):459-468.
  8. Scott DW, Miller WH, Griffin CE. Immune system and allergic skin diseases. In: Scott DW, Miller WH, Griffin CE, eds. Muller & Kirk’s Small Animal Dermatology. 6th ed. Philadelphia, PA: WB Saunders; 2001:543-666.
  9. Carlotti DN, Remy I, Prost C. Food allergy in dogs and cats. A review of 43 cases. Vet Dermatol. 1990;1(2):55-62.
  10. Rosychuk RA. Management of otitis externa. Vet Clin North Am Small Anim Pract. 1994;24(5):921-952.
  11. Fadok VA. Otitis externa: the bane of our existence. Proceedings of the 87th Western Veterinary Conference. Las Vegas, NV: WVC; 2013.
  12. Bensignor E, Pattyn J, Reme C. Reduction of relapses of recurrent otitis externa in atopic dogs with twice-weekly topical application of hydrocortisone aceponate in the ear canal: a randomized, blinded, controlled study [abstract]. Vet Dermatol. 2012;23(suppl):92.
  13. Lowrie M. Vestibular disease: diseases causing vestibular signs. Compend Contin Educ Vet. 2012; 34(7):E2.
  14. Radinsky MG, Mason DE. Diseases of the ear. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 6th ed. St. Louis, MO:  Elsevier Saunders; 2005:1180-1184.
  15. Cole LK. Treatment of otitis media. Proceedings of the 50th British Small Animal Veterinary Congress. Sao Paulo, Brazil: BSAVA; 2009.
  16. Rosychuk RAW: Feline otitis externa and media. Proceedings of the 80th Annual Western Veterinary Conference. Las Vegas, NV: WVC; 2008.
  17. Graham-Mize CA, Rosser EJ Jr. Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa. J Am Anim Hosp Assoc. 2004;40(2):102–108.
  18. Schick AE, Angus JC, Coyner KS. Variability of laboratory identification and antibiotic susceptibility reporting of Pseudomonas spp. isolates from dogs with chronic otitis externa. Vet Dermatol. 2007;18(2):120-126.
  19. Griffin CE. Otitis diagnosis, methods for determining secondary infections. Proceedings of the American Academy of Veterinary Dermatology / American College of Veterinary Dermatology. Norfolk, VA: AAVD/ACVD; 2001.
  20. Robson DC, Burton GG, Bassett RJ. Correlation between topical antibiotic selection, in vitro bacterial antibiotic sensitivity and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa. ACVSc Science Week Proceedings, Gold Coast. Queensland, Australia: 2010.
  21. Matros L, Wheeler T, Microbiology Team. Microbiology Guide to Interpreting MIC (Minimum Inhibitory Concentration). Sacramento, CA: IVS; 2001.
  22. VEDCO (ANADA 200-183, approved by FDA). GentaVed Otic Solution (gentamicin sulfate with betamethasone valerate; package insert). St. Joseph, MO: 1996.
  23. Picco F, Zini E, Nett C, et al. A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland. Vet Dermatol. 2009;19(3):150-155.
  24. Nuttall T, Bensignor E. A pilot study to develop an objective clinical score for canine otitis externa. Vet Dermatol. 2014;25(6):530-537, e91-92.
  25. Akucewich LH, Philman K, Clark A, et al. Prevalence of ectoparasites in a population of feral cats from north central Florida during the summer. Vet Parasitol. 2002;109(1-2):129-139.
  26. Roland PS, Belcher BP, Bettis R, et al; Cipro HC Study Group. A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa. Am J Otolaryngol. 2008;29(4):255-261.
  27. Hannley MT, Denneny JC 3rd, Holzer SS. Use of ototopical antibiotics in treating 3 common ear diseases. Otolaryngol Head Neck Surg. 2000;122(6):934-940.
  28. Rowlands S, Devalia H, Smith C, Hubbard R, Dean A. Otitis externa in UK general practice: a survey using the UK General Practice Research Database. Br J Gen Pract. 2001;51(468):533-538.
  29. MacDougall C, Powell JP, Johnson CK, Edmond MG, Polk RE. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis. 2005;41(4):435-440.
  30. Venezia RA, Domaracki BE, Evans AM, Preston KE, Graffunder EM. Selection of high-level oxacillin resistance in heteroresistant Staphylococcus aureus by fluoroquinolone exposure. J Antimicrob Chemother. 2001;48(3):375-381.  
  31. Graham KK, Hufcu, RM, Copeland CM, et al. Fluoroquinolone exposure and the development of nosocomial MRSA bacteremia (abstract). Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Atlanta, GA: Centers for Disease Control and Prevention; 2000:52.   
  32. Crowcroft NS, Ronveaux O, Monnet DL, Mertens R. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol. 1999;20(1):31-36.   
  33. Polk RE, Johnson CK, McClish D, Wenzel RP, Edmond MB. Predicting hospital rates of fluoroquinolone-resistant Pseudomonas aeruginosa from fluoroquinolone use in US hospitals and their surrounding communities. Clin Infect Dis. 2004;39(4):497-503.
  34. American Academy of Pediatrics Committee on Infectious Diseases. The use of systemic fluoroquinolones. Pediatrics. 2006;118(3):1287-1292.

Paul Bloom

DVM, DABVP (Canine and Feline), DACVD Allergy Skin and Ear Clinic for Pets

Paul Bloom, DVM, DABVP (Canine and Feline), DACVD, established Allergy Skin and Ear Clinic for Pets in 1984. He received his DVM from Michigan State University (MSU) and completed a 3-year dermatology residency at MSU before undertaking rigorous board certification. He is one of only 8 US double board-certified dermatologists. His clinical expertise covers specialized diagnostic procedures in allergy and otology, infectious skin diseases,  microscopy, and dedicated treatment approaches, including immunotherapy, topical, and systemic protocols. Dr. Bloom also serves as adjunct faculty at MSU College of Veterinary Medicine.

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