‘Ear we go again’: How to deal with otitis, or ear infections, in dogs

SINGAPORE – Has your dog been keeping you up at night with constant whining and scratching of its ears? Or you cannot seem to keep its ears clean no matter how much you wipe them?

Your dog could be suffering from an ear infection. Otitis, the medical term for ear infections, is one of the most common reasons dogs visit a veterinarian. Otitis episodes can be itchy, painful for the dog and are a source of frustration for owners, particularly if the infections keep coming back.

Ear infections are a dermatological condition, as the inside of the ear is lined with skin.

Normal ears do not get infected. Therefore, if your dog has had ear infections, there must be an underlying cause.

Why do ear infections keep coming back in dogs?

The causes of ear infections are generally divided into primary and secondary factors. The primary cause can be something as simple as ear mites, which can be cured, or a more chronic non-curable problem of the skin.

The most common non-curable primary cause of relapsing/chronic otitis in dogs is allergies, medically known as atopic dermatitis (similar to eczema in humans). Atopic dermatitis causes inflammation of the ear skin and wax glands.

The resulting redness, swelling and increased production of ear wax provides a good microenvironment for staphylococcal bacteria and malassezia yeast to overgrow. These are commensal organisms that usually live in small numbers on your dog’s skin.

During an inflammation, the skin microbiome changes and allows the bacteria and yeast to flourish, causing a secondary infection within the ear canal.

Other factors add onto the primary and secondary causes, such as Singapore’s high humidity, hairy ear canals in certain breeds such as poodles and maltese terriers, and excessive cleaning or moisture of the ear.

Recognising the symptoms

Dog ear canals are mostly concealed from view as they are L-shaped, making it difficult for owners to see inflammation or wax build-up over time.

The first symptoms an owner may notice are head shaking, scratching, pain, redness around the entrance to the ear canal, malodour and discharge that may be waxy or green/yellow pus.

While initial ear treatment prescribed by vets through ear cleaning and eardrops often works well in the early stages, repeated episodes of inflammation and infections can gradually damage the delicate ear canal.

In severe cases, this vicious circle of inflammation can cause severe irreversible pathology such as swelling and scarring of the ear canal, leading to a requirement for surgery.

Breaking the circle of ear infections

The key to stopping the ear infections is not only treating each episode, but also identifying and proactively managing the root cause. If the circle of inflammation can be halted, the infections will stop.

In some cases, the cause is curable. For example, treating ear mites with parasite medication or resolving a food allergy by avoiding the trigger.

More often, however, the underlying problem is atopic dermatitis. These allergies are not curable, as they are linked to environmental triggers and immune system dysfunction. However, they can be controlled with ongoing treatment.

Preventive therapy is one of the most effective long-term strategies. This involves small doses of topical steroids such as hydrocortisone that have minimal side effects. They act on the locally inflamed ear skin, but are poorly absorbed into the body. It is often used twice a week initially and reduced in frequency over time.

I generally recommend this approach once a dog has had three or more allergy-related ear infections, as it can prevent disease progression and reduce the risk of surgery later in life. In rarer cases, ear infections may be linked to tumours, in which case surgery may be necessary.

Ear cleaning also plays a role in maintenance therapy in relapsing otitis, though use in moderation is key. Overcleaning must be avoided as it macerates the ear skin and predisposes it to microbial overgrowth in the long term.

For most dogs with recurring otitis, a wax-removing, drying ear cleaner is prescribed to be used once or twice a week. This can be reduced as needed in the long run. Water-based cleaners can be useful in specific cases, such as painful or pus-filled ears, but may not be suitable for long-term use.

A word of advice

If your dog has relapsing ear infections, seek treatment from your veterinarian as soon as possible and follow his or her advice on scheduling revisits when the otitis is relapsing, even if the infection seems to be improving. This allows your veterinarian to find the underlying cause and treat it effectively, which will reduce inflammation episodes.

With the right diagnosis and a proactive treatment plan, most dogs can enjoy fewer flare-ups, healthier ears and a better quality of life.