6 Steps to Treating Ears

The 6 steps to treating ear disease is a practical, clinical method to plug into one of the most common clinical problems veterinarians face ever day.

How to clean an ear: Apply approximately one (1) teaspoon (5 ml) of the acetic/boric acid into the ear canal and massage thoroughly. Some people occlude the canal with a small amount of cotton during this process to protect against drenching should the pet shake its head. For maximum benefit, allow the solution to remain for at least 5 minutes before attempting to manually clean. Clean the ear by stuffing wads or balls of cotton in the ear and massaging so the debris sticks to the cotton. An applicator stick may be of assistance where repetitive cleaning is required. In dry and/or irritated ears with little debris and/or wax, the cotton may become irritating. In these cases, a tiny bulb or a water pick can be helpful.

In problem ears, the frequency of this process may be increased to one (1) to three (3) times daily. Should medication be necessary, apply after cleaning. A previously little known fact to remember is that with most acidifying ear the ear will be acidified and therefore may inactivate some commonly used drugs like aminoglycosides (amikacin, gentamycin). In those cases, either waiting 4 hours or applying alkalinizing agents will be of assistance. One alkalinizing agent that the literature reports to have primary antimicrobial is Tris-EDTA (Triz-EDTA^TM, DermaPet, Inc, Potomac, MD 20854). To use Triz-EDTA, one should follow the above instructions in how to clean an ear only substituting the alkalinizing Triz-EDTA solution. Repeating Steps 3 and 4 should then be more rewarding.

Step 2. Step 1 (see shampoo therapy) once daily, plus treat twice daily with the "Gemish".

Gemish

12 ml of DermaPet Ear/Skin Cleanser
2 ml of Baytril injectable
6 mg of dexamethasone sodium phosphate (for solubility)
a. Some people add .5-1 ml of medical grade DMSO
b. Some people add ivermectin for a topical treatment.

Step 3a. Step 2 plus a systemic antibiotic such as a flouroquinolone (Baytril) at double the recommended dose.

Step 4. Step 3 plus ear cleansing under anesthesia. Visualization of the ruptured ear drum or swollen tympanum should confirm otitis media. After careful and thorough cleansing and removal of "debris", infuse Baytril and dexamethasone** directly into the tympanum. In the case of a strangulated canal, with a 1 1/2 inch 20 gauge needle, inject approximately 1/2 ml of depomedrol (depending on the size of the pet) as deep as you can between the skin and the cartilage of the ear canal. If a corticosteroid injection is not done then, if there is significant erythema or exudation, then place the dog on short term (7-12 days) short acting corticosteroids. At this stage, some people do culture and sensitivity.

Step 6. Using DermaPet® TrizEDTA Ear/Skin Cleanser clean the ear thoroughly (see instructions) daily for 7-21 days. This is an alkaline solution with a pH of 8***. In many cases, daily cleansing is all that is necessary. If Pseudomonas is suspected and/or otitis media is present then use the appropriate systemic and topical antibiotic after cleansing.

Step 7. Surgery. This is if Step 4 fails and/or calcification of the ear canal is evident.

* There is no simple method of diagnosing cutaneous Malassezia. Do a topical treatment in cases where Malassezia otitis is confirmed by cytology.

** the use of corticosteroids is multifunctional. While we are most familiar with it's anti inflammatory properties, in the case of OM, the reduction in the viscosity of the tympanic exudate is a noteworthy goal.

*** There are reports in the literature of primary microbiocidal properties of tris-edta, particularly to Pseudomonas. Those reports also indicate the evidence for potentiation with antibiotics which otherwise are ionactivated by other acidifying ear cleansers.