"Hey, It's Just an Ear Infection, Right?" Not Exactly.

Isolated ear infections are uncommon in dogs. Sure, Cocoa may dive at Lake Sunapee for a week in July and develop an isolated ear infection that is readily treated. But what about dogs like Sadie with recurring or chronic ear infections? The vast majority of dogs who suffer from an ear infection that persists or recurs have an underlying cause for those infections. These underlying causes can be treated, more often than not.

OK, so what does your canine best friend look like when she has an ear infection? Even if she shows no symptoms these HURT. Most dogs will become quiet when they hurt; they seldom vocalize, especially with ongoing chronic pain. We are their best friend and their advocate. The infection is sometimes hidden deep in the canal, which you cannot see without special equipment. At home, families should watch for these symptoms:

• Shaking head
• Rubbing ears on floor
• Holding head to one side
• Increased wax of varying color
• Ear odor
• Redness to ear canal or to ear flap
• Thickened skin of ear flap

How do we eliminate the isolated ear infection? Often Cocoa's veterinarian will provide a "triple approach," giving her a topical medication that addresses all three: yeast, bacteria, and inflammation. For uncomplicated ear infections, this is highly effective. If this describes your dog, consider her very fortunate. For patients that experience ear infections that will not go away or frequently return, read on!

Chronic or recurring ear infections: Do you have to accept them as a pain that your loyal friend must endure? NO!

We must identify and eliminate the cause of the ear infection. For the vast majority of cases, this is the single most important aspect of care and often the most overlooked. What are the most common causes? Allergies, allergies, and yes you guessed it, allergies. Food allergy, inhalant allergy, and flea allergy underlie most ear infections in dogs. In a few instances, we may see a grass awn or foxtail lodged in the ear. Very few dogs may be harboring ear mites, quite uncommon in comparison to other causes of ear infections.

The tricky part: Determining WHICH of the allergies is causing the ear infections. Here are a few hints:

• You find fleas. Easy - eliminate the fleas, treat the ear infection and see how Sadie is feeling.
• The ear infections happen regardless of season. Consider a food allergy and speak to your veterinarian about the best hypoallergenic diet to try. This is often misunderstood. Please speak to a well informed veterinarian or veterinary dermatologist to appropriately institute a hypoallergenic diet trial. An entire article could be devoted to this subject alone.
• You recently changed foods (meaning in the past few months) or have started feeding new treats (especially those loaded with artificial colors, flavorings, preservatives) and now Sadie has an ear infection. As much as possible, only feed your pup foods in which you can understand all of its ingredients.
• The ear infections correspond to a move to a new house. Environmental inhalant allergens are a common culprit of ear infections.
• Sadie is 3 years old and has begun having ear infections that tend to be seasonal - meaning they are concentrated most heavily in particular seasons. Whether it be Spring, Summer, Fall, or Winter - different dogs are sensitive during different seasons. These are generally often due to inhalant allergens; allergies often develop as dogs mature in early adulthood.

My medical approach to aid our patient's suffering from persistent ear infections may include some or all of the following:

• Ear cytology (ear is swabbed and debris is evaluated under a microscope)
• Ear culture (ear is swabbed and a micro-biology lab identifies the exact organisms)
• Blood work (complete blood cell count and blood chemistry including thyroid)
• Hypoallergenic food trial. With this approach, please speak to an informed veterinarian, as choosing lamb, duck, or even kangaroo diet from your favorite feed store is not a diet trial. Also, grain-free food has become trendy and is not "hypoallergenic"; in some cases, they aggravate symptoms.
• Blood test evaluating for inhalant allergens. I do not recommend blood tests that evaluate for food allergens as they are highly unreliable (as in, as reliable as a blindfolded monkey at a dart board).
• Evaluation for mites, there are several to consider.

Ear infections, whether short-lived or persistent, are almost always treatable. However, they sometimes require some investigation, critical thinking, patience and commitment. Our pals deserve these in abundance.

Written by Jennifer Lesser, DVM for publication in the Spring 2015 issue of 4 Legs & a Tail (www.4legsandatail.com). Pick up your free copy at our front desk today.