Chronic recurrent otitis can be a painful, expensive, and frustrating disease for pets, owners and practitioners. The most important primary inciting factors in otitis media include allergies, parasites, fungal infections, endocrinopathies, immune-mediated diseases, foreign bodies, and keratinization disorders. In many cases the primary disease may not actually cause overt ear disease, but will cause alterations in the otic microenvironment, which then can lead to bacterial or fungal otitis. The most common example of this is allergic disease, which may cause inflammatory (but sterile) otitis, creating a perfect environment for the overgrowth of commensal bacteria and/or Malassezia yeast. Commonly the infection responds to initial topical therapy, but reoccurs when the underlying disease (or primary inciting factor) has not been addressed. Primary causes are the underlying problem in nearly every case of otitis, and up to 80% of otitis is caused by underlying allergic disease.
Other medical problems can lead to symptoms similar to those encountered in otitis externa. It is important to exclude these conditions before establishing a definite diagnosis. Examples are:
Atopy. Fifty-five percent of dogs with itchy skin disease caused by an allergy have otitis externa.
Autoimmune disease, such as systemic or discoid lupus erythematosus or pemphigus
Contact allergy
Demodicosis
Endocrine imbalance
Food allergy
Foreign bodies such as foxtail awns
Ear disease like cancer, hyperplasia or polyps
Parasites like ear mites, which are responsible for 10 percent of otitis in dogs
Polyps
Sebaceous adenitis
Seborrhea
Trauma
Tumors
Zinc-responsive dermatosis
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical. Follow-up for otitis externa often includes the following recommendations:
* Administer prescribed medications as directed and be certain to contact your veterinarian if you are experiencing problems treating your pet.
* Long term maintenance cleaning may be recommended in cases of long-standing infection. Cleaning procedure can be daily or weekly depending on the rate of wax and debris formation.
* Administer any prescribed medications. NOTE: Inability to medicate your pet is a common reason for treatment failure.
* Schedule regular veterinary visits to monitor your pet’s condition.
* Periodic ear evaluations with cytology may be recommended.
* Ear cultures may be useful in long-standing infections.
* Of course, the precise follow-up depends on the severity of your pet’s disease, response to therapy and your veterinarian’s recommendations.