The animal health care team can greatly assist in the diagnosis and therapy of ear disease. Twenty percent of the dogs admitted to the hospital have disease of the ears. By understanding these common diseases, you can fulfill a vital part of the hospital function in the care of animals. If you understand how ear disease is diagnosed and treated, you can greatly magnify the efforts of your veterinary staff. Many busy clinics are missing a huge opportunity to help clients and their pets through proper handling of ear disease. For example, consider the following scenario: The clinic is busy – all the examination rooms are full and the doctor is just finishing the morning surgeries. A new client “walk-in” that has a three-year-old cocker spaniel with a complaint of “ear mites”, “shaking the head” and “scratching the ears” enters the clinic. The owner also complains that the dog smells bad. Because the clinic is busy, the veterinarian performs a brief ear examination and prescribes Otomax®. (Otomax® is a medication, which kills yeast and bacteria – the most common infections in the ear.) The client uses the medication and the ear problem does not get any better, so the client tries another veterinary clinic. With a little preparation and training, this story could have been different. So let’s play the same scenario a little differently. The client communicates to you the history of the ear problem. You educate the client about some of the possibilities that could be causing the ear problem and educate the client that the problem needs to be determined before the correct treatment can be prescribed. At each step that is described below, you provide the client with cost estimates before the services are performed. You collect a sample of the earwax and stain a slide for examination. While the doctor is examining the slide, you educate the client about ear disease and how there are certain predisposing factors that cause the disease. These factors can include the anatomy of the pet and the amount of earwax they produce, as well as the drying characteristics of the ears. Cocker spaniels have poor ventilation to the ears and are predisposed to seborrhea, which creates excessive wax. These predisposing factors can create a great place for “bugs” to grow. Unless these factors are changed, the pet will continue to have ear disease. You should mention that your clinic always “makes a diagnosis before treating”, and, that your doctor is examining an ear swab of the ears as you speak. This ear swab will determine if mites, bacteria, or yeast are present. It will even tell the degree of inflammation as well as what type of bacteria we have. With this information, it will be easier to treat effectively the first time. After the doctor explains what she has seen, you can provide the client with the doctor’s recommendations. These might include a culture of the ear canal, an ear flush with deep cleaning of the ear canal, as well as oral medications to supplement the ear drops that are formulated specifically for the “bugs” in their pet’s ears. These instructions should also include the next steps that may need to be done if the ear infection does not resolve. Because you know that cockers have skin problems like seborrhea, you recommend a blood screen and a thyroid test to see if there is an underlying metabolic reason for this ear disease. Additional information is given about ear surgery and other treatment options. The client greatly appreciates all the information that you have given and asks you your name. The client declines the blood screen and the culture that you recommended, but, will be back to do them if the ear flush and medications do not work. The pet is dropped off for a sedation and ear flush. In this scenario, you perform the ear flush and prepare the medications and instructions for home care. The client sees you as an important part of the health care team. The pet wins because the ear was aggressively treated and a plan is made for what to do should the problem happen again. The client wins because she knows that she can trust you to give her important health care information. The clinic wins because the client spent more money than in the previous scenario and will be coming back even if the ears do not immediately get better. This type of Win-Win-Win relationship can be fun and rewarding. It is up to you now, to learn this material, and become part of the team!

Anatomy of the Ear