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Why Does My Vet Need to See my Dog (Again) for an Ear Problem?

August 11, 2013

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Apple head short-haired chihuahua with itchy, smelly ears

Arnold

Another Ear Infection?

On telephone: “Arnold’s ears are dirty. Can you ask the doctor if we can have the medicine that worked last time?”

As veterinary professionals, we hear this question every day. It’s almost hard not to snap back, “The doctor needs to see your dog to diagnose the problem and prescribe the correct medicine.” After all, it’s the right thing to say.

It sounds harsh to you, right? After all, your dog has had ear infections before. The doctor just looks in there and prescribes expensive medicine and you pay, again and again. How frustrating. Why can’t your veterinarian just let you have refills since the same medicine works every time, right? Sometimes, they do the “ear swab” test and charge even more money. Sometimes they change the medicine. It seems to result in the same thing: more money, temporary relief, the problem returns after the meds run out. Right? That certainly looks like what’s going on.

swabs with waxy gooey ear discharge on the cotton ends

“Dirty ears” are not always just dirty

Would you like to know what’s going on from the veterinarian’s point of view?

Well, then. Read on.

When Is an Ear Infection Not Just an Ear Infection?

“Arnold’s ears are dirty. Can you ask the doctor if we can have the medicine that worked last time?”

Veterinarian thinks:
Well, the infection is back, so it did not “work” last time.
Any medicine or ear cleaner dispensed could cause permanent deafness if the eardrum is not intact. I need to check those eardrums.
Why didn’t the medicine work last time?
Is there an underlying weakness like allergies, or hypothyroidism, or Cushing’s disease, or diabetes mellitus, or a tumor or polyp in the ear?
Is it the same infection or a new infection with a different organism?
Was the medicine applied effectively?
and finally, when was “last time” anyway? Last week, last month, last year?

An ear  infection is not an ear infection when it is secondary to another problem, or it is persistent and difficult to cure.

What to Expect from an Appointment for Ear Problems

Expect 5 Key components of ear cure success from your veterinary team:

  1. Thorough, whole body physical examination, including and otoscopic examination of the ear canals. If there are underlying diseases and they are missed, your pet will continue to have ear problems.
  2. A diagnosis. Is it yeast, cocci, rods, polyp, tumor, insect stuck in there? What?
  3. Thorough ear canal cleaning, or instructions how to do it at home. (If the eardrum is intact and if the canal is open enough and not swollen shut.)
  4. Proper medication prescription. (In case you were wondering, almost all ear infections need topical physical medication, and pills may not help.)
  5. A recheck appointment.

“An ear canal filled with debris and wax will resist the instilled medication. The infection will hide under the protective film of wax and debris and continue to thrive. You need those ears cleaned. A thorough ear flushing, with or without anesthesia can often be the difference between success or failure of your treatment,” says Doc Truli.

Good luck with your unfortunate, yet common, ear infection problem. Follow your veterinarian’s advice. If your pet is seen more than twice for an ear infection, ask if the veterinarian if they think you should be testing for anything else, like thyroid problems or allergies. Keep your recheck and be sure the ears are examined thoroughly.

5 Comments leave one →
  1. Boo,Mag,& Blackie's Mom permalink
    July 19, 2014 11:01 pm

    The ear swab test is definitely important!

    I have three sibling cats that are 3 years old. Magnet and Blackie have been fine, but Kittenkaboodle (Boo) has had really “dirty” ears. At their annual physical six months ago, the vet recommended doing the ear swab test on Boo, but I declined due to finances (the physical was covered by their wellness plan, but extra tests, meds, etc have to be paid out-of-pocket).

    Well, I recently got a new job, so a few days ago, I took Boo in for the ear swab test and found out that she has a really bad yeast infection in her right ear. Luckily her eardrum was still intact. The vet cleaned both of her ears really well and prescribed ear drops, but my kitty-baby still developed a head tilt, completely stopped eating, and became extremely lethargic. She also developed Horner’s Syndrome on that side of her head.

    The vet recommended that I syringe feed Boo (read your post about that too). She also said that it was very important that I continue the ear drops and she gave me a solution to clean Boo’s ears at home so the drops could reach the infection. With several days of syringe feedings and continual ear care, Boo is returning to herself. She has her recheck appointment in a few days. I am glad that I did get the ear swab test done, but I could have saved Boo from suffering through all this if I had just agreed to pay for the ear swab test when it was first recommended.

  2. August 11, 2013 2:32 pm

    I had a guinea pig with an ear infection and my original vet just kept saying take baytril and his head tilt was getting worse and he was getting sicker. Another specialist vet I took him to in desperation, took a swab and found it was resistant to all but one antibiotic. Unfortunately his ear drum had been destroyed somehow (whether than was the infection or something else we don’t know) and he had a variety of other problems which meant we lost him weeks later but it is really important to get a swab. That money spent on it can mean the difference between curing your pet and letting them suffer.

    ~ Amy

    • August 11, 2013 5:06 pm

      Thanks for your feedback Amy. I can’t tell you how many people think the ear swab is just to pad the bill. I stay positive and explain to everyone why.

      -Doc Truli

      • Mark permalink
        April 12, 2015 7:43 pm

        If vets didn’t charge so much and maybe had some compassion when a family with pets is going through tough time, instead of calling them bad owners or put the dog down or give em up for adoption. Maybe the vets would be more trusted. Thank god we have an old family vet who’s retired living 3 states away that we can call. Who wants to tell their kids mommy and daddy fell on hard times and your dog has got to go. Its horrible its like a Dr. Telling you well put your kids up for adoption you can’t afford them. Give me a break just prescribe refills so the dog feels better.

      • July 11, 2015 4:26 pm

        Dear Mark,
        I admire your candor. I think many people feel as you do. It’s a tough call for a veterinarian when a family cannot afford the check-ups and tests.(Veterinarians are more likely to kill themselves than the average person Then I have to guess at the problem- educated guess- but still, in the case of ears, the pathogen (disease) can change in a matter of weeks and the medication will be wrong. It can make the dog deaf, or just not work. And as the cost of meds goes up, you could be spending money on worthless meds and never really helping your dog. You feel better because you are “doing something,” but it is not a helpful “something.”

        I have had many people over the years tell me,”Just prescribe what he got last time. It worked then, it’ll probably work now.” Hmmm….except the problem is back again….hmmm.

        I try to fix this situation by explaining ears to people so they can decide what they want to treat at home. Like the predisposing, perpetuating, and infectious factors. Predisposing would be things like floppy ears or a breed prone to allergic ear disease like a spaniel or a labrador. Perpetuating would be things like swimming in the pool. Oftentimes, the medication we put in the ears is not as important as the lifestyle that leads to recurrent ear problems.

        I have not found vets to be “heartless” at all. It’s not about the money for me, it’s about prescribing meds that will not work, or will make a dog worse, or deaf! The heartless vendors are more likely the manufacturers of all the over-the-counter products that I see make ears worse, or counteract the medication and inactivate it. They are purely in it for profit.

        You can medicate yourself and care for your own health, or you can hire an expert to help guide you and if you need meds prescribed. If you see a veterinarian as a gatekeeper to drugs, then of course, you will resent the office visit and fees for tests. If you see your veterinarian as a partner to help you, then you realize the meds are the least of it.

        Ears are tough to cure. I see families come up with money to fix broken bones but not ears or, for example, dental disease. It seems to be a matter of perception of what “should” cost more. I’d like people to know that a terrible ear infection can cost US$600 or more over 3-6 months to cure. One specialist called pseudomonas ear infections “the total hip replacement” of veterinary medicine. Shocking!

        ON a final note: I do not tell people how many pets or children they can afford. But, I also do not expect them to have me pay for their family needs. I have given free exams for animals after Hurricane Katrina and in other exceptional circumstances. But day-to-day charity would bankrupt me and most veterinarians. Why should I pay for your decisions? Do what my family did growing up: figure it out. Get a book from the library, study, use common sense, and wing it a little.Take personal responsibility for the outcomes and learn and adapt as you go. We did not go the the vet or the doctor for that matter. We could not afford it and we never expected someone else to give us anything for free.

        -Doc Truli

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