While not all are simple to fix, after reading this you should have a good idea of what to do. I’ll rank them in rough order of frequency.

Before the list though, you need to do something unpleasant: make a close inspection of your dog’s body using both your eyes and nose. Pay particular attention to the crevices like armpits, groin, feet, ears, mouth and lips. We’ll use this information in a minute.

Skin Disease

The skin of dogs with chronic dermatitis almost always has a bad smell. You might describe it as ranging from an extreme ‘doggy’ smell to old socks. This is probably due to an overgrowth of secondary yeast and bacteria taking advantage of the skin’s weakness.

Affected skin often looks thickened or wrinkly, and may have a greasy or flaky surface. It can also become red or even black in colour.

Uncomplicated dermatitis on its own does not smell, and so an odour is a sign that the condition has progressed. The solution is never as simple as using antifungal or antibacterial shampoos. You will need to address the underlying skin problem, which you can read about here.

Ear Infections

Infections inside the ear canal are a specialised form of skin disease complicated by severe yeast or bacterial overgrowth. They nearly always smell strongly, and if you put your nose right up to the canal it there’s no mistaking the origin. Sometimes the infection is so deep that the ear canal looks normal on the outside.

Never, never just put cleaner into a smelly ear without your vet checking it first. As it’s probably infected by now, cleaning alone won’t work and it will sting harshly. Once you do this, your dog won’t trust you and treating the problem properly gets a lot harder.

Ear cleaners are great for prevention, but first read about the treatment of ear infections here.

Oral Disease

If you have identified the smell as coming from inside the mouth, there are still quite a few causes. The first is advanced periodontal disease, which is inflammation and infection of the junction between the teeth and gums. This is the most common cause of bad breath and tooth loss.

Once dental disease develops, you will need it treated under anaesthetic, but it can also be effectively prevented afterwards.

Any infection or ulceration in the mouth will also smell bad, so other causes I have seen include oral tumours, foreign material caught in the teeth or mouth ulcers from kidney disease. A smell from the mouth has never in my experience been caused by any area lower down like the stomach.

The smell from bad breath is often described as ‘fishy’ or ‘metallic’, leading to confusion with the next cause. The clue is to look at the location.

Anal Glands

Anal glands are special scent glands found just inside the anus. When a dog defaecates, they release an odour onto the poop which other dogs can detect. Anal glands malfunction when they release this scent at any other time.

The classic anal gland leakage situation is your dog sleeping on your lap and suddenly you smell a horrible rotten fishy odour. You might find a drop of brown fluid. Many of these anal glands are too full and not emptying by themselves.

If so, all you need to do is get your vet or groomer to express them every 3 months and the problem goes away. However others leak when they aren’t full, and these are much harder to fix. Some have infection inside, others just seem leaky. Read about their treatment here.

Skin Folds

Fold pyoderma is a localised infection in folded skin. It’s notorious in short-faced breeds like Bulldogs, but this is easy to see because the hair is short.

The more insidious form is found in dogs like Cocker spaniels and Golden retrievers. The lower lip often droops as they age and a fold forms which traps saliva in the hair. These can get very badly infected and smell like rotten meat.

The trick to finding them is to not just look inside the mouth, but also stretch out the skin on the upper and lower lips. Treatment involves antibiotic tablets or creams, then prevention with antibacterial wash and barrier ointments. Severe cases require a small facelift!

Flatulence

Passing smelly gas from the bowel is a common noxious odour, but at least no-one has trouble identifying it. The solution is almost always to find a food that agrees better with your dog’s digestion. Or put up with it, as the dog is usually untroubled!

Urinary Incontinence

Around 2.5-5% of dogs will develop urinary incontinence. In some females it can start very early, and may be more common after desexing. It is also common with urinary tract infections.

The stale ammonia smell is usually quite distinctive, but I see many dogs whose owners have got used to the scent until I point it out. These dogs can almost always be cured by either fixing an infection, removing a bladder stone or medications to prevent leakage.

Faecal Soiling

Having poop stuck in the hair might seem like an excessively obvious cause of bad smells. However, I see it regularly, especially with new owners of Poodles and Poodle crosses. The hair can quickly get thick and long around the anus to hide the buildup of soft faeces.

If this isn’t addressed urgently with a gentle bath and dry, you often end up at an overnight emergency vet. The faeces end up blocking the anus, and the resulting rash can be terrible.

Prevention is of course all about having a good relationship with a trusted dog groomer, and starting as early as possible. It’s also about avoiding soft faeces by the use of high quality diets.

Normal Doggy Smells

The last cause is the hardest and saddest. Never assume this is what is causing your dog’s bad smell unless you have consulted a vet first: it’s very rare.

Every now and again I see a dog owner who is disgusted by their dog’s terrible odour. Except that I can’t smell it at all, and neither can anyone else in the clinic.

These dogs smell normal. Nearly all of us with dogs have tuned out the natural odour of dogs and can no longer detect it. However, for an unlucky few it remains thick and intense.

I have no solutions for these people, as a bad smell can’t just be hidden under cologne or other scents. Putting a dog outside is definitely not the answer.

But let’s not be negative. Eight of the nine causes of bad smells on dogs are fixable, and the ninth isn’t a problem to the dog. Good luck working it out!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Most of the techniques and products mentioned can also be used in cats.

How To Clean Dog Ears At Home

I stand by my methods although they aren’t exactly the same as you’ll read elsewhere. Clean ears in a place where you don’t mind the cleaner and wax being flicked all over, including the ceiling!

Step 1: Look For Signs Of Infection

Ear cleaning is likely to do more harm than good if your dog is showing any of the following signs:

• Head shaking or ear scratching
• A head tilt or holding the ear down
• An ear odour that’s different from elsewhere on their body
• Redness or swelling around the ear opening

If one or more of these is present, please get a checkup before putting anything in the ear.

Step 2: Choose The Right Product

There is a wide variety of ear cleaning products available. Choosing the right one should be based on your dog’s needs and your vet’s advice.

In my experience:

• Acidic cleaners are best suited for the prevention of recurrent yeast infections
• Otoflush works best for recurrent bacterial infection
• PAW and Sonotix work best for excessive wax buildup.
• as for Ear Canker Drops, I still haven’t found a use where there isn’t a much better product

Click here for an evidence-based review of international ear cleaners.

Step 3: Apply A Trial Amount

Ear canals are long, narrow and crooked, so you can never be sure you haven’t missed a deep infection. Therefore start by inserting a trial amount.

Place only five drops of ear cleaner in each ear, give a treat, and step back to observe. Your dog or cat will shake it out in a few seconds and then go about their regular business.

If they keep scratching at the ear or show any signs of discomfort, do not proceed further. See your vet immediately.

Step 4: Apply The Full Amount

Now pour the cleaner into one ear canal until it begins to overflow. You’ll probably use 3-5mL to do so. The whole time, use a second person if available to give treats and prevent head shaking.

Ear cleaner is better tolerated if it is at body temperature, so a pro tip is to carry it in your pocket for 30 minutes before use.

Step 5: Massage The Ear Canal

To massage the cleaner in effectively, you need to know dog ear anatomy. The ear canal goes almost vertically down for half its length, before turning in towards the midline.

Therefore, feel for the tubular shape of the canal running down the side of the head below the opening. It feels like silicon rubber and you can gently grasp it between finger and thumb.

Squeeze and ‘milk’ the canal in a downwards motion. You should hear a satisfying squelching sound, and your dog should like it, not hate it. Again, if it causes discomfort, stop and see a vet.

Step 6: Rinse And Repeat

Holding the head to prevent shaking, slide your hands around to the other side of the head. You’re trying to let the first ear soak for as long as possible. Therefore, it’s good to reverse the order the next time you do it.

Now repeat steps 4 and 5 in the second ear. Afterwards, I like to continue holding and patting a dog’s head for a few minutes, all the while telling them how good they are. Once again, this is to allow it to soak in a little.

Step 7: Shake!

The only reasons you may not allow shaking is if you’re somewhere you don’t want mess, or if the dog has ear flap injuries. Otherwise, step back and let your dog rip.

They should have a good shake, take a break and then shake again. This expels more debris than trying to drain the ears using cotton wool.

Step 8: Dry Off The Excess

To finish, pat (never rub) the ear canal and ear flap with dry clean cloth or tissues. Do not put cotton buds (Q tips) in the ear canal, ever. A small amount of cleaner left behind should be OK.

You can very gently wipe extra wax from the outer folds. Use a make-up remover soaked in the ear cleaner, but please be careful; ear skin is very fragile.

In dogs with very hairy ears, you may need to apply a drying agent, but please only do this with your vet’s advice.

How Often To Clean Dog Ears

Many dogs do not need their ears cleaned. For those that do, once a week seems best. The frequency can then be adjusted in conversation with your vet.

Many vets recommend the use of ear cleaners before ointment during the treatment of otitis externa (ear infections). This would therefore be once or twice a day. I do not find this often to be necessary, but there are certainly times that I also recommend this.

It’s also important to bear in mind that excessive wax buildup may have an underlying cause that needs its own treatment. The best example is atopic dermatitis, but ear mites are a very common cause as well, especially in young dogs.

Lastly, keep an eye on the expiration date and quality of your cleaner. Even within the date, once they are opened they may degrade. This is especially true if you apply the drops by touching the nozzle to the ear or you leave it in a warm place.

I always unscrew the cap and look inside before use. If I see cloudiness or floaters, I throw it out and get a new one.

That’s it! These seven steps will altogether take you about five minutes once you get into the swing of it. Ear cleaning can be a regular weekly task without any inconvenience or discomfort if you do it right.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Unfortunately, it’s mostly based on products found in the UK and USA, but we can still use it to make some general rules for Australian dogs.

I can find three recent papers, two of which compare a number of products. Their results are summarised in the table below.

Paper 1 used the cleaner in dogs themselves, so is potentially more valid than paper 2 where they looked at activity in the lab at different dilutions. For paper 2, a cleaner that still works at a 1/32 dilution is better than one that stops at 1/16 or 1/2.

Only the first two are available in Australia, but we have other products not found on this list.

The Best Ear Cleaners In Australia

A further paper³ compares Epi-Otic Advanced with the cleaner found in Australia (Epi-Otic). Note that both were equally uncomfortable in 38% of dogs, which is why I don’t use acidic cleaners when infection is present. Pleasingly, however, it found that there is very little difference in efficacy.

This is gratifying as I feel that Epi-Otic is very good for the prevention of yeast infections.

I use PAW Gentle Cleaner primarily for wax accumulation without infection.

Note that Epi-Otic’s main weakness is its activity against Staph. And in fact, you can see a good demonstration of this here. For these infections in Australia, I have used Otoflush.

Until doing this comparison I did not realise I could also buy CleanAural in Australia. I found it being sold at a local supplier, then used it for 1 month only to find it was discontinued and I could no longer get it! Back to Otoflush for me.

The four ear cleaners in bold are pictured above.

How To Clean Ears At Home Naturally

What about these commonly recommended ear cleaners?

• alcohol
• olive oil
• hibiscrub (chlorhexidine)
• vinegar
• hydrogen peroxide

None of these are likely to work well, especially in the presence of infection. All are also likely to cause damage to hearing if the ear drum is ruptured. Some could be very painful.

I have included a recipe for an apple cider vinegar ear flush here, but I honestly would not use it unless no other options are possible. As you can see from the table above, pH is not the only factor in the efficacy of ear cleaners.

Now you’ve chosen your cleaner, all you need now is to know how to use it! So next, read my seven quick and easy steps to clean your dog’s ears.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Sources

1. Mason, C. L., Steen, S. I., Paterson, S., & Cripps, P. J. (2013). Study to assess in vitro antimicrobial activity of nine ear cleaners against 50 Malassezia pachydermatis isolates. Veterinary dermatology, 24(3), 362-e81.
2. Swinney, A., Fazakerley, J., McEwan, N., & Nuttall, T. (2008). Comparative in vitro antimicrobial efficacy of commercial ear cleaners. Veterinary dermatology, 19(6), 373-379.
3. Rème, C. A., Pin, D., Collinot, C., Cadiergues, M. C., Joyce, J. A., & Fontaine, J. (2006). The efficacy of an antiseptic and microbial anti-adhesive ear cleanser in dogs with otitis externa. Veterinary Therapeutics, 7(1), 15.

Ear cleaning can be a great way to improve the health of your dog’s ears but it can also cause a lot of harm. Therefore, it’s important to know if it’s the right treatment for your dog.

Here I’m going to help you recognise when ear cleaning is beneficial & when it’s harmful. Everything I say here also applies to cats.

In two weeks I’ll talk about how to do it and what to use.

When To Clean A Dog’s Ears

Probably less than 10% of dogs need their ears cleaned regularly. Therefore, it is not advisable to start cleaning a dog’s ears unless your vet recommends it.

Just like with toenails, new dog owners are often told that ears need regular maintenance. This is untrue. Both areas just need to be kept an eye on in the majority of dogs.

What Is The Brown Stuff In My Dog’s Ears Anyway?

The brown material seen around the ear opening is called cerumen, or just wax. In the normal ear it is transported up the canal until it reaches the outside. Therefore, a small amount just in the folds is perfectly fine if the ear is odourless and not inflamed.

A dog who may benefit from ear cleaning is one who suffers from frequent buildup of waxy material deeper in the ear canal. Certain breeds like Dachshunds are known for this, and removing it regularly via gentle cleaning at home can prevent ear infections.

To see it, shine a head torch or bright penlight straight down the vertical part of the ear canal. Brown material seen down here is abnormal. However, here’s why you shouldn’t clean it out without getting advice first…

3 Reasons Cleaning Can Make An Ear Worse

The picture at the start shows a view down my microscope after the wrong dog’s ears were cleaned. The little purple dots are bacteria, almost certainly Staphylococcus. This dog had a mild ear problem before the wash, and a severe one shortly afterwards.

I don’t blame the owner at all. In fact, if you look at the bottle she used, it actually says to use it for ‘otitis externa’ and smelly ears. This is an incredibly bad idea.

So the first reason cleaning can be bad is if the infection is bacterial, not fungal. Most ear cleaners only treat yeast (pictured here) and seem to make bacterial ones worse by adding excess moisture.

The second reason ear cleaning is harmful is when the ear is sore. Nearly all antifungal ear cleaners on the market are very painful when applied to raw tissues. It’s a lot like putting vinegar on a wound or rash.

We see a lot of head shyness in dogs who have had infections treated using cleaners. These dogs have been hurt with ear treatments and are losing their trust in people. It makes future treatment very much harder to the extent that some can only be successfully treated under sedation.

The third reason ear cleaning is harmful is when the ear drum is ruptured. Most cleaning solutions will cause nerve damage and balance problems if they enter the middle ear. I have seen this done several times. It usually occurs after a prolonged ear infection, but it can happen quickly in unlucky dogs.

When Not To Clean Ears At Home

If your dog is showing any of the following signs, please get a checkup before putting anything in the ear:

• Head shaking or ear scratching
• A head tilt or holding the ear down
• An ear odour that’s different from elsewhere on their body
• Redness or swelling around the ear opening

Almost certainly, your dog will have an ear infection or grass seed needing veterinary attention first. Afterwards, cleaning may be helpful to help prevent future infections but it’s almost certainly too late for this one.

Even for non-smelly ears with a bit of cerumen only, I would get a checkup just to be sure. Dogs are masters at hiding pain so you never know what’s lurking in the horizontal canal.

A single checkup first could save a lot of bother later.

You Might Also like: Why Dogs Get Ear Infections | How To Treat Ear Infections

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

She came to me late one night for vestibular disease. And she certainly had all the classic signs:

• a head tilted to one side
• loss of balance and inability to walk
• rapid eye flicking called nystagmus
• even nausea and vomiting

It had been happening for two years, on and off, and she needed more of her medication. Except she really needed a whole lot more than that.

The truth when I explained it was too much for the owner to take. She decided I must be wrong, and I never saw her again. As far as I know, Holly never received the treatment she needed.

To understand why, you need to know why vestibular disease happens.

The Causes Of Vestibular Disease

The vestibular system is the organ that manages things like balance, head position and posture. It has two parts: one in the middle and inner ear (peripheral), and another in the brain (central). Anything that damages these areas causes the signs of head tilt and loss of balance.

Here are some of the more commonly reported causes:

• Middle or inner ear infection
• Idiopathic Vestibular Syndrome
• Drugs or other toxicities
• Head trauma
• Hypothyroidism
• Meningoencephalitis (MUO)
• Tumours
• Cerebrovascular Disease (“stroke”)

So how common are these in everyday dogs? it’s very hard to tell, because most of the data we have comes from veterinary specialists who tend to see more of the rare things.

We looked at the 132 cases of head tilt from our own clinic over the last 15 years. Here’s what we found…

The Causes Of Head Tilt In Dogs

Notice that when you only look at the symptom of head tilt there are another three common causes: neck pain, focal seizure and otitis externa. Neck pain can cause a wry neck, or torticollis, just like people. Focal seizure is a poorly understood but mostly harmless episode. Otitis externa is an ear infection that doesn’t go through the ear drum. Read more about each at the links.

‘Other’ causes included no more than two of: stroke, shaker syndrome, hypothyroidism, MUO, toxicity, head trauma, labyrinthitis, low blood glucose and more that could not be classified. It’s important to note that some of these would also have been strokes and tumours if advanced imaging like MRI were available.

Now, finally we can get back to talking about the most common mistake, and Holly’s story.

Otitis Media vs Vestibular Syndrome

The dog at the start was thought to have idiopathic vestibular syndrome but really she had otitis media. It’s an easy mistake to make, but the results are devastating. One is a painless condition that resolves by itself, the other causes unremitting pain, and only gets worse.

Idiopathic vestibular syndrome generally affects dogs over 10 years of age, comes on suddenly, and usually starts improving within 3 to 4 days. By four weeks most dogs are back to normal except for a slight head tilt in some. It then does not occur again on the same side.

No treatments have been shown to help, although we often give sedatives or anxiety medications to control any distress. The cause is unknown.

Otitis media and otitis interna are ear infections on the other side of the eardrum. Most of the time they started on the outside and spread through a ruptured eardrum.

Middle ear infections cause their signs by direct damage to the vestibular apparatus. They also often damage the facial and sympathetic nerves which travel close by. Therefore, middle ear disease as well as causing balance disorders, often causes a dropped lip from facial paralysis and a half-closed eye with a dilated pupil from Horners syndrome.

Commonly affected breeds are:

• French bulldogs
• Cavalier King Charles spaniels
• Cocker spaniels
• West Highland white terriers

Which are all breeds known for getting ear infections.

Help! My Dog Has A Head Tilt

If your dog has a head tilt, it’s important to know how to tell the benign from the serious causes. Therefore, the first thing to do is get a check up with your vet.

A head tilt without vestibular signs is most often going to be caused by an external ear infection. It definitely needs treatment, but as long as this is done it’s a lot less serious.

A head tilt with vestibular signs will have the following breakdown according to our data*:

• 39% Idiopathic Vestibular Syndrome
• 24% Otitis media/ interna
• 10% Tumour
• 27% Other

Here are some clues that your dog does not have idiopathic vestibular syndrome:

• Smell or discharge from the ear
• Repeated episodes
• Any signs of nerve damage
• Gradual (not sudden) onset

Treatment Of Otitis Media

All this matters, because success rates with treatment of middle ear infections depend on how quickly you act.

I saw a case of otitis media just the other day (that’s why the numbers in the graphic and the table are different). I’m not at all worried about that dog. The symptoms had only been present for two days and the infection won’t have established itself yet.

He went on a combination of local treatments known to be safe when the eardrum is ruptured, plus systemic antibiotics. I’ll be amazed if he isn’t right as rain in a week or two.

The other side of the coin are dogs like Holly or Denver here. Dogs with long-standing middle or inner ear infections are usually incurable with medicines alone.

So if you’re interested, click here to read about the surgery that Holly needed, and Denver got. It made a world of difference to his quality of life.

* total number excludes otitis externa, neck pain, focal seizures and 10 cases classified in ‘other’ that had a head tilt only

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Steps In The Treatment Of Ear Infections

• Medication chosen for the type of infection
• Treatment for pain and inflammation
• Regular follow-up until resolution
• Treatment of the underlying factors you can control

Now dive deeper…

When I was a young vet, I worked in a clinic that offered an emergency service, and one thing surprised me more than anything else: the number of ear infections.

Ear infections are the most common problem of dogs, but are they an emergency? Clearly the answer can be yes. Despite taking a few days to get going, they can end up causing so much pain that sometimes these dogs need help straight away.

All the more reason to treat them before that happens. Here I’m going to focus only on the best treatments for canine ear infections. I’ve written much more about why they happen, and how to stop them coming back at these two related pages:

1. Why Do Dogs Get Ear Infections?
2. Can You Treat Ear Infections At Home?

Signs Of An Ear Infection

Dogs with inflammation of the ear show some or all of the following:

• Shaking the head
• Scratching at the ears
• Redness around the ear opening
• A brown or yellow ear discharge
• A smell from the ears
• A head tilt
• A swelling of the ear flap (we call this an aural haematoma)

You may only be given one clue such as head shaking or a musty smell, and the ear may look perfectly normal on the outside. So here’s a rule:

If the ear smells different to the rest of the dog, there’s something wrong.

So many dogs come in to me for another problem, and as soon as they walk into the room I either smell them or see them flick their head. These owners have got used to the warning signs and don’t realise what they’re missing. Almost always, the next thing I say is:

To your dog, the big problem is his ears, not what you came here for. Ear infections are painful, but dogs hide chronic pain so well that even good owners miss it completely. Those emergencies I mentioned only happen when the infection comes on fast or something changes.

Treatment Of Ear Infections

Start with a trip to the vet. It’s the only way to treat ear infections properly. This is what they might do:

Physical Exam

When I see a painful ear, I always start by examining everything else first. I want to know about your dog’s general state of health, and look for reasons why the ear infection developed in the first place. You’ll find these listed here.

Next, I look in the other ear. This is rarely as normal as it looks on the outside. Even if it is, it shows me what the bad ear looked like before it got infected.

Finally, I examine the infected ear. Have a look at how the assistant is holding the dog’s muzzle at the start. This is essential to prevent your dog shaking their head while the otoscope is inside. A badly performed ear exam can leave a dog never trusting their ears to be checked again.

To Sedate Or Not?

Sometimes dogs have already had too many bad experiences to allow examination. Other times, it’s just too painful to examine well.

There are also the anxious dogs, who often just won’t allow inspection. Even if they do, they always need special handling to prevent them getting worse each time they come.

Finally, especially in Spring and Summer when an ear suddenly gets painful after a walk, a grass seed in the ear canal is likely.

All these dogs need to be given a sedation for examination. It’s a humane act, and can usually be done on the spot.

To Anaesthetise Or Not?

Sometimes the infection is bad enough that there is a real risk of ear drum rupture. This is especially likely if pus is present. Whenever possible, these dogs should be fully anaesthetised for a gentle saline flush of the ear canal.

Other times (like the picture) there’s so much thick discharge that the chance of fixing the infection without first cleaning the ear is very low. An ear clean is optional here but will certainly speed things up and may end up being necessary anyway. You don’t want to spend 3 weeks fruitlessly battling away only to then schedule an ear clean.

An ear clean is also needed when an owner will have trouble putting ointments in their dog’s ear at home. Ear cleaning gives everyone a head start so that less-than-perfect treatment can still work. It’s also essential if we want to use the long-acting ear gel called Osurnia®.

Most vets will only flush infected ears under a full anaesthetic as it seems especially painful.

Ear Cytology & Culture

Anaesthesia or sedation aren’t necessary for most dogs, but they certainly need the next procedure: ear cytology. This is a sample of ear discharge stained and examined under the microscope. Here’s one showing budding Malassezia yeasts.

Cytology allows us to choose the best treatment. Most ointments contain both antifungals and antibacterials but each ingredient has its strengths and weaknesses. For example, the antibiotic polymyxin is nearly useless against anything serious like Staphylococcus or Pseudomonas.

If cytology shows rod-shaped bacteria, I will always advise that we send away a bacteriological swab for culture and sensitivity testing. While not compulsory, it’s money well spent as these bacteria are unpredictable and nasty. The test allows us to choose the right antibiotics the first time.

Ear Infection Medicines

The cornerstone of treatment (unless the ear drum is ruptured) is an appropriate ear ointment. I hope you can see by now why we never just prescribe ointment for a new infection over the counter.

Drops will need to be applied deep into the ear once or twice a day depending on the product. Always get a vet or nurse to show you how it’s done. Most treatment failures are as a result of owners incorrectly applying the ointment. If it seems too hard, many nurses are happy to put the ointment in for you each day at no charge if you can come in to the clinic.

Resist the temptation to use that leftover ointment from the last ear infection. Expiry dates only apply to unopened medicines and it may not be the right ointment for this infection. Both factors lead to the rapid development of antimicrobial resistance and substandard treatment.

Sometimes we will also add oral medicines or injections. These can be pain relief for especially bad ears, short-term prednisolone to reduce ear canal swelling, or antibiotics for severe bacterial infections. However, tablets on their own will never fix an ear infection.

Follow Up

The biggest mistake dog owners make is thinking that if the ear canal looks good on the outside, then the infection must be fixed. Many of these dogs come back in a few months with what looks like another ear infection, but is actually the same one reappearing.

Revisit appointments aren’t just formalities. 50% of the dogs I see one week later still require further treatment. Often the owners need to adjust their technique, sometimes a different medicine is needed, or it might just need a longer time.

Occasionally we have misjudged the cause of an infection, and can see it now the ear canal is cleaned up. This is especially true when a grass seed gets in an ear out of the normal season.

If I see a long-term chronic ear infection, I will warn the owner that we’ll be checking this dog week after week until it’s fixed. I’ve taken many dogs who seemed to have unfixable ears and proven that all that was needed was a dogged determination to take the problem to its conclusion.

To Clean Or Not?

Many vets and specialists recommend using an ear cleaner before each ointment dose. I rarely see the need nor the benefit. Home ear cleaners are pretty terrible at removing discharge from the horizontal part of the ear canal. According to me, the ear canal is either reasonably clean, or it should be fully flushed before starting.

I have a completely different attitude to long-term cleaning once the infection is under control. But it’s not one-size-fits-all.

It’s essential that you don’t try to treat a painful ear with acidic products for obvious reasons. This means you shouldn’t use them once an infection starts, which means even if it’s just smelly. They’re preventers only.

Which Ear Cleaner?

Dogs prone to yeast overgrowth can do well with certain cleaners applied once to twice weekly. My personal favourite is Virbac’s Epi-Otic® but you can read my reviews and the evidence for many ear cleaners here.

Dogs prone to bacterial overgrowth are often worsened by the same cleaners. For these, I use a neutral, antibacterial ear wash called Otoflush®.

What I used to do but never any more is make a mix of anti-fungal shampoo (Malaseb®) and water. It rarely worked, and we were always in danger of swapping an easy problem (yeast) for a nightmare one (Pseudomonas).

There are countless other products available, such as Thornit and Zymox. Nothing works on every dog, neither these nor my own preferences. Therefore, keep in contact with your vet and get the results checked.

It’s always a joy when a dog owner comes in a month or two after an ear infection just to check their progress. It’s quick, it’s cheap, and it’s pain free.

Now Read: How To Clean a Dog’s Ears | TECA: The Last Resort I Hope You Never Need

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

• Aloe vera
• Apple cider vinegar
• Calendula
• Chamomile
• Coconut oil
• Garlic
• Grapefruit seed extract
• Homeopathy
• Oil of oregano
• Mullein
• Witch hazel
• Yoghurt

The reason there is so much interest in home remedies is simple: dog ear infections can be extremely frustrating. They are common, they keep coming back and they can get very expensive. That’s without even mentioning the discomfort they bring to dogs.

I’m here to tell you that you can stop ear infections. But it’s never easy.

Later I’ll tell you my favourite natural remedy. But before choosing any treatment, natural or otherwise, you must understand two things:

1. The real reason most dogs get ear infections
2. The number one reason they keep coming back

Only then can we get a treatment to work properly.

1. Why Dogs Get Ear Infections

Look at this list from Dogs Naturally Magazine called “Why Does My Dog Get Ear Infections?”

1. Diet (not natural enough)
2. Anatomic (long ear flaps)
3. Lifestyle (also not natural enough)
4. Excessive Ear Cleaning
5. Weakened Immune System (mainly food again)
6. Other Chronic Disease (e.g. hypothyroidism or autoimmune disease)

While they are welcome to their opinion, vets will look at this list and say “it’s missing the big one”. Before I get to that, let’s quickly cover these other causes.

Food

DNM say: Dry diets feed the natural yeast in your dog’s body. This causes the yeast to grow larger colonies in the gut … leading to inflammation. That’s why you’ll often see signs of food allergies or intolerances if you feed kibble.

I say: Although possible, food is a rare cause of skin and ear problems. The two ways this could happen are via a food allergy, or if essential nutrients such as oils are lacking in the original diet. There is no evidence for anything else.

Anatomic

Everyone’s heard that dogs with floppy ears get more ear infections. That’s certainly what DNM say.

I say: There is some truth in it, but we need to also explain why so many dogs with floppy ears don’t get ear infections. Pendulous ear flaps may increase the risk, but on their own they don’t cause the problem. Clearly there’s more to it.

Lifestyle is entirely opinion-based, and I’ll say no more.

Excessive ear cleaning is certainly a real cause, but very uncommon. I never advise cleaning of normal ears, and only start cleaning after a problem is recognised. Then I monitor its effects closely so it’s only beneficial.

In other words, follow your vet’s advice and this should never happen.

A weakened immune system as a cause is once again an opinion that cannot be tested.

Other chronic diseases can certainly cause ear infections, but these are rare. Read my page on hypothyroidism in dogs and you’ll see my frustration at the over-diagnosis of this condition. As for auto-immune diseases, they’re even rarer, but here DNM come tantalisingly close to a better answer. Not autoimmune, but immune-mediated…

Causes Of Ear Infections, According To Vets

The number one reason why a dog gets an ear infection is skin disease, especially atopic dermatitis. This is an allergic skin disease that only gets more common as the years go by. Dogs who have their atopy brought under control can expect to suffer from far fewer or even no more ear infections.

Number two is a foreign body, especially a grass seed. This is mostly in spring and summer, and should only affect one ear. DNM say that you can remove them with tweezers, which is very rarely true, or to try a homeopathic remedy, which needs some explaining. Surely the most natural thing is to take it out.

Number three is ear mites, but this is almost exclusively in young puppies or neglected adults. DNM advise applying mineral oil, olive oil or essential oils to the ear canal. Not only is this hazardous (see below), it also requires a firm diagnosis, quite a bit of optimism, and a wilful disregard of the safe ways to eliminate ear mites.

To any of these causes, a floppy ear, a hairy ear canal, excessive wax or a frequent swimmer will make it a little harder to manage. With rare exceptions, these factors won’t cause an infection on their own.

One thing both Dogs Naturally and I can agree on is that ear infections are always secondary to something else. Instead of catching a nasty bug, an ear infection results from a common bug taking advantage of an abnormal situation.

2. Why Infections Keep Coming Back

Ear infections recur for two reasons. The first should already be obvious: a failure to properly identify and fix the underlying cause. I think we’ve covered this enough but you can read more about the treatment of skin diseases here.

However, it’s the second one that I see most often: a failure to properly resolve the last ear infection.

Just look at the dog ear diagram. It’s impossible to see the part of the ear canal where most infections are worst. This is why it’s very hard to treat a dog’s ear infection entirely at home.

Any treatment, no matter how well-chosen or targeted, must completely eliminate the infection right up to the ear drum. Yet you cannot tell this without a vet scoping the ear.

I am in the position of having more people wanting to bring their dogs to me than I have the time to see them. But I will always insist on a recheck appointment. I don’t do it to make more money- in fact, I’d make more by seeing someone else. I do it because it’s the only way.

Natural Remedies For Ear Infections

So with that said, let’s return to the original question: which natural remedies are effective and when can they be used? From wide experience watching them in practice, I only see one: apple cider vinegar in a 50:50 mix with cooled boiled water can be used for mild yeast infections.

But please don’t do it without reading this first:

1. Yeast is only one type of ear infection. Vinegar will cause bacterial ear infections to get much worse.
2. Ear drum rupture is not uncommon in ear infections. Once it happens, anything you put in the ear (and especially vinegar) can permanently damage the hearing and balance.
3. Vinegar is acidic, and very painful on any broken skin. What looks mild at the top is often severe at the bottom and dogs rarely show the pain they’re feeling.

So I don’t see a way to avoid getting a vet to take a look first, to assess the severity, check the ear drum and determine the type of infection. Don’t be too disappointed if your vet thinks that it’s too severe for a natural remedy to work. These can still be great for longer-term prevention afterwards.

You can also use the opportunity to get the vet to take a look at your whole dog. A single ear infection may be ‘just one of those things’ but it’s more likely they’ll see a bigger picture. Also addressing this gives you one more way to prevent your dog’s future discomfort.

You might also be interested in: The evidence for treating ear infections with cleaners | How to clean a dog’s ears

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Information from dogsnaturallymagazine.com/5-home-remedies-for-dog-ear-infection accessed 10 April, 2020.

I won’t dumb this down. I will do my best to keep it simple, but the reality of how ear infections happen is complex.

Please stick at it! What comes next may be hard going, but those who reach the end will know more than many professionals. They will also have a clear idea of why some treatments don’t work.

First, An Overview: The PSPP System

A better way of understanding the various drivers of ear infections is to divide them into four groups:

1. Predisposing Factors
2. Primary Causes
3. Secondary Causes
4. Perpetuating Factors

Not every dog will have all of these, but once an infection really gets going, they usually do. The observant will note that I’ve written them as PPSP, to put them in the rough order they happen to dogs. Now let’s dive deeper into each category.

1. Predisposing Factors

Predisposing factors are the things that affect the microclimate within the ear canal. They increase the risk of an ear infection, without causing problems on their own. These are the things you often see blamed for ear infections.

• Pendulous (floppy) ear flaps
• Excessive hair in ear canals
• Narrow ear canals
• Excessive cleaning or swimming
• Increased wax production
• Warm, humid weather

None of these causes an infection on its own, and many dogs get ear infections with none of these.

Clearly there’s a lot more to it. That’s why the next three categories are without a doubt more important.

2. Primary Causes

To get an infection, we also need to add a spark. Primary causes are the things that create inflammation of the ear canal and ear flap. They include:

• Skin diseases (atopic dermatitis, food allergy, hypersensitivity)
• Foreign bodies (especially grass seeds)
• Ear mites
• Hypothyroidism
• Ear canal tumours

Atopic dermatitis is very common and by far the most important. 55% of atopic dogs get ear infections, which can be the only sign of their problem. These are those dogs that seem to keep getting ear infections without a good reason.

3. Secondary Causes

So now we have an altered microclimate and inflammation. Conditions are ripe for a passing infection to take hold. This is usually a normal inhabitant of the canine skin, ready to take advantage of any weakness. Examples are:

• Bacteria (e.g. Staphylococcus, Pseudomonas)
• Yeast (especially Malassezia)

Once infection gets going, the whole thing ramps up a notch. Now there’s no going back. Unless the infection is properly and completely eliminated, it becomes like those bushfires that create their own weather.

What I mean is that the ear infection causes the ear canal to change in ways that help the problem not only to persist, but actually worsen. We call these…

4. Perpetuating Factors

Perpetuating factors are set up by the ear infection, and are probably the main reason for treatment failure. We are now in the classic vicious cycle of chronic otitis externa.

These changes include:

• Overgrowth of the ear canal lining and appearance of polyps
• Ear canal narrowing, thickening or calcification
• Wax gland overgrowth (especially Spaniels)
• Ear drum rupture
• Middle ear disease
• Destruction of the ear’s self cleaning mechanism

At the beginning you may not notice much, but perpetuating factors end up becoming the most severe part of ear infections. Everything they do acts to support the infection and make it harder to remove.

By now, eliminating the earlier causes has almost no effect on its own. That’s why an infection that’s been there a few months is always a lot harder to treat than one that’s only a few days old.

If this is your experience, it might all seem hopeless. But it’s not at all.

Treatment of Ear Infections

I see many, many ear infections that keep coming back. Once you understand why that is, success is just a matter of time, as long as you don’t give up.

There are only three reasons. You can probably guess by now what they are:

1. Failure to treat the primary cause
2. Failure to completely eliminate the infection
3. Failure to recognise the perpetuating factors

Too many owners of dogs with ear infections don’t know about about the skin problem that’s right there too. A lot more don’t understand the importance of regular follow-up. And many others are battling away at a hopeless cause because they don’t realise the true extent of the problem.

All these are discussed in depth at the next part of the story: How To Treat A Dog’s Ear Infection

You might also like: Is There A Home Remedy For Dog Ear Infections?

Both articles coming next week.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

His path led to a specialist and a procedure called TECA that increasing numbers of dogs are getting. If you have a dog prone to ear infections, you should read this. Not just so you know it’s there if you need it, but also so you can avoid it.

What Is a TECA?

TECA stands for Total Ear Canal Ablation, the surgical removal of the entire ear canal. It’s usually paired with Bulla Osteotomy, which is the opening and cleaning up of the middle ear.

TECA is a drastic solution to a drastic problem. It’s what we do when all else is lost. But that doesn’t mean it’s a bad. In fact, quite the opposite.

My strong position is that far too few dogs that need TECA ever get the chance. 

Which Dogs Need TECA

Dog who need TECA are those whose ears cannot be fixed in any other way.

First are what we sometimes call ‘end stage’ ears. These are external ear canals that have closed due to chronic swelling or thickening of the lining, and occasionally polyps. An old name for this was ear canker. Infections in these ears cannot easily be removed, and come back quickly.

Then there are the dogs with ear drum rupture and middle or inner ear infection. A good clue is the presence of vestibular signs. These are:

• A head tilt
• Nystagmus (rapid eye flicking)
• Falling to the side or inability to stand

But even these don’t normally need TECA if the infection is treated quickly and thoroughly. Surgery is required when the infection has caused secondary changes that make it impossible to remove with medication alone. Read the other causes of vestibular signs here.

Finally there are the dogs who do not allow ear treatment, such that there is no other way to resolve an ear infection. We will always try repeated sedation and long-acting gels first, but it isn’t always possible or successful. Then it’s a choice between two imperfect outcomes: continuous pain, or radical surgery.

There are plenty of other occasions when an owner does everything right and it still leads to TECA. Here are just two examples:

• Dogs who have already had long-standing middle ear disease when they are rescued
• Dogs whose ear canals narrow despite diligent treatment

These dogs are unfixable and in pain until surgery. In Fred’s case, like the rescue dog, time was the enemy. By the time he was found, the standard treatments for ear infections no longer worked. The sheer amount of time he’d suffered made it almost inevitable.

If you look at his CT scan at the start, the red arrow shows solid material inside his middle ear and the yellow arrow shows how his horizontal ear canal is completely closed.

A Review Of TECA

Here’s what to know before considering TECA surgery for your dog.

1. It’s a last resort. All other options need to be explored first, but especially ear cleaning under general anaesthesia and long term medical therapy with frequent follow up.
2. Lateral ear wall resection, Zepp’s procedure or lateral ear canal ablation are all possible alternatives that only remove part of the ear canal. However, these are next to useless if the rest of the canal is just as bad.
3. It’s expensive. I would estimate that TECA surgery in Australia would cost at least $4000 at a specialist but there are also some private vets who can do it well for less.
4. Success rates are good at around 90%.
5. The ear flap is not removed. Fred’s ear at the start and Denver’s ear below show how the result is generally quite pleasing. Most people won’t know it’s been done.
6. Dogs probably won’t be deaf afterwards. While hearing will be muffled on the operated side, it’s probably no worse than before. If the other ear is normal, like these two dogs, they hear just fine.
7. There are risks of facial nerve paralysis, bleeding and persistent infection but these seem low for experienced surgeons. If a dog had a pre-existing head tilt, like Denver’s, it probably won’t go away but that’s a minor concern.
8. Recovery time is like any other canine surgery. That is, much better than us!

If you have a dog who might benefit from TECA surgery, talk to your vet about it. Ear infections are common and frustrating, but there are still other options, like referral to a veterinary dermatologist.

Then there are some dogs I see for second opinions who I immediately refer for surgical evaluation. That’s because everything else has been tried, failed, and the dog is still in pain. In the end, that’s what it’s all about.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

• A swollen ear flap in a dog is usually a buildup of fluid
• The cause is anything that causes ear irritation
• Without treatment, a swollen ear flap heals badly

Now dive deeper…

One of the strangest problems a dog can get is when the ear flap suddenly puffs up like a balloon. One minute the ears are sitting normally, and the next minute one of them is hanging down, firm and heavy. We call this an aural haematoma.

An aural haematoma happens when fluid builds up between the skin and the cartilage. It usually starts small, like in the picture and grows to become the size of the entire flap over several days. Though clearly annoying, they don’t seem to be especially painful.

Causes Of Aural Haematomas

Unlike normal haematomas, aural haematomas rarely contain pure blood. We don’t know whether they start with a small bleed, or whether separation of the layers of the ear comes first. Either way, once fluid starts to accumulate it creates a vicious cycle allowing more fluid to form.

Aural haematomas always follow irritation to the ear canal or its flap. Head shaking or ear scratching are important, either by causing bleeding or separation. Then the haematoma seems to grow just by the pressure of escaping serum or blood.

Therefore, anything that causes skin or ear inflammation is important. Most dogs with an aural haematoma will also have an ear infection, while some might have fly bite dermatitis, allergic skin or even fleas. Follow the links to learn more about each.

Treatment Of Aural Haematomas

Treatment is either by drainage while awake or surgery under anaesthetic. Most vets will attempt drainage first even though it probably only works 50% of the time. Reasons why we wouldn’t try it include:

• A scared or anxious dog
• A haematoma that’s been there more than two days (clots block the needle)
• A very large haematoma

Once drained, the use of anti-inflammatory drugs seems to help prevent recurrence. Never attempt to drain or ‘pop’ a haematoma at home- it will be painful and you are almost certain to cause an infection.

Surgery involves making a cut to remove the fluid and clots, followed by suturing the two layers together. It’s almost 100% effective, but requires good pain control.

Can A Haematoma Heal Itself?

Without treatment, healing is highly unsatisfactory. An untreated haematoma heals itself by slowly reabsorbing the fluid and leaving the clots behind. The ear flap remains thickened, and as the clots mature, it starts to contract.

Eventually the ear flap becomes a small crumpled ‘cauliflower ear’ that covers the ear opening.

Just as importantly, there’s always a reason why the haematoma happened. Without attention to the underlying cause, your dog may continue to suffer from an undiagnosed ear problem like a grass seed or ear mites.

The sooner you get an aural haematoma seen, the better it goes. Early swellings are more likely to respond to drainage, and small haematomas are less likely to alter the shape and appearance of the ears.

Yes, having a dropped ear may just be a cosmetic problem, but who doesn’t think their dogs’ ears are the best? That’s all the excuse I need to put in another picture of Loki!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.