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Ear Infections in Cats

Ear Infections in Cats


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Overview
Cats catch a lucky break when it comes to ear infections, since they get them far less than their canine counterparts. However, if your cat gets an ear infection it should be addressed right away to minimize pain and damage to her ear canal.

The main causes of ear infections in cats are:

  • Ear mites (parasite)—especially in kittens; highly contagious among cats
  • An abscess from a bite wound or scratch
  • Growth in the ear canal
  • Allergies

Symptoms
If your furry friend has an ear infection, you might notice the following:

  • Discomfort when the base of the ears are massaged
  • Self-inflicted skin trauma from scratching
  • Dark or crusty debris in the ear canal opening
  • A wet sound when the ears are gently massaged
  • Head tilt or incoordination
  • Uneven pupil size

Diagnosis
Ear infections can resolve quickly or become chronic, depending on the cause and seriousness of the underlying condition. To diagnose an ear infection, your veterinarian will take a thorough history of your cat. This is very important to determine if an underlying disease may be the cause. They will also perform a complete physical exam and take a good look at your pet’s ears, using an otoscope to look down the ear canal. Depending on what your veterinarian finds, other tests or procedures may be performed for an accurate diagnosis. Some additional tests they may recommend are:

  • Cytology, which identifies if yeast, bacteria, or other microorganisms are present
  • A culture to determine which type of bacteria is present

If your cat goes outside, and/or if a bite wound or scratch is the underlying cause of the ear infection, your veterinarian may recommend testing your cat for feline leukemia and feline immunodeficiency virus. Both of these viruses are transmitted from cat to cat and are highly contagious.

Treatment
Treating ear infections can be very tricky, especially if allergies are involved. Treatment will depend on the cause, nature, and severity of the ear infection. Your veterinarian will recommend the best treatment for your cat.

Treatment may include:

  • Antibiotic ointments, drops, sprays or creams for the ear
  • Oral antibiotics
  • Surgery (for cats with repeated ear infections or no response to other treatment)

Prevention
The best way to help your pet avoid ear infections is by watching for any signs of irritation. Keeping your cat indoors makes a huge difference if he has a history of recurring infections. In addition, keeping his ears dry will help prevent infections.

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.


Treatment for Chronic Ear Infections

The veterinarian will provide antibiotic drops to place in your pet’s ears several times each day to eliminate the infection. In severe cases, the vet may prescribe an oral antibiotic to help control the infection. You will also be given instructions on safe ways to keep your pet’s ear clean, as well as advice on products that you can safely use for this process. If the source of the problem is allergies, the vet will provide medications to help control the allergic reaction.

Make Trinity Pet Hospital Your Laguna Hills Vet

Dr, Kerolos, a second-generation veterinarian, understands your pet is a part of your family. He and his experienced staff are committed to providing comprehensive care for pets, with individualized attention and gentle treatment. We provide a wide variety of veterinary services to our patients in Laguna Hills and other communities, to ensure your pet maintains good health at all stages of life. Call Trinity Pet Hospital today at 949-768-1314 for an appointment to your pet’s chronic ear problems and learn options for eliminating this troublesome condition.


Diseases affecting the middle and inner ear

Because of their very close association, diseases that affect the middle ear (otitis media) often also affect the inner ear (otitis interna), causing disturbance to balance. Affected cats may hold their head to one side, may have some difficulty in walking, and may have a tendency to walk in circles towards the affected side. In some cats disease of the middle ear will also spread to the external ear or vice versa, where the integrity of the ear drum (tympanic membrane) is compromised. Some of the more common conditions include:

  • Infection of the middle ear – this is seen more commonly in kittens than adult cats and usually results from infection spreading up the eustachian tube (the small tube that connects the nose to the middle ear). This may occur as a complication from upper respiratory infections. In cases of suppurative otitis externa, if the tympanic membrane is compromised then the infection may readily spread to affect the middle and inner ears also.
  • Polyps – benign polyps may develop within the middle ear or the eustachian tube of cats. Cats of any age may be affected, but it is most commonly seen in young adults. These are benign inflammatory masses, but the underlying cause remains unknown. The polyp may grow in the nasopharynx (throat) and/or the middle ear of the cat, and if in the middle ear it may eventually cause the ear drum (tympanic membrane) to rupture and be present in the external ear canal.
  • Tumours – rarely the middle ear may be affected by the presence of benign or malignant tumours

The investigation and management of middle ear disease will vary from one cat to another. Usually X-rays (or more advanced imaging such as CT or MR scans) will be valuable to assess the middle ears, and in most cases thorough examination of the ear canal will be needed under anaesthesia. Flushing of the middle ear and/or obtaining samples from the middle ear (for cytology or culture) may be needed to determine the most appropriate treatment. In some cases, surgery may be required, which may include a procedure called ‘bulla osteotomy’ where part of the bony wall of the middle ear is removed so that a mass (eg, a polyp) can be successfully removed completely.

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Ear Health

Cats tend to be good groomers. Still, it’s not easy for them to clean the inside of their ears. This can cause excess wax, dirt, and debris to build up inside the ear, increasing the risk of your cat developing an ear infection. Although ear infections occur half as often in cats as they do in dogs, ear infections are still a painful problem for cats.

Otitis externa is a condition involving inflammation of the outer ear canal and is relatively common in cats. The outer ear becomes red and swollen. This causes bacteria and yeast, usually present in low numbers in the ear canal, to grow abundantly, which leads to infection.

Causes of ear infections in cats

Half of all ear infections in cats are caused by minute parasites known as ear mites.1 [link to C3.0 Ear mites] If ear mites have been ruled out as the source of your cat’s ear infection, your veterinarian will examine your cat to see whether an underlying factor, such as allergies or an immune disorder, is to blame. Underlying factors must be identified and properly treated or else the ear infection is likely to return. That’s why it’s important to visit your veterinarian as soon as you suspect your cat has an ear problem.

Common causes of cat ear infections include 2–4 :

  • Ear mites
  • Allergies
  • Foreign objects
  • Immune disorders

Do all cats get ear infections?

Ear infections can happen to cats of any age or breed. Some cats, however, may be more at risk. 5

How do I know if my cat has an ear infection?

Ear infections can cause significant discomfort for your cat. One or both ears may be affected, and signs can appear suddenly or last for a long time. If you notice any signs your cat is experiencing ear problems, contact your veterinarian right away.

Be on the lookout for these signs of ear infections in your cat 3,5

Yes, ear infections can cause significant pain in cats. 3,4

References: 1. State of Pet Health 2016 Report. Banfield Pet Hospital website. Available at: https://www.banfield.com/banfield/media/PDF/downloads/soph/banfieldstate-

of-pet-health-report-2016.pdf. Accessed July 20, 2020. 2. Roy J, Bedard C, Moreau M. Treatment of feline otitis externa due to Otodectes cynotis and complicated by secondary bacterial and fungal infections with Oridermyl auricular ointment. Can Vet J. 201152:277–282. 3. Otitis externa in cats. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/cat-owners/ear-disorders-of-cats/otitis-externa-in-cats. Accessed July 23, 2020. 4. Overview of otitis externa. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/ear-disorders/otitis-externa/overview-of-otitis-externa. Accessed July 21, 2020. 5. Ear infections in cats. ASPCA Pet Insurance website. Available at: https://www.aspcapetinsurance.com/resources/ear-infections-in-cats/. Accessed July 20, 2020.

Common signs of an ear infection include frequent shaking of the head, pawing at the ear, discharge from the ear, redness or swelling of the ear canal, odor, or tilting the head to one side. 3,5 If you suspect your cat has an ear infection, make an appointment with your veterinarian right away.

References: 1. State of Pet Health 2016 Report. Banfield Pet Hospital website. Available at: https://www.banfield.com/banfield/media/PDF/downloads/soph/banfieldstate-

of-pet-health-report-2016.pdf. Accessed July 20, 2020. 2. Roy J, Bedard C, Moreau M. Treatment of feline otitis externa due to Otodectes cynotis and complicated by secondary bacterial and fungal infections with Oridermyl auricular ointment. Can Vet J. 201152:277–282. 3. Otitis externa in cats. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/cat-owners/ear-disorders-of-cats/otitis-externa-in-cats. Accessed July 23, 2020. 4. Overview of otitis externa. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/ear-disorders/otitis-externa/overview-of-otitis-externa. Accessed July 21, 2020. 5. Ear infections in cats. ASPCA Pet Insurance website. Available at: https://www.aspcapetinsurance.com/resources/ear-infections-in-cats/. Accessed July 20, 2020.

Otitis externa is one of the most common ear infections. The condition involves inflammation of the outer ear canal. The outer ear becomes red and swollen. This causes bacteria and yeast, usually present in low numbers in the ear canal, to grow abundantly, causing infection. This sets up an environment where bacteria and yeast can overgrow their normal levels, creating an unhealthy infection that magnifies the inflammation of the ears. Without intervention this becomes a vicious cycle. 3

References: 1. State of Pet Health 2016 Report. Banfield Pet Hospital website. Available at: https://www.banfield.com/banfield/media/PDF/downloads/soph/banfieldstate-

of-pet-health-report-2016.pdf. Accessed July 20, 2020. 2. Roy J, Bedard C, Moreau M. Treatment of feline otitis externa due to Otodectes cynotis and complicated by secondary bacterial and fungal infections with Oridermyl auricular ointment. Can Vet J. 201152:277–282. 3. Otitis externa in cats. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/cat-owners/ear-disorders-of-cats/otitis-externa-in-cats. Accessed July 23, 2020. 4. Overview of otitis externa. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/ear-disorders/otitis-externa/overview-of-otitis-externa. Accessed July 21, 2020. 5. Ear infections in cats. ASPCA Pet Insurance website. Available at: https://www.aspcapetinsurance.com/resources/ear-infections-in-cats/. Accessed July 20, 2020.

All cats can get ear infections, but certain cats may be at higher risk, including cats with allergies, cats with certain health conditions, such as diabetes or feline leukemia, and cats with small, outer ears, such as Himalayans or Persians. 5

References: 1. State of Pet Health 2016 Report. Banfield Pet Hospital website. Available at: https://www.banfield.com/banfield/media/PDF/downloads/soph/banfieldstate-

of-pet-health-report-2016.pdf. Accessed July 20, 2020. 2. Roy J, Bedard C, Moreau M. Treatment of feline otitis externa due to Otodectes cynotis and complicated by secondary bacterial and fungal infections with Oridermyl auricular ointment. Can Vet J. 201152:277–282. 3. Otitis externa in cats. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/cat-owners/ear-disorders-of-cats/otitis-externa-in-cats. Accessed July 23, 2020. 4. Overview of otitis externa. Merck Veterinary Manual website. Available at: https://www.merckvetmanual.com/ear-disorders/otitis-externa/overview-of-otitis-externa. Accessed July 21, 2020. 5. Ear infections in cats. ASPCA Pet Insurance website. Available at: https://www.aspcapetinsurance.com/resources/ear-infections-in-cats/. Accessed July 20, 2020.

Some cats are prone to ear infections. These include cats with allergies, cats with certain health conditions, such as diabetes or feline leukemia, and cats with small, outer ears, such as Himalayans or Persians. 5 Your veterinarian will collect a detailed history to help uncover any underlying causes of your cat’s ear infection and to properly treat your cat to help keep the infection from recurring.


Eliminate Ear Infections in Dogs and Cats

Recently, I have seen an exorbitant number of new clients with pets with chronic ear infections, called otitis. One new client brought her sheltie to see me with a six-month history of ear mite infestation. I asked this new client who diagnosed this problem. She said a pet store clerk told her that it was ear mites after she described dark, gritty debris in her sheltie’s ears. Every week, for the last six months, this client has been cleaning her pet’s ears and treating with ear mite medication with no success.

After gathering her pet’s history and performing a complete physical examination, I took a swab of her pet’s ear debris, applied a special stain, and looked under the microscope for presence of yeast, bacteria and mites. As you may have guessed, there were no mites. This pet had a terrible yeast infection.

This client was upset and embarrassed. She could not believe that she allowed her pet to suffer six months. “Good news,” I told her, “today we will begin a new treatment plan to resolve your pet’s yeast infection.”

Why do ear infections happen?

Ear infections do not spontaneously occur. Some event or underlying disease must precipitate it. My top reason why pets get ear infections is allergies.

Allergies may be triggered by ingestion of certain foods, like beef, dairy products, chicken, lamb, fish, eggs, corn, wheat, and soy. Allergies may also be triggered by allergens your pet’s skin, eyes, ears and nose may come in contact with – like tree pollen, grasses, house dust, molds, weeds, perfumes, aerosol home cleaning products, insects and wool.

In the unlikely event that allergies are not the underlying cause for your pet’s ear infection, I would then suspect the following predisposing factors: high moisture (swimming), poor ventilation (big floppy ears), suppressed immune system (like pets with hypothyroidism and Cushing’s Disease), mites, foreign bodies (like plant material) and poor conformation (like narrow ear canals found commonly in Chinese Shar-pei, Pug and Pekingese dogs).

How can I resolve it? First, see your veterinarian for an accurate diagnosis. Your veterinarian will take a complete oral history before he/she performs a comprehensive physical examination. During this discussion, your veterinarian will ask you some key questions:

1. Have you noticed that your pet gets an ear infection around the same time every year? For example, “Does your pet itch and rub his/her ears every spring during peak tree pollen season?” 2. Does your pet have ear problems all the time? Food, house dust and mold allergies occur year-round. 3. Does your pet itch elsewhere? Pets with food allergies frequently scratch their ears and shake their head, rub their face, and lick their paws and anal area. 4. Is your pet on flea preventative? Pets with allergic reaction to fleabites will frequently scratch their hindquarters, but may also scratch around head and neck area. This is especially true in cats. 5. Does your pet get ear infections two to three days after swimming or being groomed? Increased moisture in ear canal may be an issue for this pet.

Second, your veterinarian will use a special instrument, called an otoscope, to closely examine your pet’s ears. In a tolerant pet, your veterinarian will visualize the ear canal to see if it is swollen or ulcerated, debris or mass present, and if the tympanic membrane (a clear, curtain-like membrane that separates the outer ear from the middle ear) is intact. Sometimes, the pet is so painful it is impossible or inhumane to examine the ear canal while it is awake. It is not unusual for us to sedate pets with severe ear infections to properly diagnose, clean, and treat the ears.

If a ruptured tympanic membrane is discovered, the outer ear will then directly communicate with the middle ear and may result in temporary hearing loss. Pets with a ruptured tympanic membrane will require special ear cleaning instructions and medication.

A swab of debris will be collected and evaluated under the microscope for yeast, bacteria, and mites to help characterize the problem and allow for proper selection of medication. A bacterial culture and sensitivity may be recommended if the infection is severe, reoccurring and/or tympanic membrane is ruptured to insure the best treatment protocol.

How do I treat the ear infection? In order to properly treat the ear infection, your veterinarian first must properly clean the ear canal. It would be foolish to apply topical antibiotics or antifungal agents into an ear that is filled with debris. Debris traps the organism and provides a safe environment for it to thrive and avoid contact with the ear medication. Sometimes it is not possible to clean a dog’s ear when he/she is awake and painful, and sedation is required. Many times, however, it can be performed with minimal restraint of your pet.

To clean your pet’s ears effectively requires the proper selection of ear cleaning products. Recently, there has been an explosion of ear cleaning products available for your pet. Please ask your veterinarian for the best ear cleaning solution for your pet. Please do not ask a pet store clerk or groomer for advice. They are not medically trained to deliver veterinary medical advice.

At Animal Medical Center of Chicago, if my patient’s ears are full of waxy debris, I frequently recommend a gentle product, called Cerumene by Vetoguinol, to soften and loosen the earwax. For pets with a bacterial ear infection, I frequently select a product that has antimicrobial and anti-inflammatory properties, like Douxo Micellar Solution by Sogeval. I tend to gravitate to alkalizing ear-cleaning solutions that contain triz EDTA if I am highly suspicious of a nasty bacterial infection called Pseudomonas. For yeast infection, I frequently recommend an ear-cleaning product that contains ketoconazole. Alternatively, for mild yeast infections I will recommend a homemade mixture of 1- part white vinegar to 2-parts warm water as a nice cleaning solution. Remember, before purchasing any ear cleaning solution, please contact your veterinarian for advice. Using the wrong ear cleaning solution may aggravate your pet’s ear infection.

Additionally, to clean a pet’s ears requires patience and respect. Do not use cotton tipped applicators to clean your pet’s ears. Cotton tips are abrasive and feel like a coarse pad on the surface of your dog’s sensitive ear canal. In addition, these tips can push ear debris further down into the canal making the ear infection worse. I recommend gently squirting the veterinary recommended ear cleaning solution directly into your pet’s ear canal and let it sit for 5 to 10 minutes before wiping it out with a lightly moistened gauze or cotton ball. It is advisable to do this activity outside or in a bathroom where the walls can be easily wiped clean after your pet shakes its head.

After your veterinarian cleans your pet’s ears, he/she will prescribe topical ear medication. The exact selection of medication will be based on your pet’s history, physical examination findings, and ear swab results. Topical ear medication is almost always recommended for ear infections because of the high local active drug concentration it can achieve. In some situations, I will prescribe oral antibiotics or anti-fungal agents if I believe that topical therapy will not be sufficient, a middle ear infection is suspected, or the owner cannot properly administer it. A new favorite ear medication of mine, called Osurnia by Elanco, was recently introduced. This product is designed to help pets with bacterial and yeast ear infections. Your veterinarian will apply one medication-filled tube in each ear on first and seventh day of treatment, and that’s it! It works really well and my clients are happy that they do not need to medicate their pet’s ears at home.

How long do I treat the ear infections? This is a great question to ask your veterinarian for it is dependent on the cause and severity of the infection. I strongly recommend before you stop the medication to schedule a recheck appointment with your veterinarian. Don’t incorrectly assume after 10-14 days your pet’s ear infection has resolved. Often my clients think the ear infection has resolved completely and I discover at their recheck appointment that it’s only dramatically better not 100% resolved. Failure to resolve the ear infection completely only guarantees your pet will suffer from reoccurrence.

How to avoid ear infections? One must first discover and control the underlying cause of the ear infection to avoid reoccurrence. If inhalant or contact allergies are suspected, then you must address the allergy issue to break the cycle. This may include allergy testing via single blood sample collection or intra-dermal skin testing by your veterinarian. Once your pet is diagnosed with inhalant or contact allergies, you may begin symptomatic treatment with avoidance, antihistamines, steroids, immune modulating products, shampoos and/or topical spray products to help minimize your pet’s signs of allergies. Specific desensitization to the offending allergen(s) can be performed and should be discussed with your veterinarian.

If food allergies are suspected, your veterinarian will recommend that you feed your pet a single, unique protein diet exclusively for 8 to 12 weeks. Only a veterinary prescribed prescription diet or a homemade diet will meet this allergy food trial criteria. Even though there are numerous over-the-counter labeled single protein source diets at pet and grocery stores, these diets are frequently contaminated with other protein products by virtue of how they are processed.

If there is an underlying thyroid issue, I recommend a thyroid blood test for your pet. If there is an underlying metabolic issue, like hyperadrenocorticism, this must be pursued.

If you find that your pet gets ear infections after swimming, bathe the pet with a hypoallergenic shampoo after swimming or, at the minimum, rinse your pet’s coat with water and then, dry out the ears with a cloth. There are a few topical ear-drying products available for purchase to decrease moisture in your pet’s ear. Please discuss this concept with your veterinarian before using one.

Finally, inspect your pet’s ears bi-monthly. If you see mild waxy debris, clean it out with appropriate cleaning solution. In most patients, I strongly recommend not to clean your pet’s ears more than once every 2-3 weeks otherwise you disrupt the normal self-cleaning mechanism that naturally exists in the ear. In fact, I can’t remember the last time I cleaned my own dog’s ears. If all is well, leave the ears alone. If your pet’s ears are red and inflamed, substantial debris present, or a pungent odor exists, see your veterinarian.

Are ear infections painful? Absolutely. Please discuss appropriate pain medication with your veterinarian. Most ear medications delivered topically include an anti-inflammatory drug in its composition to reduce your pet’s discomfort. For pets who have swollen ear canals and it is impossible for you to deliver topical ear medications properly, it is not uncommon, that I send the pet home with pain medication and oral steroids for a few days. Then, I have the client and patient return for re-evaluation, ear cleaning and topical drug therapy.

Ear infections are almost always the result of another disease process, like allergies, thyroid or adrenal disease. Please schedule an appointment with your veterinarian as soon as your pet starts shaking or rubbing his/her ears. Pets with ear infections are uncomfortable and your veterinarian can help relieve his/her pain immediately. Please don’t dismiss your pet’s chronic ear infections with the comment, “He always has one”. Instead, ask your veterinarian, “Why does my pet have an ear infection?” This knowledge will allow you to begin an effective treatment plan to break this annoying and painful ear infection cycle in your pet.


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