Clear the ear: treating canine otitis externa

Kansas City

Darren Berger, DVM, DACVD, reviews common causes, symptoms, and treatments for canine otitis externa

Sponsored by Virbac

At the 2023 Fetch dvm360® Conference in Kansas City, Missouri, Darren Berger, DVM, DACVD, started his talk by stating, “One of the things I think we’ve underestimated for a while was really the impact on our clients, specifically when it comes to ear disease.” Both the pet parent and patient can be incumbered by canine otitis externa. Dogs face discomfort and pet parents are left stressed to find a fast-working and affordable treatment.1

Knowing the cause

The 3 R principle helps clinicians better understand the patient’s case of otitis. The first R, relapse, is when the treatment or therapy has stopped, but the infection returns within 24 hours. This implies the treatment was not long enough. The second R, recurrence, is far more common; the infection was treated and improved but, after 5 days or longer, the infection returns. The final R, resistance, was described by Berger as, “the idea that the infection is refractory to our therapy” and doesn’t improve within 2 to 4 weeks.

“Ear disease is usually brought on by underlying conditions,” said Berger. “Until [the underlying cause] is managed, the ear disease is going to continue to be a problem.” Parasites, neoplasia, endocrinopathies, keratinization disorders, autoimmune diseases, trauma, and ear hairs being plucked are potential causes of otitis in canine patients.1 The most common cause of recurrent otitis is atopic dermatitis, even if the ear infection may be the dog’s only presentation.

Symptoms and treatment

Berger listed canine otitis symptoms as “…pain, shaking, scratching, rubbing, otorrhea or discharge, swelling, erythema, or excoriations.” While Berger said he typically prescribes drugs like cyclosporine to patients for anti-inflammation, there is a class of drugs that can treat all symptoms: steroids. Steroids can be administered topically or systemically and are becoming a treatment staple in veterinary medicine.

In addition to drugs, regular ear cleanings can help treat otitis, but shouldn’t be done too frequently. “One of the mistakes I see in otitis management is that of over cleaning,” said Berger. Ear cleanings should be limited to 2 to 3 times per week to prevent further damage to the canal.

Even seemingly obvious treatment steps should be explained in detail to the pet parent. “There is this essence of caregiver burden—the idea that you’re placing something on the pet parents with regards to [expectations],” said Berger. “How do we make this easier for them?” Placing too many tasks and expectations on the pet parent can negatively impact their clinic experience, so it’s best to map out a clear, individualized treatment plan.


  1. Berger D. Canine Otitis Externa. Presented at Fetch dvm360® Conference; Kansas City, Missouri. August 25-27, 2023.
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