If you have an end-stage otitis case thats not a candidate for surgery, PBMT can help manage some of the clinical signs.
Photobiomodulation therapy (PBMT)- the more accurate term for therapy laser treatments-can be used for a variety of dermatologic conditions. It's best used in a multimodal approach, and doing so may decrease the need for systemic medications. While PBMT doesn't replace surgery, it can be used in cases where surgery isn't an option and would provide a better option than medication alone.
The most important element to check before using PBMT for otitis and other skin conditions is to first verify that you are not dealing with cancer. Because laser therapy can accelerate tissue healing, we could potentially cause a tumor to become larger or more aggressive in nature. Once it has been verified that the patient doesn't have cancer, here's how I'd treat an end-stage otitis externa case.
Also called “cauliflower ear,” end-stage cases are often painful and the ear canal has narrowed. Because of this narrowing, while awaiting culture results, it can be challenging to administer topical medications. Also, some dogs cannot take a nonsteroidal anti-inflammatory drug (NSAID), which would relieve some of the pain from the inside out. Systemic prednisone is not indicated in these cases, so what other anti-inflammatory and pain-relieving option do you have? Photobiomodulation! The therapy laser can be used once a day or every other day for two to three weeks to reduce inflammation and pain. This then allows for easier treatment of the infected ear canal and appropriate administration of topical medications.
As part of that multimodal approach, the laser treatments can then be tapered to a lower frequency and can even be used for long-term chronic management of these cases. The key is repeated treatments, as PBMT works on a cumulative effect. A one-time treatment may be helpful for temporary relief of pain, but multiple treatments will be needed for chronic conditions.
Of course, acute otitis cases happen as well. Those red, painful ears can be challenging for pet owners to manage. In conjunction with topical medications and cleanser, PBMT can be used here as well. I find it especially helpful if the dog is boarding while the pet owners are on vacation, so daily or even twice-daily PBMT treatments can be performed.
Dr. Matt Brunke is a pain and rehabilitation specialist with Veterinary Orthopedic and Sports Medicine Group in Annapolis Junction, Maryland.