Otitis externa: it’s really okay to use steroids

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“This is the dermatologist standing up in front of a group of people saying, when we're dealing with ears, we need to use more steroids,” said Darren Berger, DVM, DACVD. “Steroids are a friend when we start to talk about otitis.” Speaking at the 2023 Fetch dvm360® Conference in Charlotte, North Carolina, Berger presented on otitis externa, focusing in on the use of steroids to control inflammation and carefully considering both the cleaner and the appropriate drug for treating secondary infections.¹

Steroids

Addressing inflammation, Berger said, “When we talk about clinical signs of otitis…we're talking about pain, shaking, scratching, rubbing, otorrhea or excessive debris, swelling, redness and erythema, excoriation. What's the one drug that makes all of this better? Steroids.”

In his presentation, Berger cited 2 studies done in 2021 that he said showed the efficacy of higher doses of steroids over longer periods of time to get the ear canals open and reestablished. This in turn makes cleaning easier and more effective.

He then shared his basic approach: “The starting place for me is that if I have exudative are ulcerated ears, I'm probably going about a week at roughly a mg/kg of the [prednisone] derivative.”

He continued, “If I've got proliferative or stenotic [ears], my goal there is I just want to reestablish normal patency, I'm going to go a mg/kg, but probably for anywhere from 10 to 14 days…After that, just leave the dose alone, and go right to every other day for a couple of weeks.”

Berger explained that this has been his approach for the better part of 15 years, and he has rarely run into problems this way.

Cleaning

Berger reminded the audience that there are very few comparative studies on ear cleaning and no consensus statements either, stating “We're nowhere different than we were roughly 20 years ago.” With that said, he shared a few pearls of wisdom regarding his approach.

First, he mentioned that there is no need to clean a normal ear. In fact, he said, cleaners that are powerful cerumenolytics can cause problems by altering the ear wax. Berger also added that he doesn’t recommend cleaning more than once every 48 hours. He added, “I actually clean no more than twice a week, no matter how nasty the ear is.”

Reference

Berger D. Canine Atopic Dermatitis: How a Dermatologist Discusses Atopy with Pet Parents. Presented at Fetch dvm360® Conference; Charlotte, North Carolina. March 24-26, 2023.