Q&A on treating feline otitis externa and why the cat's ear isn't a small dog's

Feline ears are easy to overlook. Cats hide discomfort better than dogs do, and by the time an owner notices, a polyp or a secondary infection may already be well established. At the 2026 AVMA Convention, Sonja Zabel, DVM, DACVD, presented a session on feline otitis. Zabel, the founder of Peak to Coast Veterinary Specialists Otology & Dermatology in Portland, Oregon, spoke with dvm360 at the convention about how she works up feline ear disease, the anatomical differences that change treatment, and why so many practitioners hesitate to reach past the one on-label product they know.

Editor's note: This dvm360 Q&A has been edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

dvm360: Can you tell us about your background and how you came to specialize in dermatology and otology?

Zabel: I'm a veterinary dermatologist through the American College of Veterinary Dermatology. I started out in Germany, got my degree from the Tierärztliche Hochschule Hannover [University of Veterinary Medicine Hannover], and actually thought I would become a surgeon. Fortunately, my path crossed with a dermatologist in Germany, and he showed me very early on that dermatology would be my passion. I did a 12-week externship with Craig Griffin [DVM, DACVD] a long time ago, and he then basically was the one who said, "Hey, you really need to do dermatology." So I did my residency with Ralf Mueller, Dr MedVet, MANZCVS, DACVD, FANZCVS (Derm), DECVD]; Rod Rosychuk, [DVM, DACVIM; and Sonya Bettenay, [BVSc (hons), DipED, MACVSc (Feline Medicine), FACVSc (Dermatology), DECVD] at Colorado State University, and then stayed on as faculty. I was faculty at the University of Georgia before it drew me out to the Pacific Northwest. So, for the last 11 years now, I have been in Portland, Oregon. I first worked for a large corporate specialty hospital, and then for a nonprofit, but for me the inkling is really that my heart bleeds not only for dermatology but also for independent practices still, even in the Stone Age. So I founded Peak to Coast Veterinary Specialists Otology & Dermatology in 2024, so I have my own practice in Portland, Oregon, where I work with my team. We do a lot of dermatology but especially see a lot of ear cases.

dvm360: What are the most common causes of otitis externa you see in cats?

Zabel: It is probably similar to dogs. We see otitis externa specifically with allergies. However, I also see a lot of our either very young cat population or the older patients where they actually have a growth in the ear canal. This could be an inflammatory polyp. And then, we have a secondary bacterial or yeast population that is causing the trouble in the ear due to that barrier sitting in the ear canal.

It's not only otitis due to allergies. Of course, we can also have an otitis with autoimmune diseases. But I will say, [although] I see the allergy cases, I also see a lot of cases where they have a growth in the ear canal. In the younger cats, specifically, [it is] more often an inflammatory polyp that we have to successfully get out of there before we can actually treat the otitis that is secondary.

dvm360: What treatment strategies do you use for feline otitis, and what species-specific considerations differ from canine cases?

Zabel: Our feline friends, as we always say to so many of our clients, are certainly not small dogs. I refer to them as our beloved aliens. They definitely do things a little differently. When we think of the external ear canal—so an otitis externa—even when we just start looking in an ear canal, it looks very different when cats have an otitis.

It's not as inflamed as it is with a dog. The inflammation is not as visible. Then we have a little different anatomy. The eardrum looks different. When we go into the middle ear, we have a septum that divides the bulla into two compartments. So, the anatomy is just a little different.

And then when it comes to treatment, [there are differences] as well. Of course, there are not always as many approved on-label treatments for cats as there are for dogs. So we always have to look a little deeper into and be more specific about what we can use for our cats from the dog world and what we should stay away from.

For instance, even with some of the topical steroids, the ear tips can start curling. The cartilage can get a little weaker. And while that is a cosmetic [adverse effect] and most likely reversible when you stop the steroids early enough, it’s not one that all owners want to see. These are a few things, just off the top of my head, that are a little different compared to their little more slobbering, barking dog friends.

dvm360: What do you hope attendees took away from your otitis session?

Zabel: For my otitis session, I would love if people would keep in mind to actually look in the cat's ears. I think our cats are even worse communicators compared with our dogs, so often the owners are not aware that there is actually something going on with the ears. Having a look earlier—that would be definitely amazing to me. That's the first takeaway.

[Second], I think one of the barriers with our cats is that they are not always easy when it comes to looking in their ears. So [when] I hold them, or actually not hold them, I have a collapsible bucket and my room is Feliway-infused. I have a Feliway-infused towel so that we can make them more comfortable. So, some tips and tricks that you don't find in a textbook but that might make it easier to actually do an otoscopy or video otoscopy. I do mainly video otoscopy, and I do it all in the room so the owners can actually see what's going on. That would be another key takeaway.

And then I always get the question—and it’s one of the reasons why I came up with this topic and submitted it—from owners who say, "Well, I use Tresaderm, and there is nothing else that I can use in a cat."

I think, yes, while we are definitely in need of more on-label treatments for cats, our otitis cases are similar to everything else that we treat, where we have to go off-label or extra-label and use medications from the dog world. And for one reason or another, there seems to be some hesitation around that. A lot of people call me and ask if they can even use an ear cleaner in a cat, or if that's contraindicated. So, those are the 3 main takeaways.

But really, my hope is that everybody [went] home with at least one little pearl and [said], Okay, I'll at least give it a try and see what she is doing there.