Successful management of otitis externa

Otitis is one the most common problems seen in dogs. Most acute cases can be managed with topical polyvalent ear preparations. However, these cases frequently evolve into chronic or recurrent otitis that is much harder to resolve. Ongoing cycles of infection and inflammation will lead to chronic pathological changes and select for antimicrobial resistance that make management much more challenging. Diagnosis and management of the underlying triggers for the otitis is crucial, but clinicians must also understand how best to treat the ongoing infection and inflammation. Knowing how to recognise and understanding the significance of biofilms is important, as these are under diagnosed and have a major impact on antimicrobial efficacy. Cytology should be performed in all cases to determine the type of infection and the likely nature of the micro-organisms. Bacterial culture and antimicrobial susceptibility, in contrast, are less useful. The tests are based on systemic treatment, and vets need to know how to interpret the results when using topical treatment. Topical therapy is generally much more effective, and there are a very wide range of anti-microbial and anti-inflammatory options available (although not all are licensed for use in animals). Long-term remission of recurrent otitis relies on managing the inflammation in the ear canals to prevent flares. Getting clients to understand this is critical. Choosing appropriate products and demonstrating how to apply them are also important in ensuring good compliance and a good long term outcome.