Ear disease is merely a symptom that your dog’s body is dealing with another problem; there is always a reason why an ear infection develops! The challenge is to ferret out what, exactly, is the underlying cause. Start by looking at the three P’s: Primary, Predisposing, and Perpetuating causes.

(1) Primary causes lead directly to inflammation of the ear and include:

• Clean canine ears — free of inflammation, debris, or odor — are made possible through a superior diet, holistic care, and regular cleaning.
• Environmental allergies or adverse food reactions; these account for a whopping 97 percent of primary causes!
• Parasitic disease such as mites. Mites create a dark discharge, but so does yeast. If your vet doesn’t run a cytology, the conditions can be easily confused. In fact, mites are frequently overdiagnosed, and are less of an issue than we might think.
• Foreign bodies such as foxtails or other grass awn.
• Keratinization disorders. These are conditions that affect the skin’s surface appearance and may involve abnormalities in skin cell production, glandular production, and skin cell breakdown. Seborrhea, for example, produces excess sebum and build-up of skin cells. Though seborrhea is more common in certain breeds (such as Cocker Spaniels), on the whole, primary keratinization defects are uncommon.
• Autoimmune disease, such as pemphigus. A biopsy must be performed to diagnose autoimmune disease.
• Growths or polyps from glandular tumors such as adenoma and carcinoma.

(2) Predisposing factors in your dog that make her more susceptible to ear disease include:

• Variations in ear conformation. Shar-Pei, for example, may have narrowed ear canals.
• Moisture in ears, particularly in dogs who frequently swim or dive, often exacerbated by floppy ears. Nonetheless, this, too, is overrated as a reason for ear infections, particularly if the dog is only an occasional swimmer. The design of the dog’s ear — just like ours — is meant to be protective and prevent water from causing a problem.
• Excess hair in the ear canal.
• Inappropriate prior treatment. If your dog has had an ear infection that was not properly treated, improper care can accelerate the disease process by negatively altering the environment in your dog’s ears.

(3) Perpetuating factors make us ask why the ear infection keeps coming back. It could be that changes in the lining of the ear canal were never addressed. Your dog’s condition may have started out as primary (disease) but developed into a new problem. Recurrent bacterial and yeast infections and infection of the middle ear can fall into this category.

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Dr. Hershman realized that when an ear is not inflamed and not painful but full of debris or tarry exudates from a yeast or bacterial infection, flushing the ear makes sense. “If you don’t flush it out but keep applying medication on top of the debris,” she says, “you’re never going to cure the problem. But I also learned that flushing the ear is an art. You can’t simply fill the ear with otic solution and expect it to flow out by itself, taking all the debris with it. Because the dog’s ear canal forms a right angle, you just can’t get the liquid out unless you suction it gently with a bulb syringe or some kind of tube with a syringe attached.”

Flushing the ears, says Dr. Hershman, is one of the most important techniques you can learn for keeping your dog’s ears healthy. “They don’t teach this in veterinary school,” she says. “It’s something people learn by experience.”

When should the ears not be flushed? “If they’re painful, ulcerated, or bleeding,” she says, “or if there’s slimy, slippery pus in the ear or a gluten- ous, yeasty, golden yellow discharge. In any of these cases, flushing is not recommended. But if the ears are not inflamed and are simply waxy or filled with tarry exudates, flushing works well.”

The procedure begins with a mild, natural, unscented liquid soap from the health food store. Place a few drops of full-strength soap in the ear, then thoroughly massage the base of the ear. The soap is a surfactant, and it breaks up debris that’s stuck to the sides of the ear canal. From a bowl of water that’s slightly warmer than body temperature, fill a rubber bulb syringe or ear syringe, the kind sold in pharmacies for use with children or adults. Place the point of the syringe deep down in the soap-treated ear, then slowly squeeze the syringe so it releases a gentle stream of water.

“By the first or second application,” says Dr. Hershman, “you should see all kinds of debris flowing out. It’s like a waterfall. At the end of each application, hold the syringe in place so it sucks remaining water and debris up out of the ear canal. Then empty the syringe before filling it again.”
For seriously debris-filled ears, Dr. Hershman repeats the procedure three or four times, then she lets the dog shake his head before drying the ear with cotton balls and Q-tips. “I look for blood or debris,” she says, “and I check inside with the otoscope. If there’s still a lot of debris, I put more soap in, do a more vigorous massage, and flush it a few more times.

“An ear flush can be traumatic if the ear is inflamed,” she warns, “and occasionally there will be an ulcer or sore that you don’t know is there and it will bleed. That’s why you have to be careful about how you do this. You have to be vigorous but not aggressive. You don’t want to make the ear more inflamed, painful, or damaged than it was to begin with.”

After flushing the ear, Dr. Hershman applies calendula gel, a homeopathic remedy. “I put a large dab in each ear and ask the owner to do that once or twice a day for the next three days. The gel is water-soluble and very soothing. Calendula helps relieve itching and it stimulates the growth of new cells, so it speeds tissue repair.”

If the discharge in the dog’s ear is yeasty or obviously infected, Dr. Hershman skips the ear flush, instead using the following treatment.

For more on diagnosing and treating ear infections, purchase Ear Infections by Whole Dog Journal.

Holistic veterinarian Stacey Hershman, of Nyack, New York, took an interest in ear infections when she became a veterinary technician in her teens. “This is a subject that isn’t covered much in vet school,” she says. “I learned about treating ear infections from the veterinarians I worked with over the years. Because they all had different techniques, I saw dozens of different treatments, and I kept track of what worked and what didn’t.”

Maintenance Cleaning

Dr. Hershman’s healthy ears program starts with maintenance cleaning with ordinary cotton balls and cotton swabs. “This makes a lot of people nervous,” she says, “but the canine ear canal isn’t straight like the canal in our ears. Assuming you’re reasonably gentle, you can’t puncture the ear drum or do any structural damage.”

Moisten the ear with green tea brewed as for drinking and cooled to room temperature, or use an acidic ear cleanser that does not contain alcohol. Dr. Hershman likes green tea for its mildness and its acidifying, antibacterial properties, but she also recommends peach-scented Derma- Pet MalAcetic Otic Ear Cleanser or Halo Natural Herbal Ear Wash.

“Don’t pour the cleanser into the dog’s ear,” she warns, “or it will just wash debris down and sit on the ear drum, irritating it.” Instead, she says, lift the dog’s ear flap while holding a moistened cotton ball between your thumb and index finger. Push the cotton down the opening behind the tragus (the horizontal ridge you see when you lift the ear flap) and scoop upward. Use a few dry cotton balls to clean out normal waxy buildup.

Next, push a Q-tip into the vertical ear canal until it stops, then scoop upward while rubbing it against the walls of the vertical canal. Repeat several times, rubbing on different sides of the vertical canal. Depending on how much debris is present in each ear, you can moisten one or several cotton balls and use two or more Q-tips.

“You don’t want to push so hard that you cause pain,” she says, “but for maintenance cleaning using gentle pressure, it’s impossible to harm the eardrum. I refer to the external ear canal as an L-shaped tunnel, and I tell owners to think of the vertical canal as a cone of cartilage. People are always amazed at how deep the dog’s ear canal can go. I often have them hold the end of the Q-tip while I demonstrate cleaning so they feel confident about doing it correctly without hurting their dogs.”

If excessive discharge requires the use of five or more Q-tips, or if the discharge is thick, black, or malodorous, Dr. Hershman recommends an ear flush.

For more on diagnosing and treating ear infections, purchase Ear Infections by Whole Dog Journal.

There are numerous methods of natural care that the dog owner can use to keep her dog’s ears and hearing healthy:

Food for ears. When we put together a diet to aid in the prevention and treatment of problems located in or around a dog’s ears, it is important to remember that many ear infections are associated with allergies. Choose high-quality foods that do not contain artificial preservatives, flavorings, or food colorings. Consider making a home-prepared diet, or if this is not feasible for you, move up to a higher-quality diet.

If your dog experiences chronic ear infections and especially if the infections are associated with obvious symptoms of allergies, consider performing a food-elimination trial to investigate particular foods as a potential cause of the allergies.

Antioxidants are crucial for the effectiveness of the immune system, and they will aid circulatory and nerve health in the area of the ears. Consider supplementing your dog’s diet with antioxidants such as vitamins A and E, Coenzyme Q-10, or any number of the culinary herbs, including rosemary (Rosmarinus officinalis), thyme (Thymus vulgaris), and oregano (Origanum vulgare). Ginkgo (Ginkgo biloba), is high in antioxidant activity and has specific beneficial effects to the ear.

Zinc quickens the immune response; vitamin C is needed for proper immune function. Vitamin B complex is essential for healing and has been shown in humans to reduce ear pressure. Potassium helps maintain nervous system health and nerve impulse transmission. In humans, manganese deficiency has been linked to ear disorders.

For more on diagnosing and treating ear infections, purchase Ear Infections by Whole Dog Journal.

Heading to your veterinarian for help with an ear infection is always a good idea, especially if you haven’t had previous experience with a canine ear infection and you aren’t certain what it looks like, or if a previously treated infection has recurred. If you are going to take your dog to the vet, don’t clean his ears that day; it may be helpful for the veterinarian to see the appearance and amount of the discharge.

The vet will clean and examine the ears, and usually will take a look deep inside the ear canal with an otoscope – that is, if the swelling in the ear canal is not too severe. Some brave veterinarians will also put their noses near the dog’s ear and take a quick sniff; the odor of an infected ear is distinctive.

In mild cases, after cleaning the ear well, veterinarians will generally administer and give the owner a topical ear solution containing antibiotic, antifungal, and anti-inflammatory agents. This is typically used for a dog’s first or infrequent ear infection because, no matter what the causative organism, this type of topical will address it. In many cases, that’s all there is to the ear infection event.

However, if the infection recurs, it’s likely that the treatment was incomplete, whether because the solution wasn’t applied as frequently or as well as required (sometimes the outer ear looks good, but the infection continues to fester deep within the ear canal), or because the infectious organisms developed resistance to the antibiotic in the solution. In these cases, we may wonder why the infection keeps “coming back” when, in reality, it never ever went away.

When an ear infection recurs (if not before!), culturing a sample of the exudate is a must, to make sure that the next treatment is targeted to treat the specific pathogen. Oral antibiotics may be indicated in such severe cases in addition to topical therapy. Note that oral antibiotics are not the first go-to for a one-off ear infection and are rarely successful as the sole therapy.
Chronic cases may also be helped by a Traditional Chinese Veterinary Medicine (TCVM) approach including acupuncture, and/or when used preventively such as prior to spring/summer if dealing with seasonal allergies. Also, acupuncture and laser therapy can relieve pain associated with infections.

For more on diagnosing and treating ear infections, purchase Ear Infections by Whole Dog Journal.