Veterinary care should include diagnostic tests and subsequent treatment recommendations. Tests are needed to confirm the diagnosis of otitis externa and exclude other diseases that may cause similar symptoms. The following diagnostic tests are often recommended: Complete medical history and physical examination to examine your pet's external ears. Your veterinarian will pay close attention to the size of the ear canal, presence of pain, smell of ears, presence of hair or foreign material, masses or polyps, character of discharge/exudates, soundness of the ear drum, and general health. Your pet may need to be sedated.
Cytology to identify parasites, yeast organisms, bacteria and cellular components. This test will help to determine the cause of otitis externa and choose the proper treatment for your pet.
Culture and sensitivity tests in cases of recurrent infections, as there are some organisms that are often resistant to many antibiotics
Biopsy of growths to determine the presence of tumors
Radiography (X-rays) to evaluate the degree of the disease
Your veterinarian may suggest a referral to a dermatologist in difficult or recurrent cases or additional diagnostic tests to exclude or diagnose other conditions or to better understand the impact of otitis externa on your pet. These tests are selected on a case-by-case basis and may include:
A complete blood count (CBC) to evaluate your pet for other problems such as infections or inflammations
Serum biochemistry tests if there are other abnormal symptoms on the physical examination such as weight loss
Urinalysis to evaluate the kidneys and bladder
Thyroid level tests to determine the presence of hypothyroidism, which is the most common endocrine disorder that causes otitis externa in cats
Adrenal function tests to rule out Cushing's disease, which is hyperadrenocorticism secondary to excessive pituitary excretion of adrenocorticotropic hormone
Allergy tests to rule out allergic disease
Dietary trial to rule out allergic disease
Fungal cultures in the presence of severe or recurrent fungal infections
Skin scrapings to rule out mites such as Demodex
Treatment for otitis externa may include one or more of the following: Treatment of the primary disease process, the underlying factors that predispose your pet to infection, and the specific infectious agent. Flushing debris from the canal is critical prior to topical treatment. There are several types of ear cleaners. Ear cleansers can be detergent and ceruminolytic (products such as Epi-Otic, Oti-Clens, Routeen, Alo-Cetic) or antimicrobial (Chlorhexiderm, Malaseb). Ear cleaning should be once or twice daily until all debris is removed which is typically 3 to 7 days. Excessive cleaning should be avoided is it can cause ear problems. Cleaners can keep the ear moist and susceptible to infection.
Initial management includes cleaning your cat's ear. This can be accomplished by placing solutions in your pet's ear at home or by having them cleaned by your veterinarian. Moderate to severe infections may require sedation and in-hospital flushing. Uncomplicated ear infections respond well to topical ear medications such as Antimax, Otomax, Surolan.
Topical therapy usually consists of ear medication that you place in your pet's ear one to two times daily. The specific medicine will depend on the cause of the infection. It is extremely important to follow your veterinarian's directions on getting the medicine in your pet's ear. Improper medication and improper administration is a common cause for treatment failure.
Systemic therapy with glucocorticoids, such a prednisone, may be given to decrease pain and inflammation. These are hormones often used as inflammatory agents. It is often used for 10 to 14 days when pain and inflammation is present. Topical glucocorticoids can also be used.
Antibiotic therapy may be indicted with severe bacterial infections or ulceration. Antibiotics may be chosen based on cytology and/or bacterial culture.
Antifungal therapy is indicated in cases of severe recurrent yeast infections.
Regular follow-up visits to your veterinarian are important to ensure that your cat's condition does not worsen.
Optimal treatment for your cat requires a combination of home and professional veterinary care. Follow-up can be critical. Follow-up for otitis externa often includes the following recommendations: Administer prescribed medications as directed and be certain to contact your veterinarian if you are experiencing problems treating your cat.
Long term maintenance cleaning may be recommended in cases of long-standing infection. Cleaning procedure can be daily or weekly depending on the rate of wax and debris formation.
Administer any prescribed medications. NOTE: Inability to medicate your pet is a common reason for treatment failure.
Schedule regular veterinary visits to monitor your pet's condition. Repeat cytology examinations is critical to curing long time treatments.
Periodic ear evaluations with cytology may be recommended.
Ear cultures may be useful in long-standing infections.
Of course, the precise follow-up depends on the severity of your pet's disease, response to therapy and your veterinarian's recommendations.