Clean ears properly now and avoid problems tomorrow!

Useful tips from the dermatologist! Ear cleaning can enhance treatment of an existing ear problem or prevent the development of a new one. Some dogs that are prone to ear infections may need regular ear cleaning between veterinary visits. Home ear cleaning can also help remove dirt and cerumen that can prevent medications from reaching inflamed areas, as well as get rid of allergens and microorganisms that may contribute to the inflammation or infection.


The veterinary surgeon’s duty is two fold : suggest the best suitable ear cleanser for each patient and show clients how to properly use an ear cleanser when they are at home.

Non-oily ear cleansers which also contain agents (e.g. chlorhexidine, lactic acid) with antibacterial and anti-yeast properties and keratolytic agents (e.g salicylic acid) with an acidifying property may be indicated in the vast majority of our patients. It is important to look at the list of the ingredients on the cleanser bottle and familiarize yourself with them to make sure your choice is tailored for each patient need. Not every ear cleanser will be suitable for all our patients!

There are several techniques suggested for home cleaning. Below are the author’s suggestions and tips on how to achieve the best possible effective treatment and also help owner compliance. Always reassure your clients that ear cleaning can be easily done at home, as long as a few guidelines are followed. The most important guideline is to always put health and safety first: if the pet becomes so agitated that the owner feels they might be at risk of being bitten, or if the procedure seems excessively painful, it is better to stop and suggest they should contact you for further advice.

Quiet environment and restraining technique

Although some pets are willing to sit or lie quietly while the ears are cleaned, it is likely that the large majority of pets might object, at least the first time, so suggest:

  • Choosing a room or place that can be easily cleaned, or do it outside as there may be exudate/cerumen coming out from the pet’s ears after the application of the ear cleanser.
  • Placing the pet on a stable work surface so the owner can stand next to it and allow the pet to lie down; if there is no suitable high work surface, let the pet sit on the floor.
    TIP
    - If this method fails it may be necessary to get some help to hold the pet’s head while the other person cleans the ears. For dogs it is recommended to have the helper hold the nose straight with one hand, while the other hand holds the back of the head still so the pet’s head cannot move up/down or left/right.
  • Talking to the pet to keep him/her calm and take a break between treating the right and the left ear if the pet becomes agitated.
  • Massaging the base of the ear. This is usually well accepted by the pet and may help in calming him/her down before resuming cleaning the other ear.
  • Reward the pet who has behaved well with a treat !

Cleaning steps

Suggest:

  • Having pinnae, which are dirty or covered by exudates or cerumen, cleaned with veterinary medicated wipes thus avoiding leaving on the pinnae surface a rich media for microorganisms to proliferate. It is wise to clean first the healthy looking pinnae and ear canal and then the one which looks affected. The use of plastic gloves may be suggested for this procedure otherwise thorough washing of the owner hands with an antibacterial soap should be recommended.
    TIP
    – For dogs with hairy pinnae, consider shaving the excess hair away as it will be much easier to wipe and clean bare skin where exudate and cerumen may be sticking.
  • Storing the ear cleanser at room temperature to avoid causing the pet unnecessary discomfort by applying a solution which may be too cold. If the product needs to be stored in the refrigerator, time should be allowed for it to reach room temperature before cleaning is started.
  • Holding the ear cleanser bottle just over the opening of the ear and gently squeezing the prescribed amount of solution into the ear. Avoid squeezing the bottle too hard as a powerful stream of product into the ear may cause discomfort or irritate the ear.
    TIP – This technique however, is not preferred by the author as there is often contamination of the nozzle of the bottle by it touching a dirty ear. This could lead to contamination of the ear cleanser bottle and risk perpetuating an infection by re-instilling into the ear a contaminated solution. Furthermore the correct amount of solution cannot be calculated and more product than necessary is often used. The author’s preferred choice is to use 1ml single use plastic syringes as the correct amount can be measured and the tip of the plastic syringe can be gently inserted into the upper part of the vertical ear canal to make sure the cleanser is properly applied. The author also recommends having the owner fill up two syringes, one for the left and one for the right ear, before even touching the dog’s ears so there will be less chance of contamination of the bottle between both ears. Often dogs can be scared by seeing the owner approaching them with the bottle, but seem less so if the owner uses a plastic syringe.
  • After administering the solution, folding the pinna against the pet’s head to try to prevent the pet from shaking his/her head. This will give additional time for the owner to do a proper massage of the base of the ear to distribute the solution as far as possible into the horizontal part of the ear canal. Unless the ear is very painful, most animals seem to like this part! Ear canals should be massaged for a few seconds before allowing the pet to shake its head. However, this may result in some of the solution to come out from the ear canal!
    TIP – Suggest the owner has a towel handy to cover the pet’s head to avoid him/her shaking the solution and the ear content all over the room if indoors.
  • Gently cleaning the pinnae and the entrance of the ear canals with cotton balls or medicated wipes if, after the pet shakes his/her head, they look dirty or are covered by the ear discharge.
    TIP – Cotton buds should never be recommended for owners to use as they could hurt the delicate structure of the ear canals if the dog suddenly moves during theear cleansing process. Furthermore cotton buds push debris back inside the ear canal.

Conclusions

Ear cleaning sounds an easy job but many owners do not know how to do it properly. It is the veterinary surgeon’s duty to show clients how to do it properly and make sure that the client feels confident doing it before they leave the practice. Even the best ear cleanser could be dangerous in the wrong hands! Always choose an ear cleanser which you feel confident with as far as tolerability and safety is concerned, when it will be routinely applied. Normally an ear cleanser applied 1-3 times a week will increase client compliance, which means a dog with healthy ears and a satisfied owner! However, do bear in mind that the need for prolonged use of an ear cleanser may suggest that a dermatological work up is needed, as an underlying disease may be present, predisposing dogs to develop recurrent ceruminous or bacterial/yeast otitis, which will then need veterinary treatment and management.

Written by
Rosario Cerundolo DVM, Cert VD, Dipl. ECVD, MRCVS European & RCVS Recognised Specialist in Veterinary Dermatology, Hon. Associate Professor of Veterinary Dermatology University of Nottingham