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What Doctors Don't Tell You

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June 2019 (Vol. 4 Issue 4)

All ears

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Q- My two-year-old Springer Spaniel, Megan, has suffered from recurrent ear infections since she was a pup

Q- My two-year-old Springer Spaniel, Megan, has suffered from recurrent ear infections since she was a pup. My vet has tried everything and I have spent a fortune on treatments. Are there any natural therapies that may help?

A.M., via email

A- It sounds like Megan is suffering from otitis externa, an inflammation of the external ear canal. It's very common in dogs; some 10 to 20 per cent will get an ear infection during their lifetime.

While conventional treatment works in many cases, the cost is very high and the drugs can have nasty side-effects. But I have found several effective natural therapies that can be used instead of or alongside the standard medicines.

Ear cleaning

The first and most important thing you can do is learn how to properly clean Megan's ears. Ask your vet to show you how it should be done. You'll probably have to start off cleaning them every day, but this can gradually be reduced to once or twice a week.

The ear canals should be kept dry and well ventilated. Topical astringents should be used in dogs that swim a lot, as preventing water from entering the ear canals during bathing should help reduce infections.

Clipping hair from the inside of the pinna (the visible portion of the external ear) and plucking it from the ear canals can improve ventilation and reduce humidity in the ears. A note of caution, though: hair should not be routinely removed from the ear canal if it's not causing a problem; doing so can cause an acute inflammatory reaction.

A hypoallergenic diet

Food allergies are a common cause of otitis externa (see fact file, page 69), so try feeding Megan a hypoallergenic or raw-food diet for up to 12 weeks. Most food allergies are due to the primary protein source in the food, so a food trial involves changing the proteins your dog eats to those that she has not been exposed to before. I have my own range of veterinary-approved hypoallergenic dog food, and they are used in my practice with excellent results. There is also a grain-free range that we have manufactured.


This dietary supplement is manufactured and sold by the herbal company Verm-X (, whose main range of products promotes gastrointestinal health in animals.

This blend of herbs and vegetable carbohydrates and fibre has been found to assist in the eradication of many allergies, and is especially good for cases of otitis externa. Its formula includes hypoallergenic potato and peas plus Echinacea angustifolia, Cinnamomum zeylanicum, Ulmus fulva, Picrasma excels, Capsicum minimum, Thymus vulgaris, Mentha piperita, Foeniculum vulgare, Urtica dioica and Allium sativum. The biscuits should be fed daily, with the dose depending on the severity of the condition and not the weight of the dog. Suggested dosage: 2 biscuits/day for mild conditions, 4 biscuits/day for severe conditions


Calendula (marigold) is a soothing herb with antifungal properties. It's particularly effective for promoting wound-healing. One way to use Calendula is to make an ear wash, using a tincture and salt, to flush out the affected ear once or twice a day. Suggested dosage: tincture of Calendula plus 1/2 tsp salt in a cup of distilled or filtered water

Mullein and garlic

The antiviral and antimicrobial properties of mullein, also known as velvet plant, make it an excellent herb for treating ear infections in dogs. Garlic is a natural antibiotic and, when used in combination with mullein, is also effective for treating ear problems.

Here's a simple mullein and garlic herbal remedy for ear infections:

o Using equal parts of mullein oil and garlic oil, combine the two oils
o To every 1 oz of the mullein/garlic oil mixture, add 10 to 20 drops of olive oil or vitamin E
o Apply this remedy to the ear canal of your dog, then gently massage the ear.

Oregon grape

The potent antibiotic and antibacterial properties of Oregon grape make it a useful herb for treating ear infections and ear mites. Suggested dosage: 1-10 drops of an oil infusion of the herb in each ear, once or twice a day, until the infection is gone


The active ingredients in Echinacea are alkylamides, found most abundantly in the root of the plant. Echinacea modulates the immune responses of macrophages and T cells, dialing down the response in the face of a strong stimulus, so helping the system to operate more efficiently.

The herb works via the interaction of the bioavailable alkylamides with cannabinoid receptors in the brain, specifically CB2. It doesn't activate the immune system in the absence of an immunological challenge and so will not deplete the immune system, as has previously been suggested by some. The root also boosts the body's white cell count, especially of natural killer cells. Either E. angustifolia or E. purpurea can be used.

Suggested dosage: dried herb: 25-300 mg/kg three times a day; tincture (usually in 40-70 per cent ethanol): 0.5 mL three times a day

Otitis externa fact file

What is it?
Otitis externa is inflammation of the external ear, which refers to the tympanic membrane (eardrum) to the pinna. It's the most common ear disease in dogs and can affect one or both ears.

What are its symptoms?
Classic symptoms are red, inflamed, sore ears with a smelly odour. There may be a waxy or purulent discharge and, in many cases, the external ear canal may be blocked by fibrosis, the formation of excess fibrous connective tissue in the ear canal.

Signs include shaking of the head, scratching at the affected ears and rubbing the ears against the floor or wall. If the middle ear is infected, there will be a head tilt, and the dog may even vomit.

What causes it?
Possible causes include atopic dermatitis (allergic skin disease), hypothyroidism (underactive thyroid), lupus and other autoimmune diseases, drugs, ear mites and foreign bodies like grass seeds.

Food allergies can also be a cause. An allergy may cause the external ear canal to become inflamed, hot and itchy, prompting the dog to rub or scratch the ear. This damages the lining of the ear canal and disrupts the optimal microenvironment, which then allows the usually harmless fungi, bacteria and yeasts to multiply and cause a secondary infection. This infection, along with the buildup of wax or pus, results in more inflammation, irritation and itchiness, leading to a vicious cycle.

How is it diagnosed?

The ears are examined using an otoscope to look for ear mites, foreign bodies, polyps and tumours. The vet will also dip a cotton bud into the discharge in the ear and make a stained smear on a glass slide, which is examined under a microscope. The vet then looks for eggs, larvae or adults of the ear mite Otodectes cynotis or Demodex canis mange mites, and yeast or bacterial infection.

The fungal yeast Malassezia pachydermatis has a characteristic shape and colour that's easy to identify under the microscope, and is found in low numbers in the ear canals of many healthy dogs and cats. There's no specific number that indicates yeast overgrowth; the key determining factor is whether the ears are itchy. A dark fluid in the canal usually means the presence of either Malassezia or a parasite, but it may also indicate a bacterial or mixed infection.

With bacteria, the vet will look to see if the infection is by cocci (spherical) bacteria-indicating a staphylococcal or streptococcal infection-or rod-shaped bacteria, a sign of more severe bacterial infection by Pseudomonas aeruginosa. A sterile swab is taken for culture and sensitivity testing, and sometimes a biopsy is required too.

What's the conventional treatment?
After ruling out ear mites, foreign bodies and masses, most vets would start with a proprietary ear-drop medication that contains an antibiotic, an anti-yeast agent and a steroid until the culture and sensitivity results come back.

To reduce ear canal thickening and itchiness, steroids may be given by injection or tablets. I prefer tablets because if the dog has a reaction to them, they can be stopped straight away. In contrast, a steroid injection can last for one to four weeks.

I don't have a problem with either of the above as one-off approaches for otitis externa as, in most cases, the problem resolves within a week and may never return. Indeed, if the underlying cause is a seasonal allergy and only happens once a year, then it's the sensible thing to do. But, for recurrent cases, the underlying problem needs to be addressed.

If the ear needs to be cleaned out, this is best done under a general anaesthetic. Any hair in the canal is plucked so the vet can see everything clearly, then the ear is gently syringed with a saline solution to break up any wax and infection in the canal. After repeating this several times, the ear is then cleared via suction, using a syringe. Finally, the outer ear is cleaned with sterile swabs.

In the rare unresponsive cases, surgery may be required. Lateral wall resection can be performed at an early stage to increase drainage and ventilation of the external ear canal, but this should be used only in cases where otitis has recurred despite appropriate medical management.

Total ear canal ablation (TECA) and lateral bulla osteotomy (LBO) in combination involve the complete removal of all external ear tissue except the pinna as well as removal of infected tissue in the middle ear. They are salvage procedures that should only be done in cases that are so advanced that reversal is not possible.

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