Itchy ears (Otitis externa, OE) are common in dogs, affecting one in seven veterinary patients and can be frustrating to manage. Common symptoms include excessive head shaking, scratching or rubbing of the ears, redness, oiliness, and foul odor. For many dogs (and some cats), OE becomes a recurring, bothersome, year-round problem.
The most effective management combines traditional veterinary care with holistic strategies to create an integrated approach. Understanding the structure of the ear helps explain OE:
Pinna: the outer eardrum, which is visible, is made of cartilage with skin.
Ear canal: It is long and L-shaped and ends at the tympanic membrane (ear drum).
Ear canal cover: modified skin that contains hair follicles, sebaceous glands, and serous (wax-producing) glands.
Earwax plays several important roles:
• Blocks waste and foreign matter
• Antimicrobial effect
• Lubricates and protects the skin of the canal
• Promotes normal self-cleaning
Because of these important functions, excessive cleansing can be harmful, disrupting protective mechanisms and promoting inflammation. Understanding the underlying cause is the key to effective treatment. Predisposing factors are:
• Anatomy (hanging ears, eg spaniels)
Excessive hair in the canal (usually in “oodles”)
• Glandular hyperplasia (seen in some cocker spaniels)
• Excessive humidity (e.g. Labradors that swim frequently)
However, not every dog with these traits will develop OE.
Primary causes are the underlying causes of inflammation. The most common are allergies, which can cause up to 90% of OE cases. Allergies can be environmental, food, or both. Other primary causes include ear mites, foreign bodies, and rarely, inflammatory polyps or hormonal imbalances.
Secondary causes include yeast overgrowth or bacterial overgrowth caused by inflammation and increased wax production. This is best understood as ear canal dysbiosis. Because microbes flourish when the environment changes, treating the infection alone will fail if the underlying cause is not addressed. Overuse of antimicrobials can contribute to resistance. Oral antibiotics are prescribed for middle ear infections.
Management must address both the primary cause (allergy, mites, or foreign body) and secondary microbial overgrowth.
For the treatment of infection and inflammation, a veterinary ear medicine is selected based on cytology. The ear canal is sensitive – some chemicals can be ototoxic, especially when the eardrum is broken. If the ear is painful, oral anti-inflammatory drugs are needed. In severe cases, animals may require anesthesia for cleaning and a thorough examination.
Sometimes a thick microbial biofilm prevents medications from working, so it needs to be removed before treatment can be effective.
Long-term care focuses on managing underlying and ongoing factors. This is individualized for each patient. For example, consider “Olly” the cat with recurring yeast infections, seasonally itchy skin (belly and legs), mucus in stools when cleaning, and possible separation anxiety. An integrated plan for Ollie includes strategies to:
• Reduce inflammation
• Balancing the immune system
Treatment of dysbiosis (gut and ear)
• Support the skin barrier
• Elimination of emotional imbalance (skin-gut-brain axis)
Diet is the main focus. Ollie’s diet is upgraded from ultra-processed food to a minimally processed, balanced and fresh diet. If symptoms persist after three months, an elimination diet using a new protein is required. Dietary trials are difficult due to uncontrolled environments and must run for at least 12 weeks with medication and supplements reduced in the final weeks to properly assess improvement.
Dysbiosis can be resolved with dietary changes, appropriate prebiotics and probiotics for at least three months or longer if intestinal symptoms persist. Supporting the skin barrier includes internal supplements (such as flaxseed oil and zinc) and external care, reducing the frequency of shampooing, using chemical-free shampoos with nutritional conditioners, and occasionally using topical oils.
Anti-inflammatory supplements may include palmitoylethanolamide, omega-3 fatty acids, and quercetin. For Ollie, TCM’s anti-itch formula for blood deficiency can help with both dry skin and separation anxiety.
Ears should be kept relatively clean and dry without removing too much protective wax. Intermittent cleaning every two to three weeks with a dry cleaner (such as a weak acid) is usually recommended, but this is individualized. After swimming or bathing, a soft cloth can only be used to clean and dry the outer canal. There are dog swim caps available, although I don’t know how well they work.
This integrated strategy may not completely cure Ollie, but it should reduce the frequency and severity of episodes of itchy ears.
This article is in Journal of Wellbeing 222
