Expert: Dr. Louis N. Gotthelf - 3/4/2011

Question
QUESTION: Dear Dr.,

I have a german shepherd.  I bought it from a certified fancier in Greece (Del Vento Marcio). She was 1 year old then. Now she is 3. It is a very remarkable dog and i am very zoophilic. The dog started itching in ears and feet and had a lot of diarhoia. I had started with royal canin. Since 7 months i was feeding winth Z/D. She made some examinations for food allergy and they assured me that it was not the case. Since then she was twitching the right ear, and is leaning the head towards that side. After examinations she has been diagnosed with staphylococcus. He received antibiotics and she had the ear cleaned but the problem persists. After a lot of diagnosis it has been cocluded that she has drum abruption. Currently she is under medication. She receives Augmentin and Rimadyl for 7 days. She exudes from the ear a viscous fluid due to the inflammation. Now this has stopped but they told me to continue with the medaication for 20 days to avoid a surgery.  Now even though it is the seventh day receiving medication she still leans the head.
 Do you believe that following the medicationfor 20 days would be cured? Should it show already some signs that the medication helps already? or it will need surgery after all?  If it finally needs surgery will the ear still be able to stand in an upright position or will it fall?

Please let me know as i do not know what to do.

Thank you very much in advance.

ANSWER: This seems to be a middle ear infection.  That is best treated with a deep flush of the bony chamber that makes up the middle ear called the bulla.  Then medication can be placed directly into the bulla to help treat the infection and to quiet the mucous membrane that lines the bulla.  This membrane secretes mucus and that may be the secretion you are seeing.  The Augmentin will not kill a common middle ear pathogen called pseusdomonas, so ask your vet for a different antibiotic, like a fluoroquinolone. I would recommend that the dog get a very high level of intravenous steroids.  That will help with the mucus and the head tilt.

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QUESTION: Thank you so much for your reply and help. I went yesterday at a local clinic and the dog was seen by a University Doctor. He said that he suffers from pseusdomonas and cartillage alteration at left ear. I send you attached 3 x-ray images. The doctor suggested that the dog has to have a surgery and i asked if it will do any good to follow the medication you suggested and replied that she has to have a surgery anyway. My personal opinion is that doctors here prefer surgeries to get over with each problem as soon as possible. I have already spent a lot of money and each doctor has a different opinion. I am in a big dilema. After insisting at the doctor he insisted baytril 200mg/24h and prezolon 20mg at morning and another 20 at night for 7 days, ear canal douches/cleaning. After 7 days prezolon 20mg/24h. Please let me know what do you thing.

Thank you so much again for your time and help.

Yours sincerely,
Panagiotis Karvounis

Answer
In my experience, the oral Baytril medication will only make the bacteria more resistant.  The Baytril needs to be put inside the middle ear in liquid form.  In Europe, you have a liquid drug called Marbofloxacin, that may be better.  I use weekly bulla infusions first to see if I can get the infection under control.  Surgery is the last option.  Over 20 years of doing bulla infusions, I get about 80% of these middle ear cases to come under control. In my book, Small Animal Ear DIseases; An Illustrated Guide, I have  whole chapter on how to treat middle ear infections.

I only could see one X-ray and that one was not taken properly to visualize the middle ear cavity.  The open mouth view is what I would need to see to evaluate the middle ear.