Constant infections in one ear

[u/crimansquafcx2]

My dog (9 year old hound mix, 45 lbs) gets ear infections in his left ear. He has always gotten them, but in the past couple years they have increased in frequency, and we’re now to the point where it truly feels constant. We’re going back to the vet tomorrow as he’s showing signs of pain in that ear again, and I’m wondering if there’s anything I can bring with me to discuss.

We’re basically in a loop. He shows signs (head shaking, scratching, whimpering when we touch the ear). Our vet does a cytology and prescribes FluoroFlox and ear drops (have tried just ear drops, as well as other antibiotics, but they’ve stopped working). The FluoroFlox makes him feel sick but does seem to help. We take him in for 1-3 rechecks before they confirm the infection is gone. A few weeks later, he starts showing signs again.

We clean the ear 1-2x a week and have tried EpiOtic, EpiKlean, and Zymox Otic Enzymatic cleaners. Food is Royal Canin Ultamino. He takes 8mg Apoquel per day. Other meds include fluoxetine, Famotidine, and proviable.

Any suggestions for the vet are appreciated. Thank you!

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[u/Doris_Plum]

I am assuming by this stage someone has been able to do a thorough otoscopic exam and visualise the tympanic membrane. Chronic infections can cause canal stenosis which predisposes to further infections, as do ear polyps or other masses down the canal. Also assumes the ear washing technique is effective at fully cleaning the canal - sometimes you can get stubborn wax plugs right over the ear drum that you need a more thorough clean to remove.

If this is an extension of his allergies, a once weekly topical steroid treatment can be helpful to settle any brewing inflammation down the ear, which is usually what kicks off commensal fungal/bacterial overgrowth. The ear washes remove the cerumen but don't manage the inflammation from the allergies, and I haven't found Apoquel as effective at managing ear canal inflammation compared with topical steroids.

[u/crimansquafcx2 → u/Doris_Plum]

Thanks! This is very helpful. I’ll bring both items up with the vet today.

[u/V3DRER]

Is it just one ear affected?

[u/crimansquafcx2 → u/V3DRER]

Correct, always the left ear! It is his floppier ear of the two, I don’t know if that’s the reason or if there’s something else going on with the ear that makes it more prone.