Itchy Ears (Otitis externa)

Itchy ears (Otitis externa, OE) are common in dogs, affecting up to one in seven veterinary patients, and can be frustrating to manage. Typical symptoms include increased head shaking, scratching or rubbing of the ears, redness, greasiness and an unpleasant odour. For many dogs (and some cats), OE becomes a recurring, uncomfortable, year-round problem.

The most effective management combines conventional veterinary care with holistic strategies, creating an integrative approach. Understanding the structure of the ear helps explain OE:

Pinna: the external, visible ear flap made of cartilage with a skin covering.
Ear canal: long and L-shaped, ending at the tympanic membrane (ear drum).
Ear canal lining: modified skin containing hair follicles, sebaceous glands, and ceruminous (wax-producing) glands.

Earwax plays several important roles:
• Traps debris and foreign material
• Provides antimicrobial action
• Lubricates and protects the canal’s skin
• Aids normal self-cleaning

Because of these essential functions, over-cleaning can be harmful, disrupting protective mechanisms and contributing to inflammation. Understanding underlying causes is key to effective treatment. Predisposing factors include:
• Anatomy (pendulous ears, eg spaniels)
• Excessive hair in the canal (common in “oodles”)
• Glandular hyperplasia (seen in some cocker spaniels)
• Excessive moisture (eg Labradors that swim frequently)

However, not every dog with these traits develops OE.

Primary causes are the true triggers of the inflammation. The most common are allergies, which may cause up to 90 per cent of OE cases. Allergies may be environmental, food-related or both. Other primary causes include ear mites, foreign bodies and, more rarely, inflammatory polyps or hormonal imbalances.

Secondary causes involve yeast or bacterial overgrowth, which occurs due to inflammation and increased wax production. This is best understood as ear canal dysbiosis. Since microbes flourish as the environment changes, treating infection alone will fail if the primary cause is not addressed. Overuse of topical antimicrobials can contribute to resistance. Oral antibiotics are reserved for middle-ear infections.

Management must address both the primary cause (allergy, mites or foreign body) and the secondary microbial overgrowth.

To manage infection and inflammation, a prescription veterinary ear medication is chosen based on cytology. The ear canal is sensitive — some chemicals can be ototoxic, especially when the eardrum is ruptured. If the ear is painful, oral anti-inflammatory medication may be necessary. In severe cases, animals may require anaesthesia for thorough cleaning and examination.

Sometimes thick microbial biofilm prevents medications from working, so cleaning is required before treatment can be effective.

Long-term care focuses on managing underlying and perpetuating factors. This is personalised for each patient. For example, consider “Ollie,” a Cavoodle with recurring yeast infections, seasonal itchy skin (belly and feet), occasional mucus in the stool when scavenging and possible separation anxiety. An integrative plan for Ollie includes strategies to:
• Reduce inflammation
• Rebalance the immune system
• Address dysbiosis (gut and ear)
• Support the skin barrier
• Address emotional imbalance (the skin-gut-brain axis)

Diet is a major focus. Ollie’s diet is upgraded from ultra-processed food to a minimally processed, balanced, fresh diet. If symptoms persist after three months, an elimination diet using a fresh novel protein may be needed. Diet trials are challenging due to uncontrolled environments and must run at least 12 weeks, with reduced medications and supplements during the final weeks to properly assess improvement.

Dysbiosis is addressed with diet changes, prebiotics and appropriate probiotics for at least three months, or longer if gut signs persist. Skin-barrier support includes internal supplements (such as flaxseed oil and zinc) and external care, reducing shampoo frequency, using chemical-free shampoos with nourishing conditioners and occasionally applying topical oils.

Anti-inflammatory supplements may include palmitoylethanolamide, omega-3 fatty acids and quercetin. For Ollie, a TCM anti-itch formula for blood deficiency may help 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 drying-agent (such as a weak acid) cleaner is often recommended, but this is individualised. After swimming or bathing, a gentle cloth can be used to clean and dry only the external canal. Dog swim caps exist, though I’m not sure how well they work.

This integrative strategy may not cure Ollie completely, but it should reduce the frequency and severity of itchy ear episodes.

This article is featured in Wellbeing Magazine 222