Diagnosing Ear Problems  
 Ear problems are complicated
The appointment arrives. This is a Labrador that has a big problem. The right ear is blown up like a little balloon. It happened overnight. "Is it a tumor" the owner queries? I have the patient in the room . This is a dog that has had no history of ear problems before. She is 3 years old and has had some big changes since her exam a year ago. The ear indeed looks like a little pillow but in fact it is a pocket with the ear flap of blood, a hematoma. The ear canals are both dry, odorous and have excessive gray waxy debris. The ears look "old" so to speak . The diagnosis begins by performing the exam. Since the ears are an extension of the skin , often there are other dermatologic (skin) issues. Facial rubbing, red lips, feet licking, scooting the itchy anus, chronic infections are all examples of allergies or food reactions. A sample of the ear debris is examined under the microscope for evaluation of possible bacteria, yeast, mites , blood, and other cells.This dog had a mixture of 3 types of bacteria and some yeast. Skin samples may need to be exampled. In this case the lab had signs of feet licking but actual lesions. The ear treatment in this case is 3 fold. 1. First the ear "pillow" will require a surgery to correct the blood pocket. Through the years many quick fixes have been tried but there is still only one treatment. Surgically open the ear, remove the clot and sew multiple sutures (stitches) in a series of somewhat random locations which appear like an old fashioned ticked mattress. The animal has to be anesthetized for this procedure. 2.The ear canal is thoroughly examined and lavaged. Aural antibiotics, oral antibiotics and some choice of medication for the underlying allergy component ( cortisone, antihistamines, cyclosporine) and 3. the hopeful identification of the allergan. Most often it is food which can be identified by the doctor's experience. The owner mentioned the dog has been on the same food for 2 years. That doesn't make a difference. Allergies generally don't reveal themselves until the dog is 3 years or older. I believe this is in-line with the end of their full growth and time for the immune system to start deciding "what it likes and doesn't like" on a repeated basis. The surgery heals in about 3 weeks. The infection is resolved in about 3 weeks. The response to a new food can take up to 4 months. This dog has a great chance for managing the allergy as long as the owner is willing to stay with the appropriate diet.