Understanding Otitis Externa in Dogs: More Than Just an Ear Infection

Dr. Zeke Zekoff
Apr 3
2 min read

When your dog starts scratching their ears, shaking their head, or showing signs of discomfort, it’s easy to assume they’ve picked up a simple ear infection. But according to Dr. Mark Grossman, otitis externa—a common inflammation of the outer ear canal—is often just the visible symptom of a deeper, ongoing issue.

If you’re dealing with a dog who’s had recurrent ear problems, it’s time to dig deeper than the surface.

Otitis Isn’t the Disease—It’s the Symptom

Dr. Grossman emphasizes this critical point: otitis is typically a symptom of an underlying disease, not the disease itself. Without treating the root cause, ear infections will continue to return no matter how many medications are applied.

So what’s really behind all these ear issues? The three most common culprits are:

Atopy (environmental allergies)
Food allergies
Fleas

Before exploring anything else, fleas must be eliminated as a cause. From there, an 8–10 week food trial with a hydrolyzed or novel protein diet is the next step. Only when fleas and food are ruled out should we begin to suspect atopy, which may require allergy testing or long-term immunotherapy.

The Role of Steroids & Anti-Inflammatories

Steroids aren’t taboo—in fact, they can be a powerful part of short-term treatment. Grossman recommends either a prednisone taper or a one-time triamcinolone injection to reduce inflammation, discomfort, and ear discharge, allowing topical treatments to work more effectively.

However, before starting systemic steroids, a full lab panel (including thyroid levels) is advised to ensure the dog can safely tolerate the medication.

Why Systemic Antibiotics Aren’t Always the Answer

Unless a middle or inner ear infection is suspected, systemic antibiotics are often unnecessary. In fact, overuse can contribute to resistance. Topical treatments are generally sufficient, especially when inflammation is addressed first.

Grossman also clarifies the difference between cultures and cytology. While cultures can be helpful in chronic or resistant cases, cytology is a quick, inexpensive, and essential tool to determine the presence of bacteria (rods or cocci) and yeast (Malassezia).

Tailored Treatment: Custom Ear “Cocktails”

Dr. Grossman shares several of his go-to “cocktails” for managing otitis externa, including:

PhytoVet or Triz solutions with added enrofloxacin and dexamethasone
Silvadene cream mixed with Burrow’s solution for a soothing, anti-microbial blend
BNT: a lanolin-based compound with antibiotics and steroids that lasts for up to two weeks
Mupirocin cocktails for resistant infections

In severe or chronic cases, these formulations can be tailored based on cytology or culture results.

The Real Challenge: Preventing Recurrence

Treating an ear infection is relatively easy. The challenge—and true goal—is preventing recurrence by managing the underlying allergy or immune-mediated disease. Whether that means dietary changes, allergy testing, or long-term control with medications like Atopica, it requires both veterinary guidance and pet owner compliance.

Final Thoughts

Otitis externa is more than just an ear issue. It's often a sign that your dog is struggling with a chronic condition like allergies. With the right diagnostics, treatment strategy, and follow-through, you can not only bring relief to your dog but also reduce the frequency and severity of future flare-ups.

And as Dr. Grossman wisely reminds us: the goal isn’t just to clean the ears—it’s to solve the mystery behind them.