Otitis is a common disease among dogs. Without early and effective intervention, it can progress to chronic and recurrent otitis externa (CROE), which can be challenging to treat. The clinical framework of primary causes, secondary contributors, predisposing factors, and perpetuating factors is useful for creating treatment plans. General physical examination helps practitioners prioritize primary causes. Otoscopic examination can identify early and reversible chronic changes. External palpation of the ear canals can help detect suspicion for mineralization. The most valuable diagnostic tool is cytology because it enables identification and targeted treatment of the organisms involved in the infection. For treatment, most patients with CROE will benefit from oral and\/or topical glucocorticoids, the selection of appropriate antimicrobials, ear cleaning, and control of the primary causes. Regular recheck examinations evaluating otalgia and treatment response are crucial to treatment success, after which maintenance therapy is needed to prevent relapse.<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Otitis remains one of the most common diseases among dogs.1<\/sup> To help categorize clinical cases and formulate therapy, a recent review proposed definitions for recurrent and chronic otitis (see <\/span>GLOSSARY<\/b><\/span>).2<\/sup> Successful management and treatment of chronic and recurrent otitis externa (CROE) can be challenging because they require an understanding of the pathogenesis, diagnostics, and multimodal therapy.2-5<\/sup> Preventing chronic and irreversible changes to the ears requires early recognition and medical intervention.2,3,5<\/sup> Furthermore, patience and adherence from clients and patients are vital for positive outcomes.3,6<\/sup> Appropriate intervention leads to better patient outcomes, client satisfaction, improved antimicrobial stewardship,2,6<\/sup> and ultimately saves ears from end-stage CROE requiring surgical removal through total ear canal ablation and bulla osteotomy (TECABO).3,7-9<\/sup> <\/span><\/p>\n Ear infection<\/strong><\/span> Clinically significant microbial overgrowth or infection<\/p>\n Recurrent<\/strong><\/span> Clinically significant ear inflammation and\/or infection within 3\u00a0months of complete resolution of previous episode<\/p>\n Acute<\/strong><\/span> Otitis without acquired proliferative changes in the ear canals<\/p>\n Chronic<\/strong><\/span> Otitis with acquired proliferative changes in the ear canals<\/div><\/div>\n Understanding the primary, secondary, predisposing, and perpetuating (PSPP) factors of otitis externa (OE) can help clinicians create effective treatment plans (<\/span>TABLE 1<\/b><\/span>).2,3,5,10,11<\/sup> Identifying the causes through a detailed history and physical examination prioritizes differentials and diagnostic workup.2-5,10<\/sup> CROE may have more than one primary cause and multiple other contributing factors.3,5,10<\/sup> <\/span><\/p>\n\n
Pathogenesis of CROE<\/h2>\n
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