Part 2: Why the Ear Infections Kept Coming Back
One of the most frustrating parts of Peaches' journey was that her ear infections kept coming back.
The condition of her ears told us right away that this wasn't a simple ear infection. Years of inflammation had already changed the skin inside her ear canals, leaving it thickened and abnormal. Whatever was causing her problems had been going on for a long time, and treating the actual ear infection would only be part of the solution.
We would treat an infection, and her ears would improve. Then a few weeks or months later, we'd be right back where we started. Treat. Improve. Relapse. Repeat.
Unfortunately, that's a pattern we see pretty often with chronic ear disease. Many owners assume that if an ear infection comes back, the previous treatment didn't work. Sometimes that's true.
More often, the treatment worked just fine. The problem is that the infection wasn't the whole story. For many dogs, chronic ear infections are a symptom of an underlying allergy problem.
The ear canal is lined with skin, and allergies affect skin. When allergic inflammation develops, the environment inside the ear changes. Yeast and bacteria take advantage of that inflammation and begin to overgrow.
So while the infection needs treatment, treating the infection alone doesn't solve the problem. In addition to treating the infection, we started her on a several month course of steroids, which we hoped would not only reduce her overall discomfort and itchiness but also help the skin lining her ears begin to heal and return to normal.
Given the chronic changes in her ears, we were concerned early on that allergies were likely playing a major role in her problems and started working toward a long-term allergy management plan rather than simply treating each new infection as it appeared.
The challenge wasn't recognizing that allergies were involved. The challenge was figuring out which combination of treatments would work best for Peaches.
One of our first steps towards overall management was to start Peaches on a special diet. Many people think of food allergies as causing vomiting or diarrhea, but they can also contribute to chronic ear infections, itchy skin, and recurrent skin infections. Because of that, diet trials are often an important part of working up allergy patients. Fortunately, Peaches' owner was already familiar with using hydrolyzed diets to manage chronic diseases - it had been part of her life for years due to a previous dog with IBD and another with milder but still serious chronic allergies. Peaches did respond to some degree with the diet trials. Ultimately we had to try a couple of diets to find out which one managed her signs best.
Over time we layered on additional treatments. Fish oil. Redonyl. Allergy medications. Allergy desensitization. Some helped a lot, some helped a little. Some didn't help as much as we hoped. Some worked for a while and then needed adjustment.
Even while we were working on long-term allergy control, flare-ups still occurred. Like many allergy patients, Peaches didn't come with an instruction manual. Over time, though, things slowly started moving in the right direction.
One of the most rewarding parts of Peaches' story is that ears can recover.
When Peaches first came to us, years of inflammation had already changed the appearance and texture of her ear canals. Today, those changes have resolved. Her ears look normal. She still has flares, but they are much less frequent, milder and easier to manage.
That didn't happen because we found a magic ear medication.
It happened because we gradually got better control of the inflammation that was driving the problem in the first place.
Of course, allergies weren't the only challenge Peaches was facing.
In our next post, we'll talk about another important part of her story: learning that the world could be a safe place, and why helping Peaches feel secure became just as important as treating her allergies.
Continue Peaches Story in Part 3: The Other Half of the Story.
About the Author: Dr. Denise Melton is the owner and veterinarian at Tamberly Animal Hospital in Milton, GA. Learn more about Dr. Melton here.