One Sore Ear 

D. E. Larsen, DVM

“Doctor, I have just moved to town, and my son says that you are trustworthy,” Dorothy said as I lifted Brutis onto the exam table. “This ear has been looked at by three or four veterinarians. We have used just about every medicine in your cabinet. Nothing has helped. Maybe it will get better for a short time while he is on the medication, but it always comes back. They have cultured this ear several times, and they get a different bug each time.”

“That story sounds like it is pretty frustrating for you,” I said as I held Brutis’ head down a little so I could peek into his left ear.

“Yes, I am just about to give up on the whole thing,” Dorothy said. “This has been going on now for about three years.”

Brutis was a large standard Schnauzer. Luckily he was well behaved, but when I reached to touch the ear, I could hear a low-pitched growl coming from deep in his throat. I knew that was a specific warning given by large dogs. It was a severe warning, and if it went unheeded, they were always ready to back up their threats.

“It sounds like Brutis has is a little tired of the problem also,” I said.

“Most of the time now, they have to sedate him to work on that ear,” Dorothy said. “He is such a good dog, but he is tired of places like this. He lets me put medicine into his ear, but I doubt that he is going to let you do anything to it.”

“When was the last treated for this chronic ear infection?” I asked.

“A veterinarian in Salem looked at him about three months ago and gave me another tube of medicine,” Dorothy said. “He said if that medicine didn’t solve his problem, that no medicine was going to solve it. He said that Brutis needs to have surgery to remove part or all of his ear canal. That sounded pretty drastic to me, and I didn’t go back. But this ear is as bad as it has ever been. What do you think about that surgery?”

“Sometimes, that surgery is about all that we have that will solve the problem,” I said. “I have done both a lateral ear canal resection, where we just remove the lateral half of the ear canal to all better drainage for the dead canal. The total ear canal ablation occurs when the entire ear canal is removed, and the middle ear is opened for drainage. Both are drastic, with the total ablation being the worse.”

“Do you think that is what needs to be done?” Dorothy asked.

“Maybe we should try a little magic first,” I said.

“I have heard it all now,” Dorothy said. “None of these other vets claimed they had any magic.”

“Let me explain myself,” I said. “I have a recipe for an ear flush that an old veterinarian gave me. I said it works like magic, and I have found it too close to that description. Since I have been using it, I have only had to resort to surgery once, and that was in a Cocker Spaniel. They probably have the worse ears of all the dogs. The thing about trying a new medicine, it only takes a week to two to know if there is a chance of curing this problem and a month or two to know if it is really cured. We can always resort to surgery if things don’t work. The thing about these surgeries is once it is done, there is no going back. For a dog like Burtis, with cropped ears, it will significantly change his appearance.”

“Tell me a little about the so-called magic you have,” Dorothy asked.

“Everything in it is legal,” I said. “It is just a combination of a bunch of medications. I will be honest with you. The experts will consider it unacceptable. There is at least one antibiotic that has the potential for toxicity to the inner ear. Still, I have not had a problem with it. Using it on this ear, after all the medication you have used, if it works, you will indeed think it is magic.”

“So what is in this flush?” Dorothy asked.

“The base of this flush is Massengill Vaginal Douche,” I said. “Then there are several things added to it. Gentamicin, a strong antibiotic with some ototoxicity potential, is added. Synotic is an ear solution with a strong steroid and some DMSO in it. Dexamethasone is another strong steroid that is in this flush. And lastly, I add some nitrofurazone solution, an antibiotic with a small molecule and a broad spectrum of activity. This recipe comes from an older veterinarian. I doubt there are any published accounts of its use and no trials to attest to its success. But I have used it often and with almost universal success. And I only use it on problem ears.”

“It sounds like it has everything except the kitchen sink in it,” Dorothy said.

“You are just about right,” I said. “That is why it will never be considered an acceptable medication by any of the big doctors in the veterinary colleges. The old guy that gave me this recipe said that he thought that it was the douche that did most of the work. I don’t know. I have never used the douche alone.”

“Okay, I am willing to give it a try,” Dorothy said. “And I appreciate your honesty.”

“I think we should leave Brutis with me for a couple of hours so I can sedate him and clean this ear and get a good look down in that ear canal,” I said. “He has a lot of hair, and if we get that all pulled out of there, the medication will have a better chance of getting into the deep portions of the ear canal. If there as been as many hands in that ear as you report, there is a possibility something was left behind. Be it a piece of cotton or something like that. We just need to get a good look.”

I sedated Brutis with some pentothal and pulled all the hair from his ear canal. A good otoscopic exam was difficult due to the swelling in the deep ear canal. I could not visualize the eardrum, but with the long list of medication given in the past, I would assume the risk that it was intact.

I flushed the ear canal and instilled the first dose of the magic flush. Burtis was up a few minutes after I was done, and he was anxious to go home.

“I want you to place a couple of droppers into this ear twice a day,” I said. “Massage the canal if he allows you to do that. This ear might be sore of a day or two from the work we did. Then let me look at it in a week.”

“So, if you check him every week for a couple of months, I will probably own part of this business,” Dorothy said.

“No, I am a small-town veterinarian,’ I said. “My opinion on such rechecks goes back to the summer I graduated from high school. I started paying my own medical bills that summer, I had a good job working in the cheese factory. I think I was making about two dollars and thirty cents an hour. I had a wart frozen off of one hand, and the doctor said he wanted to look at it next week. The following week, I go in. He is sitting at his desk. He looks up from his paperwork, takes my hand and glances at it, and says, let me look at it next week. I check out at the front desk, and the gal says, that will be six dollars. That was the last time I went to that doctor. I don’t charge for a brief recheck. I never have. I want people to let me see how things are progressing.”

***

The following week, I entered the exam room, and Dorothy was all smiles.

“I have to tell, Doctor Larsen, this is best I have seen this ear in years,” Dorothy said. “And Brutis acts like a puppy. He feels so much better.”

“That is good,” I said. “But we have a couple of months to go before we can start to think the battle is over.”

With Brutis on the floor, I held his mouth and pulled his ear flap back to look at his ear. There was no response from him this time. I picked up my otoscope and looked at the ear. Again, there was no response from Brutis. This ear canal seemed almost normal. I could easily visualize the eardrum, and it looked fine.

“Things look perfect, Dorothy,” I said. “I want you to continue this flush twice a day for another week. If things look good next week, we go once a day for two weeks and then sit the flush on the shelf. I think we are going see this ear back to normal.”

“I am ecstatic,” Dorothy said. “And to think, I almost had this ear butchered. I like your magic.”

***

The next few rechecks continued to be favorable, and Brutis had a normal ear at the two months.

“I think you can put the remainder of that flush in your medicine box,” I said. “Only use it if this ear starts to get bad again. I let me look at him early on if it becomes a problem. I think you can think of this ear as a normal ear.”

I was able to follow Brutis for the remainder of his life, and he never had a recurrence of an ear infection.

Over the years, the ear flush became a seldom-used product. Not because it didn’t work, but because the commercial products became better at addressing these chronic ear problems.

Photo by Tim Arterbury on Unsplash