Question: Dr. Richards,
I have a neutered male cat with very itchy ears. He hasbeen to the Veterinarian several times to be tested for yeast, mites, and fungus. None of these tested positive. He has a terrible time shaking his head and scratching his ears. Anything I could use toalleviate his discomfort?
There are several possible problems that could cause itching that wouldnot also lead to infection with either bacteria or yeast. In some cats this occurs due to herpes virusinfection leading to middle ear irritation. Usually cats with this problem have a lot of ear wax butdo not necessarily have infections.
Cats with food allergies or inhalant allergies may have itchiness withoutany apparent sign of ear infection at all. Cats with fleas or hypersensitivity to flea bites may show this as itchiness around their head or ears. We have seen two or three cats with cancers affectingtheir ear canals that were very itchy. Chiggers can cause itchiness in the ears or around the earsand they are not always easy to find on an examination, although they do show up as little orange dots inmany cases.
The steps that we normally take to try to sort through these problemsstart with an ear examination. If we can't identify a cause for the itchiness we usually start to sort through the causes that are not readily apparent. We usually start with a flea control product thatwe have good experience with. In our practice this is usually Frontline Topspot (tm). If fleas are the problem, this will usually reduce the itchiness within a week or so and eliminate it over several weeks. If we do not see a pretty rapid improvement after flea treatment we usually move on with treatmentfor allergies. We often start with an antihistamine and essential fatty acid combination at the same time,such as chlorpheniramine (Chlortrimeton tm) and 3V Capsules (tm). If many cats this will help. If it doesn't help and it is possible to control the cat's diet effectively, we try a special diet designed to be hypoallergenic for three to six weeks. At this point, if nothing has helped and we still can't detect a reason for the itchiness, we often try a short course of corticosteroids such as prednisone,or an injectable corticosteroid product such as methylprednisolone acetate (DepoMedroltm), to see if the itching can be controlled in this manner. If this works we then try to work toreduce the dosage to the smallest dose that will control the itching, given at the longest possible intervals,such as every other day or every third day. If corticosteroids don't work at this point, we usuallytry to refer the patient to a veterinary dermatologist to see if there a second opinion from a specialistis helpful, if we haven't already taken this step somewhere along the way.
Hope this helps some.
Mike Richards, DVM
Complete hearing loss after teeth cleaning
Question: Dear Dr. Mike,
I have a 6 year old Persian, with a severe underbite and pushedin face, even for a Persian. She has "severe dental disease", and last week went in for a dentistry. They removed four teeth, and a large abcess. She woke from the procedure easily, buthas since then been completely deaf. The vets are all at a loss, and state they used the lowest amountsof anesthesia possible. The meds she received are diazapam, ketamine, atropine, isoflurane gas, andbutorphanol (orally). She also had her ears cleaned, which the vets say was unremarkable. She was also started on clavamox two and a half days prior to the procedure and continues on it still(day 6 after the procedure). Along with her complete hearing loss, she also has no appetite. She has received SQ fluid twice, and yesterday got an emema after no stooling for five days. I have been syringe feeding her a high calorie food (Eukanuba's recovery), and stopped that yesterdayfor 24 hours to see if we could
stimulate her appetite but it did not work. Her othersymptoms are dizziness (especially when being put down) and lots of shaking of her head. Thereis no ear drainage, and the vets said her ears looked clean and good although they could not visualizethe ear drums. The vets say none of the drugs are known to be ototoxic, and I am going to a neurologistat Tufts this Friday. I'm wondering if you have any thoughts on a possible cause, or haveever heard of this happening to another cat. She can manage to climb stairs (even spiralstairs) and can jump up on my bed with ease. I'm wondering about the chances of an inner earinfection, or damage to the cranial auditory nerve. If you have any insight, I'd be very appreciative. Thanks. Lisa
I have heard of several reports of cats becoming deaf after teeth cleaning,anecdotally, but can not find anything in the literature about it. There have also been reportedcases of deafness when an ear cleanser containing chlorhexidine is used in cats and occasional reportsof problems associated with antibiotic ointments. At the present time I am not aware of an approvedear cleansing product containing this ingredient but it can cause problems even if the eardrums are intact, so it should be avoided in ear cleansing. There are also anecdotal reports ofdeafness in cats after anesthesia alone.
In your cat's situation, in which there was dental work done, ear cleaning,anesthesia and a pre-existing abscess, which may or may not have caused high fevers,it seems like there are several possible culprits. Sometimes, there is just enough compromise to theear canals that even a small amount of manipulation, possibly including retraction of the jaws toallow dental work, is enough to set off a pre-existing problem. I would think that a middle or innerear infection could have been present and irritated by the dental work, the abscess or the ear cleaning.
I am hopeful that the neurologist was able to help, or at least to giveyou some direction as to what the cause might have been.
Mike Richards, DVM
Mittens continuing balance and inner ear problems
Question: I first wrote to you about 3 months ago aboutmy 18 year old female cat's balance/vestibular problem. We now stronglysuspect an inner ear infection. About 6 weeks ago we finally gotaround to doing a "neurological examination" and it was discovered that she couldn'tblink her left eye properly - a menace deficit. There was nothing else found and no indicationsthat point to a central problem rather than a peripheral problem.
She has had several different antibiotics over the last 14 weeks. Firstly 3 Betamox (amoxicillin) injections which she responded to. Then about 3 weeksof Vibravet, then about 3 weeks of Clindamycin. Then a prednisone injection and no antibioticsfor 2 weeks and no response to prednisone except that the sneezes that began her balance problemreappeared. Then 3 more weeks of Vibravet. Then 3 more Betamox injections during whichthe vet said her blink response had improved quite a bit. Her balance only marginally improvedwith the Betamox so now we have started on a Cephalosporin/Cephalexin called Rilexine.
We had planned to try Baytril/enrofloxacin instead of the Rilexinebut I discovered a Web page by R M Clemmons of University of Florida which said he preferred Cephalosporinto Enrofloxacin but recommended using Sulfadimethozine with it and to use it for6 to 8 weeks.
We aren't using sulfadimethozine yet. My question is - since Mittens appeared to respond to Betamox, would it do any harm to give her another one or twoBetamox injections at the same time as continuing Rilexine. Would it be worth tryingto add the sulfadimethozine to the Rilexine.
Some information I have found on sulfa drugs suggest they canbe a problem - I have no way to make Mittens drink more water. Is it possible this isa virus problem and not bacteria. My cat had an anabolic steroid injection larabolin, 5 hours before hersneezes appeared 14 weeks ago. Do you happen to know if anabolic steroids suppress the immunesystem the same as Corticosteroids.
End of Questions
Mittens current symptoms are : she is unsteady/overbalancingand "widebases" her feet to maintain her balance a lot, she shakes her head a lot, she hears somethings but can't tell the direction sounds come from. She doesn't have a noticeable head tilt atthe moment but in the past has sometimes had a tilt to the left. She does try to scratch her ears quiteoften but I can't tell if this is more than normal.
I think her suspected inner ear infection originated from thesneezing/upper respiratory infection she had at the time her balance problem started. I also thinkI would have noticed her inability to tell the direction that sounds come from if it had been there beforethe balance problem.
I hope you are not too busy.
I think it would be fair for you to charge me another fee foranswering this question.
I have one off the wall suggestion, which is to consider looking fora pharyngeal/middle ear polyp. These are more common in young cats but can occur in older cats. Itis really pretty unlikely that this is the problem but in reviewing databases looking for information onthe antibiotics you asked about and inner ear infections, I kept running across mentions of this condition.Examining the pharyngeal region and middle ear under anesthesia might be necessary to rule inor rule out this condition.
The most commonly recommended antibiotics for inner ear infections arechloramphenicol,cephalosporins, sulfa-trimethoprim combinations, fluoroquinolones (likeenrofloxacin) and clavulanic acid - amoxicillin combination (Clavamox Rx). It is necessaryto use antibiotics for six to eight weeks in most cases when it is necessary to treat pets for otitis mediaor otitis interna.
I found the information from Dr. Clemmons. I am not familiar with sulfadimethozinebecause it is primarily a large animal antibiotic and I have never used it. However, since other sulfa medications are recommended for inner ear problems, it seems as if this one would bereasonable to use as well.
It is safe to use amoxicillin and fluoroquinolones at the same timeand they are thought to have synergistic effects. It is reasonable to continue the use ofamoxicillin long term if it has been helpful, as well. There is no advantage to using injectable amoxicillin for longterm use that I am aware of, so using an oral form might be a easier.
I hope that you continue to have success with antibiotic therapy. Ifnot, checking for a polyp might be worthwhile if that hasn't been done, even though it isn't a highlylikely problem.
Mike Richards, DVM
Growths in ear - Ear problems in Kitten
Question: Dear Dr Mike,
I just have one more question relating to Geordie - as I mentioned
previously he had a bad ear mite infestation, now the ringworm andall along
since he was 3 months old he has been shaking his head and scratchingaround
and under the ears. The vet thought it was the ear mites causingthis then
perhaps the ringworm but now that these are clearing, the shaking and
scratching still persists and it is worse when something touches hishead -
i.e. patting him around the head or when he rubs against carpet orwalls -
he starts violently shaking his head and ears - then begins to scratch. We
have had Geordie for 4 months now and he had his 19th vet trip thisweek so
we are desperate to get him better and feeling happy. The vethas cleaned
and swabed his ears - there are no infections or bacteriological problems-
the only abnormality the vet does report is a small tissue growth inthe
external ear canal in both ears. I had a look at one of themmyself and it
shows a little white growth of what looks like skin tissue extendingfrom
the side of the ear canal wall.
Geordie's father and half sister had ear polpys - do you think thisis what
they could be? - due to the family history our vet thinks it may bebut is
not sure. The breeder says Geordie's father and sibling did nothave any
outward symptoms of the polyps therefore we am concerned with the head
shaking and sratching - could this be related to the ear polyps orsomething
It is very frustrating as, being a kitten especially, Geordie comesto us
for attention but as soon as we touch him above the neck he shakeshis head
-sometimes so violently that he loses his balance and falls over. Heloves
being petted and wants the contact with us but is shying away whenhe
experiences this problem.
Although he has now finished teething he only wants to eat soft food(no dry
biscuit food) and this is causing a little gingivitis although I havegot
him interested in a raw chicken meat with a little bone mixed in totry and
help. Again we wonder if the head/ear problem could be causinghim to
abstain from crunchy food?
As you can see we are finding it hard to pinpoint what it is and howit
should be treated. We would appreciate any comments or adviceyou may have
- perhaps you have seen or heard of the same problems before?
I apologize again for bothering you with another inquiry but hope thatyou
might have some input into what is a very frustrating situation.
Thanks again & Kind regards,
Seven months old seems young for growths to occur in the ears but somecats
do seem to be really prone to this problem. There are several possible
growths. We see cats that have hypertrophy of the ear tissue due to
allergies or infections. Sometimes this will have a purple hue to it.
Hemangiomas and cerumen gland adenomas seem to occur most commonly,among
the tumors, in cats in our practice. These sometimes occur in youngcats
but I can't remember one quite as young as yours.
I read that someone studied the pressure in the middle ear of dogs with
allergic otitis and discovered that they have problems equalizing pressure
when the ears are inflamed, leading to discomfort of the ears. I don't
think this has been reported in cats but I don't see any reason whyit
couldn't happen. If this was a problem there is a chance that
antihistamines might help. Your vet could provide you with an appropriate
dose for Geordie. There is also a reasonably good chance that unequal
pressure in the middle ear could lead to middle ear infection and sometimes
even to inner ear infection. If there was any infection associatedwith the
ear mite infestation it may have spread to the middle or inner ears.This
could lead to balance problems and to Horner's syndrome (unequal pupils,
visible third eyelid in one eye). It can be very hard to be certainthat
there is or is not a middle or inner ear infection and it is reasonableto
treat on the suspicion that an infection is present with the symptoms
present, probably. At least it might be worth talking this over withyour vet.
Sometimes, even when I don't see evidence of inflammation or infectionbut
there are persistent problems with ear shaking I will try a corticosteroid
ear drop, such as Synotic (Rx). This will help in some cases.
There is a chance that the problem does not relate directly to the earsbut
is the result of a neurologic injury, too.
I know that doesn't clear things up, at all --- but what I'm reallytrying
to say is that there are still possible problems to explore and thatit
would be a good idea to consider a recheck with your vet.
Oh -- middle ear infections do sometimes cause a reluctance to openthe
mouth wide or to chew much.
Mike Richards, DVM
Q: I was searching the your site for informationabout cat hemotoma's. How
do you treat this? thanks for your response.
Hematomas in cat ears are usually found in conjunction with ear mitesor an
ear infection. It is necessary to treat the irritation leading to head
shaking or pawing at the ear and caused the hematoma. We try to makesure
that the ear canal is cleaned out prior to correction of the hematoma.If
the underlying problem is ear mites and the hematoma is small we will
sometimes treat with prednisone on a daily basis for 5 days then every
other day until the hematoma has resolved. Prednisone interferes with
scarring and prevents most of the crumpling of the ear associated with
hematomas. If the hematoma occupies more than a fourth of the pinnawe
usually surgically drain it by making an incision on the inner (non-haired)
aspect of the ear and then placing sutures through ear to hold thetwo
sides of the ear together and prevent the hematoma from forming again.The
ear stitching looks like the stitching of a mattress when this is done.We
remove the sutures after a couple of weeks.
Mike Richards DVM
Cleaning cats ears
Q: Can you clean a cats ears at home? Andif so how often do you clean them?
There are a lot of good commercial ear cleaners. Your vet will probablyhave one that you could use at home. Unclean ears are often an indicationof infection, though. It would be best to let your vet examine the earsand determine if an infection or ear mites are present and causing thedirty ears. If so, treatment should clear the problem up. If not, thenit is safe to use an ear cleaning product. I think that hydrogen peroxidemixed half and half with water is pretty good for cleaning out wax butnot as good as some of the ear cleaning products. Using a bulb ear syringeto flush the ears with the solution helps to clear out the debris in theear, too. If there isn't an underlying infection or ear mites itshouldn't be necessary to clean ears very often. In many cats it is nevernecessary.
Mike Richards, DVM
Scabs around ears
Q: Dear Dr. Mike, My 9 month old kitten Stewiehas developed about five scablike places on and around her stomach andon her ear. She licks at them constantly, and I'm not sure if they makeher itch or if they are sore. She has also lost a lot of hair around thesescabs. Do you have any idea what this could be or what I should do? I wouldappreciate any advice you have to give me. Thank you, Amy
A: Amy- Scabs around earsare most commonly the result of ear mite infection. The ears itch, thekittens try to scratch them and sore develop from the scratching aroundthe ears. Since there are scabs on her abdomen as well it is likely thatsomething else may be the problem or that she may have two problems. Fleascan produce enough itchiness for scabs to develop in several spots on thebody. Ringworm (a fungal infection) can cause scabby sores sometimes andis often associated with patches of hair loss. Bacterial skin infectionsand mange are possible in kittens as well. It is probably going to takea visit to your vet to sort through these problems and determine whichone is actually present.
Michael Richards, DVM
Dizziness and disorientation
Q: My 9 year old cat began to seem slightly dizzya few weeks ago. Our vet prescribed an antibiotic (Clavamax) and Prednisolone;she suspected vestibular something or other after an xray ruled out anyphysical injury. Kitty did not improve after the 10-day round of antibioticsand we returned to the vet. Another round of antibiotics were prescribedin addition to a daily 12.5 mg tablet of meclizine, which I understandis used to treat motion sickness in people. A blood test revealed onlythat the cat was not drinking much water, nothing else abnormal. It's been3 days since we began the motion sickness medication (it was written for14 days) and the cat is considerably worse. He is highly disoriented, canbarely get around without stumbling, and spends all of his time huddledunder the bed. He is eating pretty well, although' he has lost about alb. between first and second vet visits ten days apart. He has experiencedno injuries that I'm aware of (he did go outside before he got sick) andhe does not seem to be in pain. I initially thought that he had had a stroke,but the vet did not find any evidence of that based on her examinationof his pupils. Is there anything that you know of that could cause thiscondition that my vet may have overlooked? Thanks, Sharon
A: Sharon - The major causes of dizziness are middleand inner ear infections and problems affecting the cerebellum (part ofthe brain that controls balance and spatial orientation). An ear infectionmay respond to antibiotics but sometimes surgery is necessary to relievepressure in the middle or inner ear. Feline leukemia virus, feline immunodeficiencyvirus, toxoplasmosis and other infectious diseases can lead to balanceproblems. Cats do sometimes get infarcts in the brain with similar effectsto strokes in humans. Cancer can cause these signs, as well.
If your vet is not able to make a diagnosis and you wish to pursue thisfurther it is reasonable to ask for referral to a veterinary neurologistor internal medicine specialist. If you live close enough to a veterinaryschool to go there it is possible to get opinions from several expertsat once.
Michael Richards, DVM
Pityrosporum or Malassezia ear infection
Q: Please tell me anything you can about this infection. My cat was (incorrectly) treated for ear mites for 2 years. Now finallyI have the name of the actual problem (a culture was finally done. Whatmedications should be given and for how long? What causes this? I'll appreciateany help you can give me. Thank you very much.
A: R- Pityrosporum is a yeast infection. Currently,it is usually referred to as Malassezia but that is only because mycologistshave to change the name of everything every few years in order to havesomething to do.
It is possible to culture yeast from normal ears, so this diagnosishas to be considered carefully when it is made. As many as 30 to 40% ofnormal dog ears have Malassezia organisms in them. I have not seen figuresfor the percentage of normal cat ears from which yeast can be culturedbut it is likely to be similar.
In most cases Malassezia is a secondary problem. It can occur in conjunctionwith allergies, immune mediated disease, chronic bacterial infections,long-term antibiotic use and seborrhea. It may also occur as a primaryinfection in some dogs and cats. It seems to be pretty common after earsare treated for Pseudomonas infection (a bacteria), probably because treatmentfor that condition requires long term antibiotic use with broad spectrumantibiotics.
Treating the primary problem is the first step in treating Malassezia.If that can be done, then keeping the ear canal dry and acidic is oftenenough to keep the Malassezia growth down. When that doesn't work thereare medications that work pretty reliably. The most commonly used one currentlyis probably clotrimazole (used in Otomax Rx). Thiabendazole (in TresadermRx) has been reported to be effective.
It can take extensive diagnostic work to correctly identify the underlyingcause of yeast infections when they are recurrent. Tests for immune systemdisorders like feline leukemia or feline immunodeficiency viruses, hormonaldisease, allergies, bacterial infections, parasites (ear mites, demodecticmange, etc.) and careful review of medication histories may be necessaryto establish the diagnosis of the primary problem.
Good luck with this.
Michael Richards, DVM
Chronic otitis media - ear infection
Q: Dear Dr. Mike, We have two beautiful Maine Coons-Waverly(25mos) and Chloe (22mos). Chloe has had chronic otitis media for overa year. It is predominantly in her left ear. She has grey liquid in herear that dries out and forms a black crust around her outer ear. She scratchesat it occasionally, but seems to have grown pretty used to the irritation.She has had cultures performed which reveal multiple infections, includingstaph. She has been treated with oral antibiotics, tresaderm, conofite,andother anti-bacterial and anti-fungal preparations with no continued relief.I took her to the Ohio State Veterinary School last October. Theiraggressive approach frightened me. They wanted to take skull x-rays anddo a "bulbectomy" as a precaution. I was worried that she would be moreuncomfortable if she had surgery, so we have been treating her with themedicines we have left when her ears smell foul or there is black stuffexuding from them. We love our Chloe and want to help her without causingher any pain. She is very playful and active and has a great appetite.She seems to have a good sense of smell, too. If you have any ideas ordifferent approaches we could try, we would love your help! Thank you,Lisa
A: Lisa-Chronic ear infections are almost alwaysfrustrating to treat. Taking Chloe to OSU was probably a smart move. Ican understand why you were worried about the surgery, though. It doesseem like a lot to put a cat through. The problem with cats and not doingsurgery is that many of them have otitis media because they have polypformation in the middle ear or Eustachian tube. Surgical exploration ofthe bullae may be the only way to diagnosis this complication in some cats.Medical treatment will not cause satisfactory resolution of the clinicalsigns if a polyp or cancer is present in the ear.
Just to be sure - otitis media is infection of the portion of the earthat is inside the ear drum. It can occur independently from, or in conjunctionwith, infection of the external ear. If both forms of ear disease are present,it is important to treat both.
I can not tell you if surgery is absolutely necessary for Chloe's comfortand good health but I would take the advice from OSU seriously.
Michael Richards, DVM
Itchy ears and allergy
Q: Dr. Mike, I recently moved to Missouri fromNevada with my three cats. Since living here, they have had several boutswith allergies during the spring. Last year, they began shaking their headsmuch like how you would see a cat react to ear mites. However, there wasno sign of mites and my local vet said it was a symptom of allergies. Itthis common for cats to shake their ears when suffering allergies? Whatcauses this reaction? Spring is here and the shaking has started. Thanksmuch! Kelly
A: Kelly - Allergies cause skin itching in dogsand cats. Since the ears are just specialized skin, they itch too whenallergies are present. It is also possible for allergies to interfere withequalization of the pressure in the middle ear due to inflammation of theeustachian tube. This can cause irritation or even pain and may be thesource of the head shaking behavior in some cats.
We have some luck treating cats with this sort of problem with antihistamines.We usually use chlorpheniramine (Chlortrimeton Rx). You might want to askyour vet if he has had any luck with this and for a dosage recommendationfor your cat, if so.
Michael Richards, DVM
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...