Ear Mites Or Not?

Alycin sent this email....

I found your blog by searching for "symptoms of ear mites but not ear mites"... But the thing is, it isn't an ear infection, either, according to two different vets I took her to.

I love my dog more than anyone, whether that's healthy or not. I am at a loss because I can tell she is miserable. The vet I took her to today gave me an ear wash (epi-otic I think?)  but assured me her ears looked fine. I don't have the money to keep taking her to different vets to get told there isn't anything wrong with her.

Are there any other possible causes of these symptoms? Thank you for any help you may be able to offer.

One of the most common things I see in practice is people thinking their dog has ear mites.  Honestly, it's not that common.  I see this probably less than once per year.  Yes, it's possible, but the huge majority of the time there is something else going on, usually an infection.  For whatever reason it seems that more people have heard of mites than infection, so that's what people jump to.

There are a few symptoms that tend to lead to people bringing their pet in for an ear problem:  debris or "goo" in the ears, itchiness (shaking the head or scratching at the ears), redness, or a bad odor.  Any or all of these can be signs of an infection or mites.  Personally I've noticed that ear mites tends to cause a darker, drier debris than ear infections, but you can't make the diagnosis based on this alone.

Every veterinary dermatologist will tell you that when you have a suspected ear problem, the very first thing you do is get a swab from the ear and look at it under the microscope.  If your vet isn't doing this, you need to have a talk with him or her.  In cases of ear mites it's normally easy to find the mites and/or their eggs.  In fact, I commonly will see several life stages and even mating mites when I have a confirmed case.  We stain the material from a swab and examine it under the microscope for yeast and bacteria.  Certain types of bacteria may be resistant to treatments, so if there are "rods" we usually want to send a sample to a diagnostic lab for culture and testing against antibiotics.

So we have a couple of possibilities in these cases.  

1.  The vet finds evidence of mites.  The ear is cleaned of debris, and medicine is prescribed.  Most commonly this involves drops in the ears, though Revolution and Advantage Multi are also effective against mites.

2.  The vet finds yeast or bacteria. The ear is cleaned of debris (yes, this is very important!  debris can inactivate some medications!) and medicine is prescribed.  Since ear infections typically are in the skin lining the ear canal, we heavily rely on topical treatments.  There are numerous types of drops or ointments on the market, and the vet's choice is normally based on the types of organisms seen as well as a liberal dose of personal experience and preference.

Then we have #3.  The pet is itchy and the ear may be red.  But ear swabs come up negative!  No mites, no yeast, no bacteria.  What do you do then?  What could the cause be?

Now, I'm not a dermatology expert, and in fact I really hate dermatology.  But practicing in the southeastern US where it's hot and humid for most of the year I've by necessity had to become good with skin and ear problems.  One of the single most common reasons for skin and ear irritation and infection is underlying allergy disorders.  I have seen several cases over the years where the dog is very itchy and the ear is reddened, but there is no debris or infection. In my personal experience these cases have always responded to treatment for allergies.  A food hypersensitivity or seasonal allergy can cause intense itching without automatically having lots of other symtoms.

Alycin, this is the direction I would recommend you pursue.  If several vets are absolutely sure there is no infection or mites, talk to them about therapy for allergies.  I have seen many vets miss this as a cause of problems like you describe, as well as chronic skin and ear infections (and I've blogged about this mistake).  Depending on the situation and severity, your dog might be helped with antihistamines, corticosteroids, or a switch to a hypoallergenic diet.  Some of the options are very inexpensive and affordable.  Talk to one of the vets you've seen about these options and possibilities.