Anxiety and otitis: What a pain in the ear

Photo: Shutterstock.comWe all know ear appointments don't always go according to plan. Things can go from cakewalk to chaos quickly-and much of that could be due in part to fear and anxiety in dogs. To get a leg up on the combination of pain, anxiety and otitis, consider these key steps:

Patients with the dreaded combo

In my dermatology referral practice, I'd estimate almost every dog with otitis is painful, and about half of them are fearful or anxious. I think three factors may increase the risk of ear-related anxiety:

> The breed. Label them however you want, but we all know which breeds tend to be more stressed-especially in a veterinary environment.

> Time spent suffering. This doesn't just mean the current episode of otitis, but rather the length of time between the very first episode of otitis and the current episode. Most allergy dogs suffer from recurrent otitis for months, years or even their entire life.

> The owner's anxiety. We all know that dogs take cues from their owners. If clients are scared about cleaning or medicating the ears, dogs are more likely to think they should be worried. (Hey! Here's another reason why it's so important to demonstrate ear cleaning and medicating!)

Clients and home care

Many dogs resist ear cleaning and the application of ear medication. This includes those dogs that run and hide when they see the bottle of ear wash. But I see at least two other common presentations that clients should watch out for when they're at home with their pet.

> Becoming less social. These dogs eat and drink and do basic dog activities. But when given the choice, they are quiet and return to their bed or crate.

> The subtle shrug-off. There are dogs that imperceptibly move away when their owner rubs their ears. I have had many clients who never correlated the fact that their dog had become head-shy with the presence of an ear infection.

Less common symptoms I've seen include reduced food intake, reduced chewing on bones and reduced barking.

Veterinary team: Clinic care

To start, you have to be open to the idea that otitis is painful-and that pain is stressful. Because of this, chronic pain is especially stressful. Second, veterinarians need to educate their team so everyone is on board and aware. This helps your team talk to clients on the phone and more effectively encourage exams rather than another refill of ear drops.

Be observant. This starts with receptionists observing the dog in the waiting area. Then technicians notice behaviors when moving the patient to an exam room. Then finally the veterinarian must watch with a keen eye to pick up on subtle movements and actions in the exam room. All of this helps the veterinarian ask more specific questions such as:

> “Our receptionist, Lauren, noticed that Spot was rubbing his head against the chair in the lobby, then whining. Does he do that at home?”

> “Our technician, Molly, saw Spot with his head tilted a little and veering off to the side when you came to the exam room-have you seen him do this at home?”

> “I realize that Spot may be nervous today, but he seems to be avoiding your hand when you try to pet his head. Is this a change from his usual behavior?”

Convince the owner! Most people are fortunate enough to have never experienced an ear infection. But those who have as an adult never forget the pain. This message may also connect with parents of younger children-ear infections in kids are common, and many parents have spent sleepless nights trying to soothe crying children with their pain.

For those clients who don't have the joy of either of those experiences, I use the analogy of a headache that won't go away or an infected tooth that needs a root canal. Ear pain is a type of pain that stays with you no matter how you walk, sit or lie down. There's no avoiding it. An observant team also helps convince the client. If several of your team members express genuine concern about the way the dog is acting, the owner might look at the problem from a new angle and realize that pain is part of an ear infection.

Want my top tips? They're on the next page!

My top tips for soothing this painful process

First and foremost, do no harm. As you talk to the client and observe the dog's behavior, ask yourself if physically restraining the patient is viable. You can force most dogs into an otoscopic exam once … but if it becomes a wrestling match, you may never get to look in that dog's ears again. Plus, if you and your team struggle with the dog to examine his ears, then what chance does your client have at home?

The dog that struggles in the clinic remembers that any time someone touches his ears the result is pain and lack of control-both of which increase fear. Don't let your ego (i.e., “This dog is going to let me see his ears or else!”) ruin your client's chance of good home therapy. It's better to sedate painful, anxious and uncooperative dogs.

Think low stress! When a dog presents for otitis, you need to avoid grabbing the ear as soon as the dog is on the table. Perform the rest of your physical exam and allow the dog to become more comfortable with you and the exam room first. Then approach the ears slowly and gently. If the dog is very painful or aggressive, stop and discuss sedation. If the dog is simply uncomfortable, try distractions with treats. You may have to look in one ear, then take a break for a few minutes before examining the other ear.

Finally, remember positive rewards and practice make perfect. This requires a client who sees the problem and wants to make it better. It's our job to show them how to do it, but obviously the practice and true work happen at home.

Have the client start with a sit or down command (an easy one so the dog can get a reward). Then start gentle touching of the external pinna followed by a treat. They can slowly work through touching more of the pinna, then touching the aural opening, then wiping the aural opening and concave pinna with a gauze square or facial tissue.

After all of these steps have become easy and well-rehearsed, it's time to try actual ear cleaning by instilling some ear wash into the canal. Just like with any other training exercise, break the task down into small parts and go slow. Praise good behavior vigorously and avoid accidentally condoning bad behavior. Remember that even dogs without ear infection may resist having ear wash poured into their ear.

If your team or clients are feeling burned by otitis, stop and consider your approach. With some simple adjustments, you may be able to take much of the pain out of this process-for pets, for clients and for your team too.

Dr. Darin Dell spent six years in general practice and two years in emergency medicine before becoming a diplomate of the American College of Veterinary Dermatology in 2012. He is currently on staff at Animal Dermatology Clinic in Indianapolis. Dr. Dell's hobbies include woodworking and mountain biking.