Overcoming client challenges in canine otitis treatment

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Otitis can be a challenging condition to manage in canine patients, so recognizing common compliance challenges can help ensure each patient is getting the proper care. Making it a team effort between veterinary teams and clients can make it easier to understand the challenges each client faces when it comes to treating pets.

During her lecture—Missing links In the medical management of chronic otitis—presented at the Veterinary Meeting & Expo conference in Orlando, Florida, Elizabeth R. Drake, DVM, DACVD, shared some of the obstacles she has encountered with clients when treating otitis patients, how she gets around them, and the crucial aspect of understanding client expectations and lifestyles.

Treatment obstacles and expectations

Drake told attendees it is better to say "treatment obstacles" instead of "compliance obstacles" because owners want to do the right thing, but they may struggle to do so without a maintenance plan. For patients with otitis, it can be challenging for clients to apply topical medications because of how painful the ears can be, making them wish for a “magic pill” of some kind. Although this magic solution is not available, understanding the challenges clients could face with treatment can help teams design a therapeutic plan for each client.

Drake, for example, stated if the pain is preventing clients from treating the otitis with topical solutions, an oral steroid could be considered for a few days to decrease the pain and swelling for the patient to be more comfortable. Veterinary teams can also choose products that can be administered in measured-dose syringes rather than a predetermined number of drops. Because owners have to count the number of drops to make sure the patient is getting the correct amount, this can take longer, making it harder for the patient to get the full dose if they are in pain.

Besides pain, the sizing of the ear canal can also present an issue for administering the medications needed. Drake shared findings from some of her research conducted with students at Iowa State University, and Jim Noxon, DVM, DACVIM.

“What we were able to show, using CT scan and measurements by the radiologist, is that body weight is directly a linear relationship to the volume of the ear canal. And that seems very logical, but that means some of the medications that are labeled for 8 drops or 4 drops, or what have you, have no chance of being successful in a dog with a large, large, large ear canal," she explained.

“And so the body weight is linear, except for the brachiocephalic breed, it's where you really can't tell, just like when you're trying to use an endotracheal tube, it's hard to predict the size. So the larger the dog, a big Hound Dog 2, mils of medication is a lot more than the label allows for,” Drake continued.

Veterinary teams may also need to consider the client's lifestyle when it comes to designing a plan for them. For example, with organisms like Pseudomonas spp, which is likely to develop resistance, it can be important to utilize a chelating agent like tris-EDTA, especially when the veterinarian is prescribing enrofloxacin to minimize the resistance. When prescribed together, owners are likely to administer these products separately as a ”flush” and “ear drop,” which mean the owner may abandon the flush portion of the regimen or it will occur less often than necessary, which can be more common in a busy household. Drake explained this is why the chances of success will improve if veterinary teams are looking for “one-stop” treatment.

Drake also explained that sometimes, when it comes to administering treatment, sometimes veterinary teams need an alternative or creative approach to make sure the patient is getting the medication they need, and the owner has success administering it.

For expectations with treatment, the desired outcomes for the patient can differ between clients and veterinary teams. Drake explained most clinicians will wish for their patients to be comfortable at a minimum, and everyone wants to discuss the origin of the problem. This may not be possible for those patients suffering from chronic conditions, but making an improvement in a pet's quality of life is always a welcomed occurrence with treatment, Drake stated in her provided proceedings.

Clients tend to want to treat the condition once and then never again. It is common for clients to ask for surgical intervention when presented with this mentality. However, if the primary problem is allergic disease, inflammation, pruritus, and lichenification of the ear tissue that remains post surgery will continue, despite if whether a total ear canal ablation and bulla osteotomy are performed.

Reference

1. Drake E. Missing Links In The Medical Management Of Chronic Otitis. Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.