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Ear Infections In A Dog

by CorinneC - April 10, 2019 View Case Report

Mei-Mei is an 11yo FS Cocker Spaniel - lovely sweet girl!

She developed IMHA and ITP several years ago. The history is muddy but I suspect vaccine induced. Her CBC has been WNL for over 2 years now and she takes Azathioprine EOD, Pred was stopped 2 yrs ago. The owner is afraid to take her off completely. I met her March 25th for an ongoing ear infection (started last MAY!!!!). Her ears are extremely sore and pruritic, swollen, and exude a white-yellow creamy pus. I cannot visualize the horizontal canal or tympanic membrane in either ear. She has been give several course of ear medications and antibiotics which all initially worked to clear the ears temporarily but I took a swab for C & S because I was worried this was getting out of hand = + for Methicillin-resistant Staph 4+. She is on monthly Nexgard, has had several 14 day dosing of Otizole, Surolan, Mometamax (7 day only here), and now Osurnia. She responded to Cephalexin initially but is now resistant.

She also tends to break out in a ventral belly and inguinal "rash" where she gets patches of erythematous, dry, slightly elevated scale with light yellow crusts. They are pruritic and she will drag her belly to relive. Her dorsal coat looks healthy.

Her pulses are slightly narrow and toned and her tongue is a dark pink/purple, wet , no swelling. I started her on Qing Qing Tang and Hoxsey to take down Heat. She seemed to respond well initially as ears weren't as sore and the ventral skin was lighter pink, drying up. However, I also added Si Miao San one week later and it seems to have set us back. Her ears are back to white creamy pus, pain, and her belly is flaring up again. I assume I draining Damp where I should be tonifying Blood and Yin? Anyways I started her on Clindamycin to get her more comfortable while I figure out the TCM end of things.

I am wondering about a SHaoYang disharmony now? Or should I just persist with QYT and Hoxsey? Nothing is really giving this dog relief but am I crazy to think I can "fix" her with Azathioprine on board?

Thanks in advance,
Corinne

by naturevet

April 12, 2019

Hi Corinne,

Si Miao San internalizes the blood supply, whereas the pulse tells us that circulation needs to be externalized (regardless how red things are) to help actively resolve chronic inflammation. Moving the blood supply inward stopped the inflammation-resolving process and perhaps weakened local immunity, strengthening the pathogen. The cold herbs in Hoxsey and QYT helps these two formulas enhance circulation without aggravating existing inflammation

Given the longstanding use of immune suppressants, I suspect you need to stimulate some immunity, and in a case like this with such severe inflammation, Bupleurum is the best plant for that. So I'm with you that the next choice is something like XCHT, perhaps mixed 2:1 with Si Wu Tang

I think you could roll it in now, or give the dog time to plateau on your existing treatments - whichever you and your client prefer

Steve

by CorinneC

April 24, 2019

Hi Steve,

MeiMei's ventral skin inflammation has cleared but her ears continue to exude white creamy pus :( She has now been on the Clindamycin 3 weeks, the Hoxsey ongoing, stopped QYT 3 weeks ago (owner ran out and did not refill), and XCHT 2:1 SWT for 2 weeks.

I'm wondering if you've ever had success with anything put into the ear (of course I know it's risky since we haven't seen her eardrums in months). I'm just so sad for this dog. Am I expecting too much too soon with the herbs?

Corinne

by naturevet

April 24, 2019

Hi Corinne,

Hoxsey has the same circulatory effects as Si Miao San, and so may be getting in the CHSWT's way. I'd probably stop it.

Topical treatment is not a problem. To avoid hindering the healing process with topical steroids, the first thing I do is take a hexadene ear wash and add 1 ml of tea tree oil, and then have the owner flush the ears once a day. Assuming there is no evidence of ear drum rupture, the owner should fill the ear to the brim with the solution, massage the canal briefly, then allow the dog to shake its head so she can wipe away what gets spun out. Another solutions that can serve as a base for the tea tree oil might be Chamomile or green tea, concentrated two to three times more than normal.

Our worst otitis case finally has somewhat dry ears after a couple of months of steady herb use. If the dog is in a real food diet, adding soluble fiber (like pureed cooked beans) and probiotics can help the ears, too

Steve

by CorinneC

June 25, 2019

Ok so update on Mei Mei! We ended up staying solely on XCHT with SWT as you suggested. I also made up a Burrows solution combined with Mupirocin and her owner applied daily to flush. Mei Mei has been ear infection-free for 2.5 months!!!!!! Thank you once again for all of your help!

by CorinneC

June 26, 2019

Ears are both cleaned of yeast and bacteria! Burrows solution with Mupirocin really helped and she continues on her QYT.

by naturevet

June 29, 2019

Awesome! Thanks for the update!

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