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Chronic Left Ear Infection In A Dog

by CorinneC - April 17, 2025 View Case Report

Odin is a 2yo intact male French bulldog with severe brachynathism (why is this still allowed? When will we fight to end the breeding of these poor creatures?). He is lovely but came to me as a second opinion for a persistent left ear infection. For 4 mth the previous Vet had tried to get on top of the issue. He also has itchy feet that he was licking incessantly but the owner started spraying with an over the counter foot spray that has apparently helped. He has had courses of Mometemax, Surolan, Claro, Prednisone, Cytopoint, and Apoquel to no effect according to the owner. He was sedated and the ear explored, Vet did not culture, just cytology which showed cocci and yeast but did not respond to the above. The O says his ear consistently leaks a straw colored liquid that has an odor. The O also daily “cleans” the ear with tissue by making a thin cone and tries to remove fluid.

I saw him last week for the first time. He is very sweet, although the previous Vet was afraid of him, I have never seen an aggressive gesture. He will nudge my hand away from his hind feet but no teeth or nastiness. He has a pretty normal pink, moist tongue, maybe a little small and thin. His pulses are toned to taut, I feel somewhat wiry. His left ear has whitish-grey blister-like lesions, a bit cauliflower-like at the vertical-horizontal junction and it’s too wet to see the tympanic membrane. Not overly painful, nor particularly smelly either. Just very wet.

His feet have 2 small interdigital cysts, small at 5mm round, sl raised, semi-firm, non-painful, one on RF between digits 4 & 5. Other LH between digits 3 & 4.

He has terrible stertor and stenosis nares and a giant block head.

I started him on Cessorex as I felt like he was a Shaoyang disharmony with major immune issues. I also started him on Baytril/Dex ear drops while waiting for the culture.

The culture and sensitivity came back and was positive for Staph and Strep, sensitive to many things, including the things he’d had previously including the Baytril. This week he came in and his ear was worse according to the O, saying that it now seems more inflamed, that the canal is more narrowed and puffy. Now his skin is really dry and dandery, a little itchy, and he is shedding like crazy. So I’ve dried him out with the Bupleurim I think? But this crazy ear?!? I’ve now temporarily stopped the ear drops and Cessorex and started BZYQT with the idea that he is a Wei Qi Deficiency with Liver Blood deficiency. But I don’t know WHAT to do next?!?!? Aaarrrrghhh!!!

Please help!!! My boss thinks he should go to a dermatologist but the owner is so frustrated and wants a holistic option. He’s also been told this guy, in order to neuter him, will need a specialist to do the surgery as he needs the nose, laryngeal saccules, and soft palate resection. Looking at a solid 10K procedure!!! He doesn’t even want to consider putting him under GA if we can’t figure out the ear. Very disheartening.

I’d really appreciate your take on this! Writing at night without files. Will review in the am and clarify if I’ve missed anything else.

Corinne

by naturevet

April 20, 2025

Hi Corinne,

I like your idea of Bu Zhong Yi Qi Tang. It's one option for sure. The lack of response to immune suppressants suggests an immune deficiency, as does the failure of antibiotic treatments for the ears in the past, to the point that the bacteria are sensitive to everything. Antibiotics just don't work without an immune system to help them.

Other signs of deficiency compatible with BZYQT include the mild (but present) interdigital lesions and the dog's young age. The thin yellow fluid suggests a deficiency cause as well, with thick turbid discharges signifying excess. The drying of the coat suggests Blood deficiency and occasionally Wei Qi deficiency (which you're addressing with BZYQT).

Given all that, I would anticipate some improvement. My other thought was Chu Shi Wei Ling Tang (in case it was the oral antibiotics that aggravated the dog, since Cessorex is not really that drying). CSWLT also fits the abundance of moisture (which you could interpret as Damp) and persistent bacterial overgrowth (although that is usually associated with lichenification in CSWLT cases). So it's not my top pick but I guess keep it in mind.

Hopefully you get somewhere with this case! If you don't, then we'll have failed together. Small consolation, but misery loves company

S

by CorinneC

April 22, 2025

Ok, I am so happy to hear this BUT!!!!...he came in last Thursday and his left ear was seeping bloody fluid. The male O is very obsessed with his ear and will stick a cone of tissue down it to draw up the fluid, but I think this has only added to irritating the ear further. So at this point the female O was quite upset (not with me, but with the blood). I applied Osurnia and started him on Prednisone while we get the BZYQT on board. I see by your notes that the Pred may not touch it, as it didn't in the past, but I felt pretty desperate to get this ear more comfortable. I also told the O to stop the tissue cleaning and just dab from the outside. I see him again in a couple of days but also left a message today for an update.

by naturevet

April 22, 2025

Qing Ying Tang works well with BZYQT. Consider even Yunnan Bai Yao

S

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