Common Ear Diseases in Dogs: Diagnosis and Management

This chapter discussed some common ear illnesses such as otitis, haematoma, tumors etc. and establishes the groundwork for understanding the significance of ear health in dogs. We will go more into each ear ailment and examine diagnosis and treatment options in the upcoming chapters. It is crucial for any veterinarian to comprehend the anatomy of a dog's ear, identify common ear illnesses, and know how to diagnose and treat them.

Hearing is one of the fundamental sense. Ear also known as the vestibulocochlear organ, is subdivided into three parts namely external, middle and inner ear. Auricle and external acoustic meatus comprise external ear. Sound waves are transmitted from the external ear to the middle ear. In dogs, breed-specific variances of external ear is noticeable. The auricle has a funnel-like shape which helps in sound collection. Auricle is divided into the proximal conchal cavity and distally located scapha. Anthelix divides the conchal cavity from the scapha and is located close to the conchal cavity. External acoustic meatus is made up of a proximal osseous portion and a distal cartilaginous portion. The cartilaginous portion of carnivores is relatively long and curved which hampers the passage of the straight otoscope for examination. The tympanic membrane consist of two parts, namely the pars flaccida and the pars tensa. The middle ear comprises the auditory ossicles (malleus, incus and stapes), muscles and auditory tube. Tympanic cavity is contained in the petrous temporal bone and has dorsal (epitympanicum), middle (mesotympanicum) and ventral (hypotympanicum) section. Auricular ossicles are located in the dorsal portion. The tympanic membrane is located on the lateral wall of the middle portion. The tympanic bulla is known as the ventral hypotympanicum. Internal ear has membranous and osseous labyrinth. The membrane labyrinth is filled with endolymph and includes the vestibular labyrinth which houses the receptor organ for balance and cochlear labyrinth containing the organ of hearing. The osseous labyrinth consists of vestibule, semicircular canals and cochlea. While defects in the inner ear may result in sensorineural hearing loss, defects in the outer, middle, and middle ear can cause conductive hearing loss. Therefore, it is crucial to research the anatomy and physiology of the ear. This chapter's main objective is to explore the fundamental anatomy and physiology of numerous components of the canine ear that plays a vital role in hearing. 

Sense organs that is eye, ear, nose, tongue and skin provide a true sense to communicate with the outer world. Ear is the organ of hearing and balance. Ear is a complex organ consisting of three divisons, the outer, middle, and inner ear. The structures of the external ear are auricle, external auditory meatus and outer layers of the tympanic membrane. The middle ear is an air filled cavity (tympanum) consists of ear ossicles, auditory tube (Eustachian tube), middle ear muscles, inner layer of the tympanic membrane. The internal ear consists of the osseous labyrinth consisting of cochlea, vestibule and semicircular canals and membranous labyrinths and the vestibular and acoustic (spiral) ganglia associated with the eighth cranial nerve (vestibulocochlear nerve). The auditory system of ear convert sound waves into neural signals. The auricle acts as a condiut to collect the sound waves. The middle ear acts as a precochlear amplifier and impedance matching device. Transduction of sound occurs in the cochlea by spiral organs (formerly known as organs of Corti) resulting in an action potential that transmits along the auditory nerve to cochlear nucleus in the brainstem for hearing. The vestibular system plays an important role in maintaining the equilibrium and balance of the animal. It is a primary sensory organ consisting of vestibule and semicircular canals which orients with respect to the gravitational field of the earth and co-ordinates the movement of various sensory organs and thus the linear, rotatory, acceleration and deacceleration movements of the animal. 

Otitis is an inflammation of ear in dogs, can be noted following primary, secondary, perpetuating and predisposing factors. Otitis externa is more frequent than otitis interna and otitis media. Globally the prevalence of otitis externa is 5-20% which reach up to 30-40% in tropical environment. Infections in otitis externa is generally secondary after inflammation. The mycotic microorganism reported from otitis are Malassezia pachydermatis, Aspergillus spp., Candida spp. While, the predominant bacteria belongs to Staphylococcus spp., Enterococcus spp., Pseudomonas aeruginosa, Streptococcus spp., Corynebacterium spp., Proteus spp., Escherichia coli and Klebsiella spp. In culture, the yeast Malassezia pachydermatis and bacteria Staphylococcus pseudintermedius predominates. With advent of metagenomics Finegoldia magna, Peptostreptococcus canis and Porphyromonas cangingivalis anaerobic bacteria were identified. Colonization of ears by antibiotic resistant microorganism makes the treatment challenging for the veterinarian. The bacterial culture along with antibiotic susceptibility test is recommended.

Ear diseases represent one of the most common clinical presentations in dogs seen by small animal practitioners. These conditions can arise from primary causes, secondary causes, and perpetuating factors, all of which are essential to identify for successful management. Cytology, the study of cells, offers a nonexpensive, readily available, and low cost diagnostic tool that can be utilized to screen dogs with ear diseases. The ear infection can be judged by the clinical examination, ear examination by otoscopy, imaging diagnostics, cytological intervention, and proper treatment should be undertaken based on the severity and duration of the infection in the ear. Cytology proves useful to clinicians for assessing the origin of types of infectious, such as yeast, mites, and bacteria; presence of types of leukocytes. In cases of recurrent or non-responsive ear diseases, cytology should be complemented with culture and susceptibility testing. Yeast, including Malassezia and Candida, can be identified on cytology by their specific morphology on cytology, which is crucial for selecting appropriate topical ear medications. Cytology also provides valuable information about mite infestations and the intensity of mite populations. It serves as a useful tool to assess the endpoint of therapy and ensure the resolution of infection. Additionally, cytology aids in decision-making by guiding the selection of antimicrobial medications and /or proceeding with further diagnostic methods, while also determining the endpoint of therapy. In cases where first-line therapy fails or bacilli are present, bacterial culture with an evaluation of antibiotic susceptibility is recommended. A comparison of healthy control dogs and clinical cases revealed significantly higher levels of organisms and inflammatory cells in the latter, with Malassezia pachydermatis isolated in both infected and healthy ears of dogs. Cytological examination of impression smears is a straightforward, readily applicable, and minimally cost-involved diagnostic method to provide the identification of etiological agents, which include bacteria, fungi, and mites. Processing and making the dermatological diagnostic cytological slide requires only professional skill without any special equipment, which can be evaluated in less time in routine clinical settings. Before receiving culture and sensitivity results, the immediate results of cytology are invaluable for making informed diagnostic decisions during consultations.

The chapter underscores the vital role of ear health in dogs, covering various aspects of the subject. It highlights the importance of a dog's ears in maintaining overall health and well-being, focusing on sensory perception, communication, balance, and orientation. The anatomy of the external ear is detailed, explaining the functions of its components. The diagnostic approach for otitis externa is described, involving observations, external ear canal cytology, diagnostic imaging, and differential diagnosis. Basic principles of ear cleaning are outlined, including restraint and handling, observation, and the cleaning process itself, performed manually or using advanced techniques and solutions. Prevention strategies are provided, promoting routine ear care, proper drying after water exposure, regular inspections, allergy management, and collaboration with veterinarians. This abstract offers a comprehensive overview of canine ear health, serving as a valuable resource for veterinarians, and dog owners interested in this subject. 

Ear hematoma is collection of blood between skin and cartilage of ear, and it is one of common surgical condition. This occurs due to self-inflicted trauma or many other multiple reasons which leads to rupture of blood vessels and capillaries. Dog breeds with pendulous or heavy floppy ears are prone to ear hematoma. Both Surgical and non-surgical methods are adopted to treat this condition but surgical method have better treatment results as compare to later. Reoccurrence is one of the most common post operative complications irrespective of available treatment methods. However, control of inflammation, edema and drainage are important determinants for an effective treatment strategy.

Traumatic ear injuries in dogs are relatively common due to their propensity to play, fight, scratch, and explore. Trauma to the ears can result from an external source or it could also be self-inflicted. Ear injuries can happen as a result of vehicular accidents, dog bites, ear burns, exposure to cold temperatures, faulty ear cropping techniques, and sharp objects. Mite and tick infestation, insect bite dermatitis, food allergies, and fly bites lead to intense pruritus and discomfort. Intense itching associated with such conditions can lead to excessive scratching and head shakingassociated traumas. Such trauma can lead to conditions like an aural hematoma, ear lacerations, broken ear cartilages, separation of auricular and annular cartilages, avulsion injuries, ear tip injuries, fractures of the tympanic bulla, tympanic membrane rupture etc. Medicinal treatment helps in management of ear infections but surgical intervention is required to deal with traumatic injuries.

Understanding pinna diseases is essential for veterinarians, pet owners, and anyone caring for dogs. The pinna, or external ear, plays a vital role in a dog's health and well-being, serving as a protective barrier for the sensitive inner ear, aiding in sound localization, and enhancing auditory perception. However, its anatomical features make it susceptible to various diseases, including infections, parasites, allergic reactions, traumatic injuries, and neoplastic conditions. Bacterial and fungal infections can cause inflammation, pain, and discharge in the pinna, necessitating proper diagnosis and treatment with antibiotics or antifungal medications. Parasitic infestations, such as ear mites and ticks, also target the pinna and require specific antiparasitic treatment. Allergic and immunologic disorders manifest as redness, swelling, and itching on the pinna, demanding accurate diagnosis and management strategies such as allergen avoidance, medications, or immunotherapy. Traumatic injuries, like hematomas, lacerations, and avulsion injuries, may affect the pinna, necessitating immediate attention to prevent infections and promote healing. Neoplastic diseases, both benign and malignant, require precise diagnosis and treatment planning. Understanding congenital and developmental disorders of the pinna is vital, as certain breeds may be predisposed to specific malformations leading to chronic ear problems. Genetic disorders affecting the pinna can contribute to hearing impairment or structural abnormalities, emphasizing the need for thorough assessment and management strategies. Recognizing the significance of pinna diseases enables early detection, intervention, and prevention strategies, emphasizing the importance of regular ear care and veterinary attention. By comprehending the anatomy and function of the pinna in dogs, optimal ear health and overall well-being for canine companions can be ensured.

Otitis due to allergy induced by dietary protein is a common problem in dogs and cats. Topical treatment mostly seems to be successful as temporary relief, but chronic recurrence of inflammation and infection can lead to permanent inflammatory changes, discomfort and anatomical dis-arrangements, with anti-microbial resistance. This makes the otitis condition difficult to treat by a veterinarian. Eventually, the changes can become irreversible and require a total ear canal ablation/lateral bulla osteotomy or ablative laser surgery. Proper diagnosis of subtle changes in an animal's lifestyle, diet and skin pattern is very important to be noticed. Most importantly, clinicians must appreciate that all recurrent ear infections in dogs are secondary. Treatment are usually in 2-3 phases: treating the root cause of the allergy, treating the ongoing damage and inflammation and pruritus, and elimination of secondary infections/ organisms. This will typically involve ear cleaning, topical anti-microbial therapy, and topical or systemic glucocorticoids. Novel treatments including herbs and special animal extracts for infection and inflammation may offer additional options in the future. Understanding the underlying causes and pathogenesis of the disease condition, diagnosing it at the right time and addressing the treatment in collaboration and association with primary veterinarian, referral dermatologist and pet parents can make a huge difference in the treatment outcome of food allergy induced otitis.

Ceruminous otitis is the most common type of multifactorial disorder in dogs and is commonly associated with bacterial and/or yeast infections. The main diagnostic workup for Ceruminous otitis requires a detailed history, thorough physical as well as ear examinations, and cytologic evaluation. Diagnostic imaging may be essential tool for assessing the extent of mineralization of cartilage in the external ear and destruction of bone in the middle ear. If the ear canals are severely inflamed, pretreatment with systemic anti-inflammatory drugs is needed before flushing. Frequent ear cleaning with appropriate topical medication can control the odor associated with this condition. Steroids, cytotoxic drugs, and retinoic acid have variable effects to control ceruminous otitis.

Epithelial migration plays a crucial role in maintaining the health of the ear canal and tympanic membrane. This process involves the movement of keratinocytes, and it serves to eliminate debris, prevent cerumen (earwax) buildup, and facilitates the healing of tympanic membrane damage. Keratinocytes not only acts as a physical barrier but also have immunological capabilities to protect the ear canal from contaminants. Failure of epithelial migration can lead to ceruminoliths, which are hard earwax concretions that can cause discomfort and even hearing loss. Ceruminoliths are commonly associated with factors like over production of cerumen, obstruction in the ear canal, and damage to the germinal epithelium. Diagnosis of ceruminoliths typically involves otoscopic examination and otic cytology. Management options include cerumenolytic agents, irrigation, and manual removal under vision, each with its own considerations and precautions. Treatment of the underlying cause, such as ear mite infestations, may also be necessary to prevent ceruminolith formation. This comprehensive review sheds light on the mechanisms, causes, diagnosis, and management of ceruminoliths, emphasizing the importance of ear health and the various strategies for effective removal.

The nervous system's vestibular system is primarily in charge of preserving the animal's balance and orientation in reaction to gravity. It recognises the head's rotational movements, static position, acceleration, and deceleration. After then, it synchronises the head's movement and position with the position of the eyes, trunk, and limbs. The vestibular system's structure and the symptoms of malfunction is covered in part one of this article. Part two explores the various illnesses that may be at the root of this and gives in detail the proper diagnostic procedures, available treatments, and associated prognoses.

An ear is called a vestibule-cochlear organ since it enables to hear as well as sense of balance to animals. The external portion of the ear consist of a flap known as pinna and an opening at the base of the ear. Otitis externa is defined as an acute or chronic inflammation of the epithelium of the external ear canal which may also involve the pinna and it results from a combination of dynamic changes affecting the anatomical, psychological and microbiological status of the external ear canal. The etiological factors of the otitis externa can be categorised as predisposing factors, primary causes, perpetuating factors and secondary causes. Predisposing factors are those which increase the risk of developing otitis externa, whereas primary causes directly induces otitis externa. These long-term alterations causes the skin to be thicken, the canal to become stenosed, and a great deal of folds to form, all of which prevent the area from being cleaned effectively and serve as a breeding ground for secondary infections. Diagnosis of otitis externa is done by proper history and symptomatology, roll smear examination for mites and other cytological evidence, otoscopy, isolation and cultureantibiotic sensitivity test for selecting suitable antibiotic for treatment.

Generally otitis externa can be treated by application of suitable cleansers, topical antibiotic and anti fungal therapy along with corticosteroids. Sometimes it is difficult to treat chronic and recurrent otitis externa.

Otitis externa and otitis media are prevalent conditions in veterinary medicine, frequently encountered in dogs suffering from chronic ear ailments and in cats affected by upper respiratory diseases and polyps. Detecting otitis media necessitates a comprehensive evaluation of the patient's medical history and clinical manifestations, coupled with additional diagnostic techniques to ascertain the presence of disease within the bulla. In cases where the integrity of the eardrum cannot be definitively assessed, it is judicious to assume the presence of middle ear pathology and initiate appropriate management. An essential precaution is to abstain from employing potentially ototoxic ear cleansers and topical medications in suspected otitis media cases. The successful treatment of this condition often involves a combination of systemic and topical therapies within the thoroughly cleaned bulla.

Within the realm of veterinary practice, otitis media is an affliction that is all too common and frequently proves to be a vexing challenge. Its diagnosis can be a laborious and, at times, invasive process, incurring substantial costs. Otitis media typically emanates as an extension of external ear afflictions, often arising as a consequence of chronic otitis externa. Furthermore, the presence of otitis media can be a causative factor in cases where treatment for otitis externa has proven ineffective, underscoring the imperative of reaching a definitive diagnosis to guide appropriate therapeutic interventions. Otitis media, or middle ear pathology more broadly, poses a diagnostic conundrum, as the presenting clinical signs often mirror those of otitis externa, rendering differentiation difficult in the absence of evident facial and/or sympathetic nerve dysfunction. It is worth noting that otitis media can progress, in some instances, to otitis interna, giving rise to peripheral vestibular syndrome symptoms. This underscores the critical importance of recommending tomographic imaging in situations where chronic otitis externa manifests as a suppurative or proliferative condition.

Otitis interna define as inflammation of inner ear, which will be an extension of infection from the otitis media or secondary to the chronic otitis externa. Improperly treated / untreated cases of otitis media can lead to development of otitis interna by involving the tympanic membrane. Clinical signs in otitis interna were impairment of hearing apparatus i.e. deafness and neurological indications such as tilting of the head towards the based on the side of the ear affected, development of the horizontal or rotary nystagmus, unequal legs coordination with diffused strength, circular walking pattern, sudden collapse, and even rolling towards the impacted side. Complication of otitis interna leads to development of life-threatening iotrogenic intracranial infections and meningitis by travelling the infectious organisms to the brainstem. In dogs with severe otitis interna that progressed to an intracranial infection, changes in mentation, ataxic changes, paresis, proprioceptive deficits, and development of seizures. Diagnosis of the otitis interna achieved by detailed history; dermatological, neurological and systemic examination along with the identification of underlying and/or associated factors. Otoscopic examination, cytology, microbial culture, antibiotic sensitivity test, radiography, computerized tomography scan evaluation and magnetic resonance imaging are helpful to differentiate the extent of lesions and severity. Medical management of otitis interna is carried out by identifying the suitable antibiotic by antibiotic sensitivity test followed by the correct dosage and duration approximately ranging from 4 to 8 weeks along with the systemic corticosteroids which have been advised to reduce the stenosis. When there is rupture of tympanic membrane, cautious utilization of topical antibiotic and/or anti-inflammatory preparations are advisable. If medical management fails to respond, surgical intervention are advised with vertical ear canal ablation, lateral ear canal resection, total ear canal ablation with lateral bulla osteotomy. 

Total Ear Canal Ablation (TECA) and Bulla Osteotomy are surgical procedures in veterinary medicine utilized to address various ear-related conditions, primarily in dogs and cats. TECA is indicated for chronic inflammatory ear diseases, trauma, neoplasia, cholesteatoma, congenital malformations, and failed prior surgeries. It involves the complete removal of the ear canal, often coupled with Lateral Bulla Osteotomy (LBO) for middle ear issues. LBO is essential for conditions like otitis media. Preoperative evaluations encompass physical exams, otoscopy, and imaging, with antibiotic and analgesic administration. Surgical equipment includes specialized instruments like rongeurs, curettes, and retractors. The surgical procedures require meticulous technique to ensure patient safety and involve incisions, dissection, and removal of affected tissue, with a focus on preserving vital structures like the facial nerve. Postoperative care includes pain management, bandaging, swelling control, antibiotic therapy, and drain/suture management. Potential complications include nerve damage and hearing loss. TECA and Bulla Osteotomy are crucial interventions for alleviating chronic ear problems in animals, enhancing their overall quality of life. 

Canine ear consists of external pinna, external ear canal, middle ear and inner ear. External ear with its cartilage structure catches the sound while middle ear through its three unique ossicle structures and tympanic membrane transmits the wave to internal ear. The bony labyrinth and associated structures of inner ear along with different nerve innervations in inner and middle ear acts as sensory organ for hearing and balance. The complex nerve structure which passes part of its course through middle or internal ear structures also innervates the surrounding facial, lip, ear, nose, eye, neck regions. Thus, a little obstacle or infection (otitis media or interna) in middle or inner ear affects the nerve function and creates different muscular or nueurogenic abnormality presented through different clinical symptoms. Among various canine ear problems, the most common vestibular diseases (peripheral and central), namely horner’s syndrome, hemifacial spasm, deafness, facial nerve paralysis are discussed briefly in this chapter. 

The adverse effects of many medications used in veterinary treatment might cause hearing or balance problems in an animal. Although the predominance and ototoxicity pathways in both humans and lab animals have been well explored, significantly less research has been done on domestic dogs and cats. Since these adverse effects are universal among species, one can extrapolate from them and provide the veterinarian with details regarding possible chemotherapeutic side effects.

Para-aural abscessation refers to the extension of purulent inflammation and infection outside the deeper parts of the external ear canal or the middle ear cavity, into the surrounding soft tissues. It can arise from trauma, neoplasia, foreign bodies, chronic otitis externa and previous ear surgery. Clinical signs of pain upon opening the mouth, para-aural swelling and the development of draining tracts in the region of the ear base and parotid gland can appear followed by signs of otitis interna such as ataxia and head tilt toward the affected side, and of facial nerve paralysis. Otoscopy will usually allow recognition of obstruction; however, large abscesses can be opened and drained if indicated before definitive treatment. Apart from contrast radiography (fistulograms), CT imaging is recommended as a diagnostic technique as it provides useful information with respect to the cause of the condition and the recommended surgical approach. Various diagnostic procedures and surgical approaches recommended for the treatment of para-aural abscessation have been elaborated in this chapter. The success and outcome of a surgical procedure does not only depend on the knowledge, experience and instrument and tissue handling of the surgeon, but also on the best periand postoperative care. In this chapter, peri- and postoperative analgesia, peri- and postoperative antibacterial therapy, postoperative nutritional management and postoperative dressings and wound management of patients undergoing ear surgery will be discussed under different headings.

Inflammation is the main cause of ear pain and it is termed as otitis. Pain is an entirely subjective experience and in animal species the assessment of pain is more challenging compared to humans. The pain should be recognized as early as possible in companion animals and should be treated accordingly, particularly the acute pain. Any types of tissue injury in the animals can be generator of pain. At times pain may occur in the absence of such causative factors also. Understanding the mechanisms of pain is very important for successful prevention and treatment. Assessment of pain is a vital and essential part of patient evaluation not only in individuals presented with a problem of pain but also in routine check-up individuals. Different classes of pharmacological agents are available and they are used for the management of pain. The chapter intends to present a practical and logical approach to the assessment and management of acute and chronic pain in animals.

Dogs can get affected with several ear infections like parasitic ear diseases, bacterial disease, hormonal dysfunction, auto immune diseases as well as otitis externa and treatment may be initiated even in the absence of the diagnostic imaging. Nevertheless, animals suffering from infections like recurrent or severe otitis, and those having pronounced symptoms of para-aural inflammation, discomfort in mouth, vestibular syndrome or facial paralysis, require comprehensive check-up of the middle ear and contiguous structures. The anatomical complication and comparative inaccessibility of these structures is best dealt with diagnostic imaging of radiography, ultrasonography, computed tomography or magnetic resonance imaging technique. This article highlights the applications of certain imaging techniques for ear infections of dogs and cats and exemplifies some of the more representative findings.

Surgeries where light beams are used for different operative procedures by absorbing laser energy and controlling reflection, scatter, and transmission are simply termed laser surgeries. Photobiomodulation (PBM) is extensively known for its therapeutic benefit in the safeguarding and regeneration of tissues by employing visible light to excite biological functions in a non-thermal and non-cytotoxic mode. By using a twenty-watt CO2 laser with a straightened handpiece and a 1.4 mm metal grip, aural hematoma of canines and felines can be easily done. Lateral ear canal ablation by the Lacroix-Zepp technique is done using CO2 laser surgery. Special laser-induced thermotherapy (LITT) can be used in interstitial spaced organs where tumor cells need to be treated. In throat cancer, Neodymium Yttrium Al garnet, popularly known as Ndyag lasers, is used successfully. Some lasers, like argon, only pass the external layer of skin in laser therapy.

Ear diseases are considered as one of the common disorders in small animal practice and the number one cause for veterinary visits among dog owners. Commonly reported clinical signs in dogs with ear disease were scratching or pawing at the ear, otitis, head tilting, head shaking, strong and unpleasant odour from the ears, abnormal ear discharges and pain evincing while palpation of ears. These ear infections can cause significant discomfort to the dogs as well as occurrence of recurrence. The first step in the control and prevention of ear infections is to identify the primary and/ or perpetuating factors. Followed by regular cleaning of the ears to facilitate the removal of debris, exudates, microbes and foreign bodies. In already existing ear diseases, to prevent further extension of the infection systemic and topical antimicrobial therapy is advised. Selection of the antibiotic must be based on the antibiotic sensitivity test in recurrent ear diseases, with the required dosage and duration of therapy. Most of the ear diseases, the combination of systemic and topical antimicrobial therapy along with steroids is advised to control the inflammation of the ear canal. In the case of ectoparasitic infestations, regular control measures are to be taken care of further by utilizing localized or generalized ectoparasiticidal drugs. Dogs who were allergic to grasses, trees and weeds should not allow for swimming in ponds and as a preventive measure always ear plugs should be applied while swimming and cleaning the ears with ear cleansers which will contain acetic acid. Dogs with Malassezia pachydermatis are more prone to the development of ear infections specifically dog breeds with high skin fold packets and it can be prevented by regular bathing with medicated shampoo containing the ketoconazole and chlorhexidine. Early diagnosis of adenocarcinoma, sebaceous gland tumour and basal cell tumour should be carried out by cytology and diagnostic imaging techniques. To maintain the immunity of the skin, nutrition supplements like omega-3 fatty acids, polyunsaturated fatty acids, linoleic acid, eicosapentaenoic acid and docosahexaenoic acid are advised.. To help prevent the recurrence of dermatological or ear diseases, it is recommended to provide food containing probiotics, essential amino acids, fatty acids, magnesium, pantothenic acid, pyridoxine, biotin and zinc. These nutrients play important roles in maintaining healthy skin and ear function, supporting the immune system, and reducing the likelihood of recurrent issues. Dogs with a history of atopic dermatitis can be offered a hypo-allergic diet and immunotherapy to prevent further development of ear infections. Breeds with floppy ears are more prone to ear diseases because of the presence of predisposing factors like floppy ears, hairy ear canal openings, perpetuating factors like easily inflammable ear canal glands and other common primary factors like high moisture and humidity. It can be controlled by frequent ear examinations, drying of the ears and early diagnosis of other dermatological issues. Dogs with endocrine disorders like hyperadrenocorticism and hypothyroidism can develop ear diseases more frequently than other dogs because these diseases can alter the dog’s immunity, causing the thinning of the skin which is more susceptible to skin and ear infections.