Why Does My Dog Keep Getting Ear Infections? How to Break the Cycle

As a veterinarian, I see a lot of dogs with ear infections. Fortunately, many respond well to treatment without needing ongoing care. But why does your dog keep getting ear infections over and over again? 

Chronic ear problems in dogs are caused by untreated underlying problems, such as allergies, deep ear infections, foreign objects and ear canal tumors. Bacteria and yeast infections are often secondary rather than primary diseases.

It’s important to find and treat the cause of recurrent or chronic ear infections. When you take steps to clear them up you can 

• remove a constant source of pain
• avoid permanent changes from chronic inflammation
• prevent deafness
• prevent a serious ear infection from spreading to the whole body

In this article, I will cover the risk factors for and causes of chronic/recurrent ear infections in dogs. You’ll learn about the steps you can take to break the cycle of inflammation and pain. 

Acute ear infections, or otitis externa, come on suddenly over a period of hours. Your dog’s ear is fine one day and very inflamed the next. Many dogs have obvious symptoms of pain with an acute ear infection. 

A chronic ear infection is one that lasts more than three months. (1)  Dog’s pain symptoms tend to be less severe when they’ve been dealing with it this long. 

Acute and chronic otitis share many of the same causes. Chronic ear infections tend to have higher yeast and/or bacteria populations. 

Chronic changes not seen with acute ear infections include thickened skin with a cobblestone appearance, calcification of tissue and decreased hearing. Chronic ear infections are generally more difficult to treat than acute cases. (2)

An ear infection is one of the most common complaints dogs are seen for in vet clinics. Many dogs with this condition will have a recurrence at some time in the future. Some dogs develop chronic ear inflammation in which their symptoms are present most of the time. (3) 

Risk Factors

Dog breeds with an increased risk of developing ear inflammation include

• Cocker Spaniels
• Golden Retrievers
• Labrador Retrievers
• Springer Spaniels

Increased risk of chronic/recurrent ear inflammation also occurs in dogs with

• Environmental or food allergies
• Other skin diseases (seborrhea)
• Immune-mediated diseases (pemphigus)
• Endocrine disease (Cushing’s disease and hypothyroidism)

The most common cause of chronic and recurrent ear infections in dogs is hypersensitivity to pollen or food. Secondary bacterial and/or yeast infections in the ear lead to pain and structural changes that make treatment more difficult. 

The tiny parasitic ear mites called Otodectes cynotis are another common cause of ear inflammation in certain dog populations. They’re less likely to cause chronic ear infections when all pets in the household are treated appropriately. 

Less common causes of chronic/recurrent ear problems include ticks, middle ear infections, resistant bacterial infections, foreign objects such as grass seeds and tumors in the ear canal. 

Incomplete treatment of an acute ear infection can also lead to chronic ear trouble.

Contagious ear infections are uncommon in dogs. Infections caused by resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) can be passed to humans. Children and immune-suppressed individuals have a higher risk. 

Wear gloves and wash your hands very well after touching your dog’s ears to reduce the risk.

Acute otitis causes itching, redness, heat, pain and ear discharge. Symptoms of chronic ear infections also include

• Ear redness, swelling and discharge lasting 3 months or more
• Cobblestone texture to the skin around the ear opening
• Stiffening of tissue around the ear canal
• The ear canal becomes narrower
• Hair loss on the ear flap and around the ear canal
• Neurological symptoms such as head tilt, circling or falling

Diagnosis

To diagnose a dog’s chronic or recurrent ear infection, the vet will do a physical exam and ask about ear symptoms lasting more than three months. Additional testing may also be done to determine the severity and underlying causes of the issue.

Tests that can help diagnose the severity and underlying cause of recurrent otitis

• Ear cytology to look for bacteria, yeast, blood cells and skin cells
• Sedated otoscopic examination
• Radiographs or advanced imaging to look for deep ear changes and tumors
• Culture of ear exudate to look for drug-resistant bacteria
• Skin or blood testing for environmental allergies
• Blood testing for hypothyroidism and Cushing’s disease
• Food allergy trial to identify hypersensitivities to food

If your dog is dealing with a chronic problem, it’s not enough to use home remedies like apple cider vinegar or coconut oil for your dog’s ear. Even regular ear flushing might not be enough to overcome the issue.

The key elements to successful treatment are

• Clean excessive debris from the ear canal using products such as Epi-Otic® and Douxo® Micellar Ear Solution.
• Treat inflammation using topical steroids like betamethasone and/or oral steroids like prednisone
• Treat infection using a combination ear drops such as Posatex® or Claro®. Some dogs need to take an oral antibiotic such as cephalexin or an antifungal such as ketoconazole.
• Treat underlying disease which is often related to allergies. 
• Recheck exams to make sure treatment is complete.
• Ongoing maintenance to keep the ear inflammation from coming back.

Hypoallergenic dog food can help dogs with food sensitivities. Dog food with high levels of omega-3 fatty acids reduces skin inflammation. 

Prescription diets are often more effective than non-prescription options.

Medications prescribed for chronic ear inflammation may include:

• Ear cleaner
• Topical ear medication containing steroids, antibiotics and/or antifungal drugs
• Oral steroid
• Oral antibiotic
• Pain medication
• Anti-allergy medication such as Cytopoint® or Apoquel® for other skin allergy symptoms

Prognosis

The prognosis is good for long-term improvement if the underlying cause can be treated. If treatment of the underlying cause is not possible, supportive treatment can often keep a dog comfortable.

In some cases, chronic ear infections can be cured with ongoing care. However, if the ear canal is severely affected, a surgery called ear canal ablation may be needed to provide a long-term solution.

Prevention

The best way to keep ear inflammation from coming back is to identify and treat the underlying cause. Unfortunately, that’s not always possible or treatment may not be 100% effective. 

Follow your vet’s advice for recheck exams and cleaning your dog’s ears at home. Use an ear-drying solution after your dog swims. Ask your groomer to remove excess ear hair that can trap moisture and debris.

When should my dog see a veterinarian?

See a veterinarian any time your dog has symptoms of ear problems. If you’ve treated their ears as recommended and still see symptoms at the end of treatment, have a vet recheck your pup’s ears. 

What questions should I ask the veterinarian?

• Should my dog see a veterinary dermatologist?
• Could my dog have atopy or food allergies?
• How often should I clean my dog’s ears at home?
• Will you show me how to clean my dog’s ears?

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