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Ear Disorders of Cats
Itchy ears in cat
Complete hearing loss after teeth cleaning
Mittens continuing balance and inner ear problems
Growths in ear - ear problems in kitten
Ear hematoma
Cleaning cats ears
Scabs around ears
Dizziness and disorientation
Pityrosporum or Malassezia ear infection
Chronic otitis media - ear infection
Itchy ears and allergy
also see Ear mites
also see Allergy
also see Hairloss
also see Parasites
also see Skin problems
Question: Dr. Richards,
I have a neutered male cat with very itchy ears. He has been to the Veterinarian several times to be tested for yeast, mites, and fungus. None of these tested positive. He has a terrible time shaking his head and scratching his ears. Anything I could use to alleviate his discomfort?
Answer: KC-
There are several possible problems that could cause itching that would not also lead to infection with either bacteria or yeast. In some cats this occurs due to herpes virus infection leading to middle ear irritation. Usually cats with this problem have a lot of ear wax but do not necessarily have infections.
Cats with food allergies or inhalant allergies may have itchiness without any apparent sign of ear infection at all. Cats with fleas or hypersensitivity to flea bites may show this as itchiness around their head or ears. We have seen two or three cats with cancers affecting their ear canals that were very itchy. Chiggers can cause itchiness in the ears or around the ears and they are not always easy to find on an examination, although they do show up as little orange dots in many cases.The steps that we normally take to try to sort through these problems start with an ear examination. If we can't identify a cause for the itchiness we usually start to sort through the causes that are not readily apparent. We usually start with a flea control product that we have good experience with. In our practice this is usually Frontline Topspot (tm). If fleas are the problem, this will usually reduce the itchiness within a week or so and eliminate it over several weeks. If we do not see a pretty rapid improvement after flea treatment we usually move on with treatment for allergies. We often start with
an antihistamine and essential fatty acid combination at the same time, such as chlorpheniramine (Chlortrimeton tm) and 3V Capsules (tm). If many cats this will help. If it doesn't help and it is possible to control the cat's diet effectively, we try a special diet designed to be hypoallergenic for three to six weeks. At this point, if nothing has helped and we still can't detect a reason for the itchiness, we often try a short course of corticosteroids such as prednisone, or an injectable corticosteroid product such as methylprednisolone acetate (DepoMedrol tm), to see if the itching can be controlled in this manner. If this works we then try to work to reduce the dosage to the smallest
dose that will control the itching, given at the longest possible intervals, such as every other day or every third day. If corticosteroids don't work at this point, we usually try to refer the patient to a veterinary dermatologist to see if there a second opinion from a specialist is helpful, if we haven't already taken this step somewhere along the way.Hope this helps some.
Mike Richards, DVM
3/21/2001
Complete hearing loss after teeth cleaning
Question: Dear Dr. Mike,
I have a 6 year old Persian, with a severe underbite and pushed in face, even for a Persian. She has "severe dental disease", and last week went in for a dentistry. They removed four teeth, and a large abcess. She woke from the procedure easily, but has since then been completely deaf. The vets are all at a loss, and state they used the lowest amounts of anesthesia possible. The meds she received are diazapam, ketamine, atropine, isoflurane gas, and butorphanol (orally). She also had her ears cleaned, which the vets say was unremarkable. She was also started on clavamox two and a half days prior to the procedure and continues on it still (day 6 after the procedure). Along with her complete hearing loss, she also has no appetite. She has received SQ fluid twice, and yesterday got an emema after no stooling for five days. I have been syringe feeding her a high calorie food (Eukanuba's recovery), and stopped that yesterday for 24 hours to see if we could
stimulate her appetite but it did not work. Her other symptoms are dizziness (especially when being put down) and lots of shaking of her head. There is no ear drainage, and the vets said her ears looked clean and good although they could not visualize the ear drums. The vets say none of the drugs are known to be ototoxic, and I am going to a neurologist at Tufts this Friday. I'm wondering if you have any thoughts on a possible cause, or have ever heard of this happening to another cat. She can manage to climb stairs (even spiral stairs) and can jump up on my bed with ease. I'm wondering about the chances of an inner ear infection, or damage to the cranial auditory nerve. If you have any insight, I'd be very appreciative. Thanks. Lisa
Answer: Lisa-
I have heard of several reports of cats becoming deaf after teeth cleaning, anecdotally, but can not find anything in the literature about it. There have also been reported cases of deafness when an ear cleanser containing chlorhexidine is used in cats and occasional reports of problems associated with antibiotic ointments. At the present time I am not aware of an approved ear cleansing product containing this ingredient but it can cause problems even if the ear drums are intact, so it should be avoided in ear cleansing. There are also anecdotal reports of deafness in cats after anesthesia alone.
In your cat's situation, in which there was dental work done, ear cleaning, anesthesia and a pre-existing abscess, which may or may not have caused high fevers, it seems like there are several possible culprits. Sometimes, there is just enough compromise to the ear canals that even a small amount of manipulation, possibly including retraction of the jaws to allow dental work, is enough to set off a pre-existing problem. I would think that a middle or inner ear infection could have been present and irritated by the dental work, the abscess or the ear cleaning.
I am hopeful that the neurologist was able to help, or at least to give you some direction as to what the cause might have been.
Mike Richards, DVM
1/16/2001
Mittens continuing balance and inner ear problems
Question: I first wrote to you about 3 months ago about my 18 year old female cat's balance/vestibular problem. We now strongly suspect an inner ear infection. About 6 weeks ago we finally got around to doing a "neurological examination" and it was discovered that she couldn't blink her left eye properly - a menace deficit. There was nothing else found and no indications that point to a central problem rather than a peripheral problem.
She has had several different antibiotics over the last 14 weeks. Firstly 3 Betamox (amoxicillin) injections which she responded to. Then about 3 weeks of Vibravet, then about 3 weeks of Clindamycin. Then a prednisone injection and no antibiotics for 2 weeks and no response to prednisone except that the sneezes that began her balance problem reappeared. Then 3 more weeks of Vibravet. Then 3 more Betamox injections during which the vet said her blink response had improved quite a bit. Her balance only marginally improved with the Betamox so now we have started on a Cephalosporin/Cephalexin called Rilexine.
We had planned to try Baytril/enrofloxacin instead of the Rilexine but I discovered a Web page by R M Clemmons of University of Florida which said he preferred Cephalosporin to Enrofloxacin but recommended using Sulfadimethozine with it and to use it for 6 to 8 weeks.
Questions
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We aren't using sulfadimethozine yet. My question is - since Mittens appeared to respond to Betamox, would it do any harm to give her another one or two Betamox injections at the same time as continuing Rilexine. Would it be worth trying to add the sulfadimethozine to the Rilexine.
Some information I have found on sulfa drugs suggest they can be a problem - I have no way to make Mittens drink more water. Is it possible this is a virus problem and not bacteria. My cat had an anabolic steroid injection larabolin, 5 hours before her sneezes appeared 14 weeks ago. Do you happen to know if anabolic steroids suppress the immune system the same as Corticosteroids.
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End of Questions
Mittens current symptoms are : she is unsteady/overbalancing and "widebases" her feet to maintain her balance a lot, she shakes her head a lot, she hears some things but can't tell the direction sounds come from. She doesn't have a noticeable head tilt at the moment but in the past has sometimes had a tilt to the left. She does try to scratch her ears quite often but I can't tell if this is more than normal.
I think her suspected inner ear infection originated from the sneezing/upper respiratory infection she had at the time her balance problem started. I also think I would have noticed her inability to tell the direction that sounds come from if it had been there before the balance problem.
I hope you are not too busy.
I think it would be fair for you to charge me another fee for answering this question.GRAEME
Answer: Graeme-
I have one off the wall suggestion, which is to consider looking for a pharyngeal/middle ear polyp. These are more common in young cats but can occur in older cats. It is really pretty unlikely that this is the problem but in reviewing databases looking for information on the antibiotics you asked about and inner ear infections, I kept running across mentions of this condition. Examining the pharyngeal region and middle ear under anesthesia might be necessary to rule in or rule out this condition.
The most commonly recommended antibiotics for inner ear infections are chloramphenicol,
cephalosporins, sulfa-trimethoprim combinations, fluoroquinolones (like enrofloxacin) and clavulanic acid - amoxicillin combination (Clavamox Rx). It is necessary to use antibiotics for six to eight weeks in most cases when it is necessary to treat pets for otitis media or otitis interna.I found the information from Dr. Clemmons. I am not familiar with sulfadimethozine because it is primarily a large animal antibiotic and I have never used it. However, since other sulfa medications are recommended for inner ear problems, it seems as if this one would be reasonable to use as well.
It is safe to use amoxicillin and fluoroquinolones at the same time and they are thought to have synergistic effects. It is reasonable to continue the use of amoxicillin long term if it has been helpful, as well. There is no advantage to using injectable amoxicillin for long term use that I am aware of, so using an oral form might be a easier.
I hope that you continue to have success with antibiotic therapy. If not, checking for a polyp might be worthwhile if that hasn't been done, even though it isn't a highly likely problem.
Mike Richards, DVM
11/26/2000
Growths in ear - Ear problems in Kitten
Question: Dear Dr Mike,
I just have one more question relating to Geordie - as I mentioned
previously he had a bad ear mite infestation, now the ringworm and all along
since he was 3 months old he has been shaking his head and scratching around
and under the ears. The vet thought it was the ear mites causing this then
perhaps the ringworm but now that these are clearing, the shaking and
scratching still persists and it is worse when something touches his head -
i.e. patting him around the head or when he rubs against carpet or walls -
he starts violently shaking his head and ears - then begins to scratch. We
have had Geordie for 4 months now and he had his 19th vet trip this week so
we are desperate to get him better and feeling happy. The vet has cleaned
and swabed his ears - there are no infections or bacteriological problems -
the only abnormality the vet does report is a small tissue growth in the
external ear canal in both ears. I had a look at one of them myself and it
shows a little white growth of what looks like skin tissue extending from
the side of the ear canal wall.Geordie's father and half sister had ear polpys - do you think this is what
they could be? - due to the family history our vet thinks it may be but is
not sure. The breeder says Geordie's father and sibling did not have any
outward symptoms of the polyps therefore we am concerned with the head
shaking and sratching - could this be related to the ear polyps or something
else?It is very frustrating as, being a kitten especially, Geordie comes to us
for attention but as soon as we touch him above the neck he shakes his head
-sometimes so violently that he loses his balance and falls over. He loves
being petted and wants the contact with us but is shying away when he
experiences this problem.Although he has now finished teething he only wants to eat soft food (no dry
biscuit food) and this is causing a little gingivitis although I have got
him interested in a raw chicken meat with a little bone mixed in to try and
help. Again we wonder if the head/ear problem could be causing him to
abstain from crunchy food?As you can see we are finding it hard to pinpoint what it is and how it
should be treated. We would appreciate any comments or advice you may have
- perhaps you have seen or heard of the same problems before?
I apologize again for bothering you with another inquiry but hope that you
might have some input into what is a very frustrating situation.Thanks again & Kind regards,
S. McK.
Answer: Susan-
Seven months old seems young for growths to occur in the ears but some cats
do seem to be really prone to this problem. There are several possible
growths. We see cats that have hypertrophy of the ear tissue due to
allergies or infections. Sometimes this will have a purple hue to it.
Hemangiomas and cerumen gland adenomas seem to occur most commonly, among
the tumors, in cats in our practice. These sometimes occur in young cats
but I can't remember one quite as young as yours.I read that someone studied the pressure in the middle ear of dogs with
allergic otitis and discovered that they have problems equalizing pressure
when the ears are inflamed, leading to discomfort of the ears. I don't
think this has been reported in cats but I don't see any reason why it
couldn't happen. If this was a problem there is a chance that
antihistamines might help. Your vet could provide you with an appropriate
dose for Geordie. There is also a reasonably good chance that unequal
pressure in the middle ear could lead to middle ear infection and sometimes
even to inner ear infection. If there was any infection associated with the
ear mite infestation it may have spread to the middle or inner ears. This
could lead to balance problems and to Horner's syndrome (unequal pupils,
visible third eyelid in one eye). It can be very hard to be certain that
there is or is not a middle or inner ear infection and it is reasonable to
treat on the suspicion that an infection is present with the symptoms
present, probably. At least it might be worth talking this over with your vet.Sometimes, even when I don't see evidence of inflammation or infection but
there are persistent problems with ear shaking I will try a corticosteroid
ear drop, such as Synotic (Rx). This will help in some cases.There is a chance that the problem does not relate directly to the ears but
is the result of a neurologic injury, too.I know that doesn't clear things up, at all --- but what I'm really trying
to say is that there are still possible problems to explore and that it
would be a good idea to consider a recheck with your vet.Oh -- middle ear infections do sometimes cause a reluctance to open the
mouth wide or to chew much.Mike Richards, DVM
11/16/99
Q: I was searching the your site for information about cat hemotoma's. How
do you treat this? thanks for your response.A: E-
Hematomas in cat ears are usually found in conjunction with ear mites or an
ear infection. It is necessary to treat the irritation leading to head
shaking or pawing at the ear and caused the hematoma. We try to make sure
that the ear canal is cleaned out prior to correction of the hematoma. If
the underlying problem is ear mites and the hematoma is small we will
sometimes treat with prednisone on a daily basis for 5 days then every
other day until the hematoma has resolved. Prednisone interferes with
scarring and prevents most of the crumpling of the ear associated with
hematomas. If the hematoma occupies more than a fourth of the pinna we
usually surgically drain it by making an incision on the inner (non-haired)
aspect of the ear and then placing sutures through ear to hold the two
sides of the ear together and prevent the hematoma from forming again. The
ear stitching looks like the stitching of a mattress when this is done. We
remove the sutures after a couple of weeks.Mike Richards DVM
Q: Can you clean a cats ears at home? And if so how often do you clean them?
A: Jerry-
There are a lot of good commercial ear cleaners. Your vet will probably have one that you could use at home. Unclean ears are often an indication of infection, though. It would be best to let your vet examine the ears and determine if an infection or ear mites are present and causing the dirty ears. If so, treatment should clear the problem up. If not, then it is safe to use an ear cleaning product. I think that hydrogen peroxide mixed half and half with water is pretty good for cleaning out wax but not as good as some of the ear cleaning products. Using a bulb ear syringe to flush the ears with the solution helps to clear out the debris in the ear, too. If there isn't an underlying infection or ear mites it shouldn't be necessary to clean ears very often. In many cats it is never necessary.
Mike Richards, DVM
Q: Dear Dr. Mike, My 9 month old kitten Stewie has developed about five scablike places on and around her stomach and on her ear. She licks at them constantly, and I'm not sure if they make her itch or if they are sore. She has also lost a lot of hair around these scabs. Do you have any idea what this could be or what I should do? I would appreciate any advice you have to give me. Thank you, Amy
A: Amy- Scabs around ears are most commonly the result of ear mite infection. The ears itch, the kittens try to scratch them and sore develop from the scratching around the ears. Since there are scabs on her abdomen as well it is likely that something else may be the problem or that she may have two problems. Fleas can produce enough itchiness for scabs to develop in several spots on the body. Ringworm (a fungal infection) can cause scabby sores sometimes and is often associated with patches of hair loss. Bacterial skin infections and mange are possible in kittens as well. It is probably going to take a visit to your vet to sort through these problems and determine which one is actually present.
Michael Richards, DVM
Q: My 9 year old cat began to seem slightly dizzy a few weeks ago. Our vet prescribed an antibiotic (Clavamax) and Prednisolone; she suspected vestibular something or other after an xray ruled out any physical injury. Kitty did not improve after the 10-day round of antibiotics and we returned to the vet. Another round of antibiotics were prescribed in addition to a daily 12.5 mg tablet of meclizine, which I understand is used to treat motion sickness in people. A blood test revealed only that the cat was not drinking much water, nothing else abnormal. It's been 3 days since we began the motion sickness medication (it was written for 14 days) and the cat is considerably worse. He is highly disoriented, can barely get around without stumbling, and spends all of his time huddled under the bed. He is eating pretty well, although' he has lost about a lb. between first and second vet visits ten days apart. He has experienced no injuries that I'm aware of (he did go outside before he got sick) and he does not seem to be in pain. I initially thought that he had had a stroke, but the vet did not find any evidence of that based on her examination of his pupils. Is there anything that you know of that could cause this condition that my vet may have overlooked? Thanks, Sharon
A: Sharon - The major causes of dizziness are middle and inner ear infections and problems affecting the cerebellum (part of the brain that controls balance and spatial orientation). An ear infection may respond to antibiotics but sometimes surgery is necessary to relieve pressure in the middle or inner ear. Feline leukemia virus, feline immunodeficiency virus, toxoplasmosis and other infectious diseases can lead to balance problems. Cats do sometimes get infarcts in the brain with similar effects to strokes in humans. Cancer can cause these signs, as well.
If your vet is not able to make a diagnosis and you wish to pursue this further it is reasonable to ask for referral to a veterinary neurologist or internal medicine specialist. If you live close enough to a veterinary school to go there it is possible to get opinions from several experts at once.
Michael Richards, DVM
Pityrosporum or Malassezia ear infection
Q: please tell me anything you can about this infection . My cat was (incorrectly) treated for ear mites for 2 years. Now finally I have the name of the actual problem (a culture was finally done. What medications should be given and for how long? What causes this? I'll appreciate any help you can give me. Thank you very much.
A: R- Pityrosporum is a yeast infection. Currently, it is usually referred to as Malassezia but that is only because mycologists have to change the name of everything every few years in order to have something to do.
It is possible to culture yeast from normal ears, so this diagnosis has to be considered carefully when it is made. As many as 30 to 40% of normal dog ears have Malassezia organisms in them. I have not seen figures for the percentage of normal cat ears from which yeast can be cultured but it is likely to be similar.
In most cases Malassezia is a secondary problem. It can occur in conjunction with allergies, immune mediated disease, chronic bacterial infections, long-term antibiotic use and seborrhea. It may also occur as a primary infection in some dogs and cats. It seems to be pretty common after ears are treated for Pseudomonas infection (a bacteria), probably because treatment for that condition requires long term antibiotic use with broad spectrum antibiotics.
Treating the primary problem is the first step in treating Malassezia. If that can be done, then keeping the ear canal dry and acidic is often enough to keep the Malassezia growth down. When that doesn't work there are medications that work pretty reliably. The most commonly used one currently is probably clotrimazole (used in Otomax Rx). Thiabendazole (in Tresaderm Rx) has been reported to be effective.
It can take extensive diagnostic work to correctly identify the underlying cause of yeast infections when they are recurrent. Tests for immune system disorders like feline leukemia or feline immunodeficiency viruses, hormonal disease, allergies, bacterial infections, parasites (ear mites, demodectic mange, etc.) and careful review of medication histories may be necessary to establish the diagnosis of the primary problem.
Good luck with this.
Michael Richards, DVM
Chronic otitis media - ear infection
Q: Dear Dr. Mike, We have two beautiful Maine Coons-Waverly (25mos) and Chloe (22mos). Chloe has had chronic otitis media for over a year. It is predominantly in her left ear. She has grey liquid in her ear that dries out and forms a black crust around her outer ear. She scratches at it occasionally, but seems to have grown pretty used to the irritation. She has had cultures performed which reveal multiple infections, including staph. She has been treated with oral antibiotics, tresaderm, conofite,and other anti-bacterial and anti-fungal preparations with no continued relief. I took her to the Ohio State Veterinary School last October. Their aggressive approach frightened me. They wanted to take skull x-rays and do a "bulbectomy" as a precaution. I was worried that she would be more uncomfortable if she had surgery, so we have been treating her with the medicines we have left when her ears smell foul or there is black stuff exuding from them. We love our Chloe and want to help her without causing her any pain. She is very playful and active and has a great appetite. She seems to have a good sense of smell, too. If you have any ideas or different approaches we could try, we would love your help! Thank you, Lisa
A: Lisa-Chronic ear infections are almost always frustrating to treat. Taking Chloe to OSU was probably a smart move. I can understand why you were worried about the surgery, though. It does seem like a lot to put a cat through. The problem with cats and not doing surgery is that many of them have otitis media because they have polyp formation in the middle ear or Eustachian tube. Surgical exploration of the bullae may be the only way to diagnosis this complication in some cats. Medical treatment will not cause satisfactory resolution of the clinical signs if a polyp or cancer is present in the ear.
Just to be sure - otitis media is infection of the portion of the ear that is inside the ear drum. It can occur independently from, or in conjunction with, infection of the external ear. If both forms of ear disease are present, it is important to treat both.
I can not tell you if surgery is absolutely necessary for Chloe's comfort and good health but I would take the advice from OSU seriously.
Michael Richards, DVM
Q: Dr. Mike, I recently moved to Missouri from Nevada with my three cats. Since living here, they have had several bouts with allergies during the spring. Last year, they began shaking their heads much like how you would see a cat react to ear mites. However, there was no sign of mites and my local vet said it was a symptom of allergies. It this common for cats to shake their ears when suffering allergies? What causes this reaction? Spring is here and the shaking has started. Thanks much! Kelly
A: Kelly - Allergies cause skin itching in dogs and cats. Since the ears are just specialized skin, they itch too when allergies are present. It is also possible for allergies to interfere with equalization of the pressure in the middle ear due to inflammation of the eustachian tube. This can cause irritation or even pain and may be the source of the head shaking behavior in some cats.
We have some luck treating cats with this sort of problem with antihistamines. We usually use chlorpheniramine (Chlortrimeton Rx). You might want to ask your vet if he has had any luck with this and for a dosage recommendation for your cat, if so.
Michael Richards, DVM
Last edited 08/01/05