Ongoing Pseudomonas

[mrs tornsocks]

Our 5yo lab boy has ongoing ear infection - psuedomonas keeps recurring. We've had two cultures with treatment using various ABs and eardrops - usually they've cleared the problem but it recurs after treatment stops.

It's back again & I returned to the vet today - the usual treating vet wasn't available and a different vet is now suggesting surgery (lateral ear resection).

Can anyone help with experiences or feedback on where we should go next ?

Is there such a thing as a canine ear nose throat specialist ?

Any help appreciated.

[kelpiecuddles]

You are in Sydney, SASH might have someone they can refer to

[VizslaMomma]

Other option might be University of Sydney Vets.

[Erny]

Has your current Vet looked beyond the symptoms to help work out the cause?

There are numerous possibilities such as :

1. Improper cleaning or even too much cleaning;
   
2. Bacteria;
   
3. Antibiotics;
   
4. Allergies (through diet or contact);
   
5. Hypothyroidism;
   
6. Yeast/fungas;
   
7. Mites/parasites.
   

Unless the cause is through "1" and "3" listed above, I'd be inclined to not only address the cause but ask "why" is the cause there? So far, much of my own research, enquiries and personal experience trials have all lead full circle back to the immune system and this (primarily but not totally in so far as my boy's individual case is concerned), back to diet.

[Wundahoo]

Pseudomonas can be very tricky to treat because it can change resistance rapidly, within days and what might start out to be a bug that is sensitive to one antibiotic can rapidly become resistant in a matter of a couple of days. As the infectious processes proceeds, tissues become inflamed and thickened which in turn make penetration of the antibiotics very difficult, hence its propensity to return again and again..... usually a bit more resistant each time it makes its return appearance

You need to ask for a referral to a specialist dermatologist. These are usually the people who deal with chronic ear infections. There should be a work up done to decide if the problem has breached the middle and/or inner ear. If the infection is still confined to the outer ear canal then routine procedures still have a likelihood of success, but if the problem has reached the middle or inner ear structures then there is often little that can be done in the way of medical management and treatment. This is when surgery is recommended.

I dont know who are the current "gurus" in Sydney but I'm sure that they will be of great help to you and your dog. Of course these services never come cheaply and so it is likely to be an expensive exercise but most of them get really good results. Andrew Marchevsky at SASH is a great surgeon should you reach the stage where you do need one...... but a DERM is the first port of call I think.

In truly chronic infections where the problem has become centred in the middle or inner ear, the usual end stage procedure is a total ear canal ablation (different to a lateral resection)..... this is essentially where the structures of the outer and middle ear canals and the structures within the middle ear canal are surgically removed. The ear is completely closed over and there is no opening at all. The external ear flap is left intact and untouched. It sounds dreadful but I have seen many of them done and as long as they are done by an experienced specialist soft tissue surgeon the results are amazing. The cosmetics of the procedure are really good once healing and hair regrowth has occurred and the difference to the dog is incredible...... and of course the owner is so much happier as well. Some dogs can still hear sounds although at a different level and lower pitched, but some owners will say that the dog's hearing seems to have imporoved to that which was present prior to the surgery. I suppose that the surgery removes all the infected, inflamed and thickened tissues so that what remains can function better than before the surgery. Of course once healed, the pain and discomfort is gone as well as the need for constant medication and cleaning, so the dog is far more comfortable and the owner doesnt have to inflict these dreaded things onto their beloved dog.

[mrs tornsocks]

THanks everyone. I think I'll get the derm referral and go from there. I have read a little more about total ablation which seems drastic so I'm hoping we can address the problem before we get to that point.

Obviously the key is getting veterinarians experienced in the area.

Thanks again, will update soon.

[Wundahoo]

THanks everyone. I think I'll get the derm referral and go from there. I have read a little more about total ablation which seems drastic so I'm hoping we can address the problem before we get to that point.

Obviously the key is getting veterinarians experienced in the area.

Thanks again, will update soon.

Total ablation sounds drastic but the results are amazing.

If it is suggested as an option for your dog, try to speak with people who have gone down that path..... most owners are SO pleased with the results and many admit that they have delayed the procedure because of their concerns, but once done and healed it's a Godsend for so many animals and their owners.

It's a procedure that should be done by an experienced specialist soft tissue surgeon but is well worth it.

I know of many dogs that have had bilateral total ablations and the owners cant believe the difference that it has made to their dog's lives and to their own as well.

First step is the derm referral and assessment of the disease, then a plan.

You are on the right course now !

[westiemum]

Wundahoo you are so right. My Mac has had a total left ear abalation for chronic pseudomonas infection and my only regret was I mucked around for too long - all the time he was in a great deal of pain. We tried every AB on the face of the planet - even flew ABs in from Sydney - and finally reached the end of the clinical management road.

The surgeon told me straight after Macs surgery that it was so extensive in the ear cavity and so infected he doubted we would ever get on top of it clinically regardless of what we did. For Mac surgery was the only option so the whole ear mechanism on the left was removed. I just wish I'd tried it earlier rather than having him in what would have been quite severe pain and spending all that money on specialists, pathology, ABs, pain relief, consults etc - which was probably as much as I ended up spending on the surgery.

It's a personal choice - but my advice is always remember your dog is probably in a lot of pain, and that you don't have to go through every AB known to man like I did to see the pattern. Once you've tried a couple and this damn bug has become resistant I think you need to consider surgery. This si a water-borne bug I think - and is so clever it becomes resistant to most ABs really quickly. IMO surgery will relieve your dogs pain and be cheaper in the long run. Surgery isn't and shouldn't always be a last resort.

Anyway just my thoughts and I hope that helps.

ETA - Mac was a new dog after the surgery - much brighter and happier. And sadly I realised just how much the previous infection was affecting him. The surgeon described the infection as an ear filled with stinking cottage cheese!!

Edited April 7, 2014 by westiemum