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Date:   26 March, 2010  
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Toa Payoh Vets Clinical Research
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Painful ears of Miniature Schnauzers - 2002 and 2010 case studies   
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First case was written: August 2002
Upd
ate:  26 March, 2010
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Be Kind To Pets
Veterinary Education
Project 2010-0129

EAR PROBLEMS IN DOGS
Ear pain and scratching all the time is a cause for concern, but the unenlightened Miniature Schnauzer owner usually thinks that the groomer will be able to resolve the problem. Besides, it is cheaper to consult the groomer than the veterinarian. It is not cheaper if the owner calculates the costs over the lifespan of the dog, assuming the dog lives up to 15 years. Besides, painful ears are hellish for the dog who tries its best to avoid the groomer as well, if the owner really cares to find out the real situation at the grooming shop.
 
Hairy ear canals in Miniature Schnauzers trap water and dirt and obstruct ear ventilation. Bacteria, yeast and fungus proliferates inside the ears. The painful ulceration inside the ears causes the dog to bite people.

Lateral ear canal resection of the dog is the solution but many Singapore dog owners are ignorant of this surgery. Vets seldom recommend this surgery as many owners are price-sensitive. Furthermore, it is cheaper for the owner when treatment is ear cleaning and drugs.  As Singapore evolves, the younger generation of dog owners will be better educated and sophisticated to understand that persistent and painful ears in their dogs are not to be ignored and that groomers cannot resolve the problem with cleaning and ear powders packed into the ear canal. This article illustrates the typical thinking of the Singaporean dog owner some 10 years ago. 

Case 1 in 2002: Once Bitten Twice Shy
"We could not go back to the first vet as our Schnauzer had bitten his nail off his finger!" Mr Ho said as he wriggled his left forefinger. "The vet's hand was trembling subsequently. But we had warned him that the dog would bite. He still touched his ears and was bitten. This dog dares not bite me as I will whack him." Mr Ho laughed. 

I could feel the pain of the nail bitten off the finger in my bones. Just a simple bite would be painful and if the nail was bitten off, it must be excruciating for the poor vet.

This Schnauzer did not growl or give warning before biting. He was the strong silent type.  He put his head down close to the floor, his tail turned sharply downwards and headed towards the door to get out of the veterinary surgery.  Some dogs do associate the vets with pain and some would not enter the surgery room. Their legs became wobbly as they reached the surgery.  Legs became so heavy that they glued the dog to the ground.

"Why not use the ear ointment regularly instead of putting him under anaesthesia to open up his vertical ear canals?" I asked Mr Ho as the Schnauzer was really pitiful at that moment. His greyish white face with long hair made him looked very depressed.

Mr Ho had tried the ear ointment for the past 3 months but the pus kept coming back inside the ear canals. He had to spend over three hundred dollars for two ear irrigations and medication.  

If the lateral ear canal resection surgery could solve his problem once and for all, this dog would be euthanased.   
 
This Schnauzer had ear canals choked full of ear hairs trapping water during bathing. Furthermore, the ear pinnae or flap closed over the ear canal opening. The closed ear canal was not ventilated well.  The dampness from bathing encouraged the bacteria to grow and infect the ear walls.  Pus formed as the dog's white blood cells tried to contain the infection. The ears became painful and inflamed. Therefore the dog bit anybody when his ears were touched.  

The dog was kept in the cage pending surgery. He was passive
and quiet in the cage, a good patient. Just as I was going to take him out for surgery, he bit my left thumb without warning. Fortunately my nail was not ripped off. I washed off the red blood oozing from a small puncture wound.  I had to use the hand to operate.  A piece of plaster covering the wound stopped the pain.  The dog had both ear canals opened up. I hope he would be happy to see the veterinarian in later years and not associate vets with pain all the time. 
 
Singapore, Schnauzer excessive ear hairs, otitis externa. lateral ear canal resection, toapayohvets

Left ear canal fully covered by ear hairs over 1 cm long.  Some Schnauzers have very hairy ears and groomers keep plucking the ears frequently. A permanent solution may be lateral ear canal resection.

Singapore, Schnauzer excessive ear hairs, otitis externa. lateral ear canal resection, toapayohvets

Side of left ear's vertical canal removed showing opening of horizontal canal as a hole at the lower part of the picture. Lots of ear hairs obstruct the ear and prevent proper ventilation.

Singapore, Schnauzer excessive ear hairs, otitis externa. lateral ear canal resection, toapayohvets

Right ear canal also obstructed by a profuse growth of ear hairs. Very uncomfortable for the dog as it traps water and become ulcerated and infected.

Singapore, Schnauzer excessive ear hairs, otitis externa. lateral ear canal resection, toapayohvets

Pulling out the long ear hairs from the horizontal ear canal and cleaning up the canal after removal of the side wall by surgery.  Should have no more ear problem now.

"I can give you a 90% guarantee of success in this surgery," I said to Mr Ho who wanted the dog back immediately after surgery. The family just loved this Schnauzer and did not want him to be away from the best care at home.

"Your dog will no longer suffer from pain and pus infections inside his ear forever."

"This dog bit two vets," Mr Ho pronounced proudly to Nurse Ann.  It was an achievement to bite the dog doctor who is supposed to be invincible and a controller of all dogs big and small, ferocious and submissive. I was the 3rd vet to be bitten.  A brown waterproofed plaster wound round my left thumb as I washed out the dog's canal.  

Mr Ho turned to me and furrowed his forehead, "Your guarantee better works. Otherwise it would be a lethal injection to kill it as I can't afford to spend more money on veterinary fees."  

As for me, I hope this dog would never bite the 4th veterinarian. I have to be super alert whenever I encounter dogs with ear problems. 

From this Miniature Schnauzer and a sore thumb, I now appreciated the meaning of the English idiom "Once bitten, twice shy."  One of those idioms I memorised for the English test during the Primary School Leaving Examination.  That was 3 decades ago, but the Miniature Schnauzer refreshed my English idiom swotting by biting me and making me avoiding him.

UPDATE IN 2010:
No further complaints about the ear or visit from Mr Ho for many months after the surgery. I presume the Schnauzer has had recovered.  
 

Case 2 in 2010: A caring lady owner

I have stopped advising lateral ear canal resection surgery for dogs with chronic otitis externa as I find that Singaporean owners in my practice are price-sensitive and cannot see the big picture when it comes to chronic otitis externa and pain in their Miniature Schnauzers with hairy ears.

If I am calculating, the surgery is not worth doing as it takes a long time to do it. It takes around 1.5 to 2 hours. In that time, I can do more consultations or recover from a day's hard work. If you think about it, the surgery actually resolves the dog's ear problems and well, no more need to consult the vet. Therefore, no more income from one dog owner, if one is business-minded in veterinary medicine.

Therefore I was much surprised that a lady owner referred by her sister to me accepted my advice to perform surgery. Her sister came to have her dog spayed and to ask me about the licking of the ventral aspect of four paws. This sister wanted me to spay her dog myself and I assured her it was me who would be doing the spay.

spay pomX, prevent blood staining house, toapayohvets.com spay pomX, prevent blood staining house, toapayohvets.com
tpvets_logo.jpg (2726 bytes)3229. Spay dog before heat tpvets_logo.jpg (2726 bytes)3230. Spay dog before heat

"You had consulted a vet before?" I asked the second sister who looked so much like a twin of the first. Siblings should look alike as they come from the same mould.

"Yes," she said. "The vet took out a long stick to clean the ears and showed me how to do it."

"She gave you a lot of medication for the ears?" I asked. "Yes," she said.

"Does the treatment work?" I asked a stupid question. Obviously, she would not be seeing me if the treatment was effective. The dog now had a very painful hyperpigmented right ear canal. The left ear canal was reddish and also choked with hairs.

miniature schnauzer, hairy ears, infection, head shaking, rubbing, smelly. singapore, toa payoh vets miniature schnauzer, hairy ears, infection, head shaking, rubbing, smelly. singapore, toa payoh vets miniature schnauzer, hairy ears, infection, head shaking, rubbing, smelly. singapore, toa payoh vets
tpvets_logo.jpg (2726 bytes)3231. Head shaking and smelly ears tpvets_logo.jpg (2726 bytes)3232. Head shaking and smelly ears tpvets_logo.jpg (2726 bytes)3233. Head shaking and smelly ears

Some dogs just would not allow their owners to clean their painful ears regularly and so the regular ear cleaning and treatment might have had worked. But no self-respecting dog would tolerate ear hair plucking by the owner. It is extremely painful. A torture. The dog would try to run away. At the groomer, the dog had no choice and "behaved" well for ear hair plucking.

"Only the right ear need to be operated," I advised as it is best to save the owner some money and to present a lower veterinary bill. "You have to clean the left ear and pluck its hairs monthly." The right ear was extremely painful but this dog did not bite me. Well, I muzzled the dog first. Can't afford to be bitten as I need my hands to perform surgery.  However, the owner preferred 2 ears to be operated upon. I gave medication and injections and asked the owner to come back in 2 weeks for the surgery.

I don't expect her to be back. Many Singaporean owners don't come back after the first treatment as they are price-sensitive or too busy. There is always the groomer and heck, the dog has to go to the groomer every 2 or 3 months anyway. So, why bother to spend money on surgery?

But the woman brought the dog for surgery as scheduled. The right ear was less painful but the left ear was normal. The lateral ear canal resection surgery is documented for the benefit of veterinary undergraduates in their 4th and 5th year. I hope to bring boring veterinary surgery lectures alive for them.  

Now, I am a better photographer now compared to my pictures taken some 8 years ago. Better photographs are a joy to see and I hope the students in their rooms, eating fast junk food and trying to fight sleep after slaying virtual dragons online, will benefit from the picture story of how lateral ear resection surgery is done in practice.

The veterinary surgery books only show illustrations. The lecturer is doing his best but you can't blame him or her as it is not possible for him or her to show a real dog being done. The dog was given Domitor 0.15 ml IM (preanaesthetic dose). There was vomiting. After 15 minutes, the dog was anaesthesized with isoflurane gas at 1-2%. The surgery was time-consuming as the vertical ear canal was narrow, esp. for the right ear. Electro-surgery was effective and useful as there was little bleeding unlike the use of the scalpel blade, especially for the left ear.

In the right ear, there was bleeding from a bigger subcutaneous blood vessel nicked. Ligation should be done but this might not be possible. Try and do it. Be careful not to over-cut the lower part of the vertical canal as there is a branch of the facial nerve and the salivary gland. Damage to the facial nerve branch can lead to the dog not being able to move its eyelids, that is paralysis. Check out which branch of facial nerve before your external professor tests you at the oral examination!  

The dog surgery took around 1.5 hours. The writing of this article including creating  pretty pictures to wake up sleepy undergraduates took 3 hours and lots of discipline. I hope the students learn something for their veterinary surgery examinations. 

More case studies, goto:  Ear Problems in Singapore dogs
or:
Cats  or  Dogs

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