Ear infections are a common source of frustration for pet owners, but they aren’t always a one-time event. Dr. Emily Rothstein, a board-certified veterinary dermatologist, joins Dr. Alice Jeromin and Janet Novotny King to demystify why these infections occur, from pendulous ears to underlying allergies. They break down why “simple” treatments often fail, the importance of rechecks, and why over-the-counter products can do more harm than good. You’ll learn exactly what triggers chronic issues and how to advocate for the right treatment plan during your next clinic visit. This conversation gives you the clinical vocabulary to take control of your pet’s ear health effectively.
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Understanding Dog and Cat Ear Infections: Expert Veterinary Advice- Dr. Emily Rothstein
Everyone, welcome to the show. It’s all about the ears. Ear infections in our pets. Why do they have them? What should we do? When should we go to the veterinarian? What not to put in the ears? You name it. All about ears in dogs and cats with our special guest, Dr. Emily Rothstein, a veterinary dermatology colleague of mine. I’m going to embarrass her because she was awarded the Award of Excellence by the American College of Veterinary Dermatology in 2025. Janet, what would Daddy say?
Smart cookie. I really wish we could have a human ear doctor on to figure out why husbands do not hear you.
On that note, and an ophthalmologist. “Where is the mustard?” They did not even open the fridge yet. Shall we digress? Anyway, Dr. Emily Rothstein, so good of you to spend an hour with us. Janet, you probably will not get a word in edgewise because she and I are going to be like that about ears.
Talking top.
Keep it down, ladies.
Janet, I’m going to have you start because it’ll just be me and Dr. Emily rehashing people we know. I want it to be all about the pets and ears.
We all hear that ear infections in pets are so common. Why?
Why Your Pet’s Ear Infections Keep Returning
In fact, about fifteen percent of dogs visit the veterinarian for ear infections. Diarrhea is probably the next biggest. It’s common for a couple of reasons. One is there are primary factors. You are a breed that has really pendulous ears, and you live in the middle of a humid environment. There are predisposing factors like allergies. Allergies are probably the biggest reason. There are perpetuating factors. Those are the factors that things happen with the infection, and everything snowballs. If you do not back all the way up and conquer the first problem, your snowball will keep rolling to you know where.
Those tears create a nice moist environment.
The Hidden Reality Of Pet Ear Anatomy
When you think about it, I have my little ear here. It’s a blind tunnel. It is a canal like us. It does not go anywhere. It does not go to the other side. Dog ears are shaped like an L. We have this part straight in, but dogs have down and over. That’s a lot of space. It’s like a teaspoon or so of room in a big dog. That’s a lot of places for things to go wrong.
What is a misconception for pet owners about ear infections in dogs or cats?
A misconception is, I guess the biggest might be, “I did not know it was an infection,” even though they’re doing this, shaking. All of a sudden they’re like, “What is that smell?” That could be the biggest one. I guess the second. Biggest, and I think unfortunately some veterinarians too, is that an ear infection is just an ear infection. When it’s gone, you’re good to go. There is always something underlying. If the underlying is not dealt with, or if the infection is not dealt with properly, again, it becomes that snowball.
Janet, I agree with Emily on that because, to me, when I see people on Facebook asking questions about ear infections, they do not understand that, more often than not, it’s not a one-time event. There’s something feeding that, and they think their vet is a failure because he gave me this medicine and it got better, but it’s back again. Emily, I read somewhere a long time ago that one of the number 1, 2, or 3 reasons for an ear infection not to get better is lack of the owner or the veterinarian to have them come back to recheck. For example, you can get a bad bacterium called Pseudomonas, which, by the way, people can get from hot tubs because it likes a warm, moist environment. You would get a dog in with this horrible, and you know it because it smells horrible, heavy Pseudomonas bacteria ear. I would get rid of the Pseudomonas, and in two weeks when I check it again, they’re back to yeast. I am happy about that because Pseudomonas will eat through your canal. Had I not rechecked that dog in two weeks, now it’s something different. You see what I’m saying? People need to know, “Here’s the medicine, bye-bye.” We have got to get to the bottom of this.
Understanding Dog and Cat Ear Infections: Expert Veterinary Advice | SOP Ep. 124 – Dr. Emily Rothstein Share on XIt’s like that in humans, because if your kid gets strep throat or an ear infection, they’ll treat them with, what’s the pink stuff, Amoxicillin? The kid still has it. It just was not the right dose of the antibiotic. Sometimes you have to recheck, human or dog or cat. It’s just part of the system.
Medicine is not magic. One thing cannot fix everything. It’s got to be a little bit so that the patient and the client can handle it. Sometimes the patient cannot tolerate things, and we have to tailor their treatment to what they’ll tolerate.
Can food allergies lead to ear infections?
Connecting Food Allergies To Ear Health
Sure. In fact, Alice and I have a dog that we share.
That’s great.
I wish she was up here. I can call her. I am on the Guiding Eyes medical release thing. When they have a dog that has a medical reason that they cannot continue in Guiding Eyes for the Blind, they say, “Do you want it?” Here’s the thing. I adopted. She was about eight months old, a black lab puppy from Ohio, which is where Alice practiced. Alice happened to see this dog as a puppy to start her workup. She had chronic ear issues and runny eye issues. She was a food-allergic dog, or is a food-allergic dog. She’s on a special diet. She probably has a little environmental allergy stuff too, so I periodically have to work on her ears. We share a patient that actually ended up being my own dog. Food allergy is one of the allergies that can lead to ear infections.
What if my dog is a swimmer, particularly like labs are swimmers? They just love it? They are swimmers. What do I do after they get out of the lake or the pool or whatever?
Swimming Safety And Cleaning Tips
You’ll probably have different answers with different dermatologists. My thought is if swimming does not cause a problem, let us not put anything in there and mess with it. If it ain’t broke, do not fix it. If they seem to be irritated, then there are drying solutions that you can do. There is even old-fashioned vinegar and water that you can rinse their ears with that will be drying as long as they’re not red and irritated.
Imagine sticking a cut finger into some vinegar. That is an ouch. Just sometimes a dry cotton ball can help. You do not want to do the screw-in like a light bulb thing because if there’s something in there, you do not want to jam it in further. Wipe what you can reach is what I always tell my clients. Wipe what you can reach. If they’re little dogs, you use little cotton balls, a little piece of the cotton. If they’re bigger dogs, you probably stick your whole finger in there with cotton.
We’re talking about swimmers ear. Emily, I’d be interested to hear what you think about these poodles that go to the groomer. They have all this hair inside the ear? I’d like to hear your opinion on that because we all think the same, all of us dermatologists. Talk about that.
There’s a lot of that on Instagram. They go in, and they twist.
I know.
I want to scream. It looks like that hurts.
There are a couple of things, again, if the poodle does not, they need air outside. If they can, you can sometimes even just use your fingers and just get a starting point so that the ear can breathe, so to speak. Some of them need to be removed or plucked. That’s irritating when I would sometimes get a poodle under anesthesia to pluck them. I would put a cortisone or steroid ointment drop in there to soothe it down because it’s irritating. When you pluck your eyebrows. That’s one hair.
A bikini wax, that’ll kill you.
There you go, bikini wax. There have been numerous reports and trials of using epilating products in dog ears like Nair, but it’s not a good thing because you can hardly ever rinse it out. It does not really work because, just because you stick it in, you cannot get it back out. When it’s appropriate, they should have a little bit of hair removed and more hair. Sometimes the veterinarian needs to get involved.
I do not think owners should try to do it themselves.
No, not unless a veterinarian has the time to show and be careful, because I know I’ve done it with hemostats and accidentally pinched the skin, and then you feel bad too. The dog hates you now, and it’s really irritating. It’s not necessarily a home thing unless they can just use their fingers sometimes. That’s just the very outer woods.
Can you leave an ear infection untreated? What happens?
The Dangerous Risks Of Leaving Infections Untreated
Probably the worst thing that happens is you get a middle ear infection. It goes through the eardrum into the middle ear, and God forbid it travels further in like otitis interna, and you get a brain infection, which I have never had happen, thank goodness. If you do not treat it, one, it hurts. If you’ve ever cut your finger, “That’s really red,” and you touch it, “Ouch.” Think of it if it were in your ear. It hurts. What do you do next to your ear? You chew. Dogs that chew hard food or cats that chew hard food. That’s like putting extra pressure right on that ear. Not treating an ear infection is not a good idea.
I cannot even imagine the pain. Emily, you and I see the worst of the worst. I cannot even imagine the pain of these ear infections that have been left untreated. In the show notes, I put a picture of what we used to see a lot of in Cocker Spaniels, right, Emily? Where you get hyperplastic ears, Janet. As I tell owners, skin lines your ear canal. It has these sebaceous glands in there. It has sweat glands in there. The longer the infection is in there, those glands get bigger to try to fight it off. It almost looks like BBs, and it closes off the ear canal. These poor dogs, it’s just horrible. Of course, surgery is the only option. They have to cut all that out.
They can possibly, depending on what surgery, be deaf. That’s the snowball effect.
Myth-Busting Over-the-Counter Products
What over-the-counter products should never go in a pet’s ear?
Everything.
I’m just saying, you got two hours?
One thing that I really think should not go, and people think, “Hydrogen peroxide kills everything. I’ll put hydrogen peroxide in there.” You know what hydrogen peroxide does when it hits blood? Can you imagine you’d be going magnified in your ear, so it’s not going to help. Two, it’s got to be just distracting to the pet to have all that in the ear. That’s not a good thing. As your mom used to say, never put anything smaller than your elbow in an ear.
Understanding Dog and Cat Ear Infections: Expert Veterinary Advice | SOP Ep. 124 – Dr. Emily Rothstein Share on XYou do not want your little kids trying to put barrettes on the hair of the ear. You do not want to stick Q-tips down in there. Even using ear flushing bulbs can be a concern because if you insert it all the way, you are not going to hurt at the tip, but you are going to block the airflow that needs to come back out. You know how ketchup always pours better when you let a little air back in the bottle. Hold it on the side. Same thing with an ear bulb. If you occlude that canal and you squeeze, all that pressure goes to the eardrum. That’s bad. I’d be very careful having a client flush with ear bulbs.
We have some myth busters for you. True or false? Dirty ears always mean infection.
False.
False. Am I allowed to vote too?
Yes. True or false?
I will tell you why.
Go ahead. Tell us why.
It’s because some dogs are just big ear wax producers. Some people have greasy hair. Their glands produce more wax. The longer the wax sits there, the more it potentially acts as food for the normal organisms that live in the ear, like yeast and bacteria. They go, “Look, it’s a buffet. Let’s eat this wax. Let’s cause an infection.” You can have dirty ears.
What if your dog does what mine sometimes do and gets that dirt nest going in the summer? They are definitely on the cool ground, and then they stick their head in, and they come inside, and they’ve got all this junk. Dirt is not an infection. Dirt is not an infection. Infection usually has an odor, which is not convenient if you do not have a sense of smell. My mentor, Danny Scott, did not have a good sense of smell. Usually there’s redness and/or tenderness that goes with the redness.
True or false? Ear mites are the most common cause of ear infections. In cats?
You have to narrow down the age of the species. How’s that, Alice?
Is it ear mites more common in older dogs or what?
No. Young cats, 100%. Nothing more rewarding than cleaning out an ear mite.
As far as ear mites, Emily, I cannot remember the last time I saw ear mites in a dog. Demodex ear mites, but not Otodectes.
No, and it could be that it was probably even before the new flea control, the isoxazolines came out. That’s true. Dogs do not get ear mites, regular ear mites that look like coffee grounds like kittens do. Kittens, yes. Others, no.
Janet, while we’re on the subject, I want to switch to cats because cats’ ear anatomy is different from dogs’ and what we use in dogs we cannot use in cats. Would you comment on that, Emily, because I’ve seen some really screwed-up cat ears even by a regular vet’s office because they’re so delicate.
“Cats aren't small dogs. Their ear anatomy is delicate and requires specific, safe veterinary care.” Share on XManaging Cat Ear Health
The big thing is that there are a lot of ear medications that are labeled for dog use only, and a lot of veterinarians, for some reason, do not read labels. Sometimes there’s nothing that’s approved, and you have to do what’s called off-label treatment. This says treated. You can treat dogs, but I have to use it on a cat because there’s nothing else on the market.
I know that it’ll work, and I know that it’s safe, but it doesn’t just because it’s made for a dog doesn’t mean it’s made for a cat. That’s across the board. That’s dog food. That’s flea and tick. That’s any medicine. Cats are not small dogs. Cats have the same L-shape, but they’re much smaller. If you were an aggressive large dog ear cleaner with a Q-tip, which you do not want to be, and you stick it in the cat’s ear, you can do some damage.
I hope the cats did not hear you say that. Cats are not small dogs.
They would say dogs are not big cats. They would have to.
They would say dogs are all mine.
Dogs are stupid.
I’ve seen problems in cats. It’s when they’ve been at a certain vet that they’ve had an ear flush, and that pressure was way too much. The cat ends up with a head tilt because of that nerve damage. That’s why, to me, cat ears should be handled very gently. I do not like to put a lot of meds in cats’ ears. I just do not. That’s my thing.
Interestingly, I can almost count on one hand how many times I actually saw a cat for a chronic ear infection. It’s just not nearly as common. The only time that it’s more common is when they have ear polyps, which are little growths that can either be in the canal or in the middle ear or even up behind their soft palate. Those cats will get chronic ear infections.
That’s mostly young cats, for people tuning in.
Yes.
Are some dog breeds or cat breeds more prone to ear infections? I’m assuming is, I guess yeast is an infection. That could contribute to ear infections?
If you look at the breeds that more commonly have, for example, environmental allergy, then those breeds are the ones that are more likely to get ear infections, because that’s part of environmental allergy, one of the most common reasons. People would always say Cocker Spaniels because they have floppy ears and it holds the moisture, but they’re also one of the higher allergic breeds. They have some other things. Their ears produce a lot of wax, some of them. Again, the wax feeds organisms. Some you think of more commonly. The most common ones nowadays are also some of the most popular breeds. It’s hard to really tell. The biggest is probably the French Bulldog. They have a funny ear anatomy. Their whole head is a disaster.
An English bulldog?
Both of those breeds are also really allergic breeds that are going to have these secondary problems.
I do not want pet owners to think that they’re a failure when they cannot treat the pet’s ear, especially dogs. It’s so painful. They should tell the veterinarian that because then we can maybe use more of a long-acting. I remember one time my cat was on an oral sulfa antibiotic, and when I would reach for the vial, she’d run away. That’ll happen when the poor dog is so painful, and they see you come at him with the ear whitening. You need to tell your veterinarian, “Listen, I do not know that I can do this,” because then Dr. Rothstein and I take that into consideration. If the dog does not get treated, they’re not going to get better. You guys need to be frank with us and let us know what you can and cannot do.
You’re right. We can tailor the treatment program to what’s available. There have been a couple of studies of the quality of life of pet owners with dogs with chronic allergies and chronic ear problems. It really depletes an owner’s quality of life. For example, my brother, they just got a puppy who’s maybe six months old now. They called me last weekend, the weekend before, and said, “She has an ear infection, and we cannot get the medicine in,” because she was being a little nippy even as a puppy. I said, “Here are some suggestions. One is, get her out of her comfort zone.
If you put them, take their feet off the ground, so either have someone hold them or put them up on the washer or a counter or something.” They’re in that weird place, and they’re wondering what’s happening. They do not pay as much attention. The other is that some dogs need a muzzle. It’s a fact of life. If you said, “Go get a tie or a long sock and just loop it around their little schnozzer, and then do it and then release her and give her cookies and tell her she’s a good girl.” Her here was not apparently very bad. They do not like it.
You’re right. The muzzle thing, as my technician used to say, I’ve got to show you. I’ve got two dogs. I can hear them.
I hear them breathing.
They’re biting each other. This one’s biting the other one’s leg. A muzzle, actually, as my technician used to say, “Give them something to focus on so that they’re not obsessed.” Sometimes just a few little suggestions to be able to do it because they’re afraid they’re going to hurt the dog. That kind of thing.
They do not want to be mean. My dogs run from me because I’m always the medicator. I’m the mean mermaid with a syringe or with the ear flat or with foot pads or whatever. You feel bad, and we do not want diets to feel bad because they’re doing a great thing helping to treat their pet’s ear. If the animal hates it for whatever reason, “I do not want to be still. I do not like your perfume smell. Get away.” Whatever the reason we got it, we will tailor it to help.
Are there any veterinary medical advancements that you guys are excited about to treat ear infections? Is there good on the horizon?
One pretty new thing. A lot of ear preps are what we call polypharmacy. They have a steroid for inflammation, something for bacteria, something for yeast, because often those are for bacteria and yeast infections together. They’re often not. There are a few companies in the last year or two who have now made solely steroids, which is very important for the inflammation, and either an antibiotic or an anti-yeast medicine. You’re not treating bacteria that do not need to be treated, and you’re not getting resistance. You’re not treating yeast because yeast is not the problem. Bacteria are.
We did not have any choice before. That’s one of the big advances. One of the things I’m not sure how much I like, they make these leave-in products that can treat for 7 days up to 14 days. Those patients need to be selected carefully because you’re not allowed to clean between the installation of those meds. If you put this thick stuff and the dog already has a bunch of junk in there, you’re adding soup to the sewer, and it just festers.
Although for clients it’s nice, they do not have to do anything, but that’s not always a good thing. Vets like it because they just put it in and then they get them back in a week or two and put another one in. You have to adjust that to which ear you’re treating. Although that’s considered an advantage, I do not know that I would think all the time.
Janet, I want to add to what Emily said. The sad part is some of these are jack of all trades, master of none. That is why when I have a client that contacts me now, I am retired, as is Emily, although we’re busier than all get out doing other stuff. I will say, “When you took your dog in, what did they find on the ear smear?” It is also called ear cytology. It’s very important to have that done. You can have mites, i.e., demodex, or you could have yeast. You could have bacteria. You do not know which one of those you have unless you get in there, look under the microscope, and then pick the appropriate product.
Anti-yeast for yeast, antibiotic for bacteria. An ear smear is so important to have done. I do not know about you, Emily, but I did not take a lot of histopathology in vet school. I took the required one. I taught myself because I love finding out what is in there and treating accordingly. Sometimes when Emily and I lecture to regular vets, they will say, “Why do I need to do that when I can reach for the product that has a steroid, anti-yeast, and antibiotic in there?” You may not need the antibiotic because it is all yeast.
You’re inducing resistant strains of bacteria, which is a big deal right now. The other one that I always hated was, “It smelled like yeast.”
You can be fooled.
I cannot tell you how many times I am like, “That smells like yeast,” and then you look, and it is bacteria. Although I did have almost a full true-in-the-room technique. I would get ready to take my swab to put on the slide for diagnosis. If the dog licks it, this does not count for laughs. English bulldog. If the dog licks it, then it is usually yeast. If it is a lot of it, then it is usually bacteria. Do not do that at home.
You need to write that up.
What is the weirdest thing or strangest thing you have ever found in a pet’s ear?
I tried to send a video to Alice.
What is it?
It was a Cocker Spaniel with a ruptured eardrum. When it was panting, you could hear it out through the ear. It breathes out through its ear. It was never visible. I sent a picture to maybe be posted about a blob of earwax. Remember that? It’s as big as theirs and nothing.
The weirdest thing I had, it was really not weird, according to a veterinary dermatologist, when French Bulldogs first came out, because now they’re rampant, but it had what we call a cholesteatoma, which is like a big blob of wax and goo. I could diagnose it on an ear smear because that is all you saw. There was no bacteria, no yeast there. It was just all waxy keratin cells. We did not know much about it then, and now you read about, I think what are they calling it, tympanokeratoma?
Yes. There have just been two recent articles about that too. I do not think I ever saw one in practice, at least one.
I saw one in 35 years or 30 years.
What is earwax?
I’ll let you take that one.
It is just the secretions of the glands that line the ear canal.
We call it wax because it looks like wax. That is not like that.
It feels waxy like soap. That is another thing you never want to put in an ear. Detergent of any sort. Mineral oil.
Remember the old thing when you were a kid, and you had an ear infection, warm mineral oil? Yeast loves oil. If you put warm mineral oil in a dog’s ear, that yeast is going to be loving it. It’s a party.
It’s an oil bath party.
Tell us about your pets.
My pets? They’re usually right behind me, one, but one cannot come upstairs anymore, my princess, the love of my life, Holly. Holly is 13.5 and a month. Who’s counting? She came to me from Guiding Eyes with a leg injury at a very young age that was never diagnosed. They did not know about it at the time. How do you tell how well a puppy walks because they’re all legs anyway? Anyway, it was not diagnosed. She is my princess. She is a yellow lab. My next one is Garland, whom we finally called Gigi. That’s the one that Alice saw. She is a black lab. I call her Miss Kissy Face because if you get anywhere close to her, I tell people she cannot hold her liquor at all.
Our newest addition, as of a couple of years ago, is Fresco. Fresco was an early release from Guiding Eyes and had a sound aversion to loud noise, which is much better now that he has grown up. That was when he was younger. You can imagine if you’re walking in the city as a guide dog and you hear a backfire and your dog jumps and knocks you over, not such a good guide dog. He has a little food sensitivity, so they’re all on special diets. Fresco’s about 90 pounds. He is massive. He looks like he has hound in him. Looks like he’s got a hound in them.
Is it a yellow lab or black lab?
Yellow. I got his pedigree, and they’re all black lab. Whether someone snuck a little.
Who cares?
Emily, how do you apply for one of those? Janet, that would be a great idea for Anne.
Melanie gets one every time in her lab.
Needed to apply for one of those?
To apply for a released puppy that does not pass training, that’s normal. The list is years old. You do that on Guiding Eyes for the Blind. For her medical releases, you can give me your email, and I can pass it along to the coordinator of that. They do have dogs. One of the people that runs our veterinary association, the Hannah Street company that runs, has placed two dogs with her. She just got her second one, Sean, and Otto was her first. When you get them, they’re so well trained. He had little seizures. Again, not a good guide dog. When you medicate them, just like my dogs when they’re on their special food, they do not have any problems at all.
You’re in Connecticut, right?
Yes.
Janet’s friend is in New Canaan.
She’s right over the border on something Heights.
We’re by Stamford.
They’re up, like, west of Danbury where they’re Guiding Eyes.
Our friend, Melanie, whenever her lab passes, she gets one. Now she has Rosie, who’s adorable, a big black lab.
Is she puppy raising?
She does puppy raising, and then she does adoption, as she has always had one from there. Anne knows about it. I’ll tell her again.
Where are you, Emily, in Connecticut?
Smack in the middle in Southington. I am like dead center in the middle of the state.
I’m in Darien.
My brother’s in Greenwich.
There you go. We say it, Greenwich.
That’s quite good.
I do not want to hear like it’s going to storm.
Emily, would you comment on your opinion, and then I’ll give my opinion on the new medications for allergy, the monoclonal antibody and the JAK inhibitors? How do you feel they work for ear infections?
What are those?
Whatever you do, I’ll let Emily take that.
There is a newish one that’s been around for about thirteen years, a family of drugs that inhibit an enzyme within the cell so that the itch pathway gets stopped early. Those are called JAK inhibitors. People are probably seeing commercials for Apoquel a lot on TV. Now there are two newer ones out. Those are given on a daily basis to stop the itch before the snowball happens. The monoclonal antibodies, those are antibodies that are designed to target a specific chemical in the body even before it gets to the cell to start this. You’ve probably heard a lot about one online. There’s Keytruda for non-small cell lung cancer. There are lots and lots of them used for rheumatoid arthritis in humans and all sorts of things.
These are given in veterinary medicine by injection. The idea is that you block all those little chemicals that are flying around called cytokines before it even gets to the cell to bind to have anything triggered. That’s a very targeted therapy. You’re only going after that itch chemical. Those are really an advance, and they’re coming. There are two of the injectable and now three of the pill form that are quite good. Nothing is guaranteed. Every patient’s an individual. Sometimes it works, sometimes it does not. I forgot what the other part of your question was.
What’s your opinion on doing those to help ear infections? A lot of vets think they do certain.
I would have to say that they are somewhat, but not super, effective in treating. I would tell clients that anything in front of the head, in front of the neck, ear infections, runny eyes, they just do not really do much. Some dogs, there’s enough anti-inflammatory in the pill form to help a bit, but then you’re also medicating an entire pet, whether they lick their feet or not, if you only need to medicate their ears. If you want to spend the money and/or medicate the entire body, if you’re only focusing on the ears.
Now granted, most allergic dogs have ears and feet and belly and armpits, and you need to medicate the whole dog. Still, these newer meds are not super effective at dealing with otitis externa in the dog, and there are no cat-approved pill forms, although it’s used off-label in cats and there are no injectables that go after that one cytokine or that one thing that binds before it gets to the cell. There are no cat plans of that yet.
Is there a particular age when a dog or cat becomes more allergic?
In fact, I was just listening to a couple CEs this week, and what I was taught was if something starts between the age of one and three more or less, then it’s more likely to be environmental allergy. Environmental allergy does not typically start before one year of age because you need a whole season to expose and react, or over the age of three unless you move pollen zones. If you’re from Texas and you’re four and you moved to New England, you’re starting your book all over.
It happened to me in California.
Food allergy, on the other hand, can start at six months until the day before you die. Any age, or people are always, “I feed them the same thing.” That does not mean it’s good to switch it up because then you get the other complaint to see a veterinarian, which is diarrhea. They’re changing their food all the time. Food, any age, environmental, usually between one and three.
Some clients do not even realize that there are other things besides the ears because they hear the dog going flappy or they smell the ear infection, but they do not know that when the dog’s in the other room, it’s licking the heck out of its feet or scratching its armpits. The veterinarian needs to do a full dog exam, make sure none of these other signs of allergic disease are present, and not just hone in on the ears.
Understanding Ear Hematomas and Contact Allergies
Speaking of ears, what is an ear hematoma?
That’s a good one. When I got my first veterinary-related job when I was eighteen, I was in a high school that had a program that allowed you to work part-time to gain high school credits. I went to a veterinarian’s office, and the first surgery I ever saw was an ear hematoma. For those who do not know, an ear hematoma is a little pocket of blood between the outside flap part of the tissue of the ear and the inside. Let me see if my little friend can help us here. A hematoma would be between this part of the ear and this part of the ear, and it looks like that, just a big balloon.
Does it feel like a bubble in there?
It can feel like a bubble, or it could feel harder and can be painful, or some dogs do not even know it is there. They’re filled with blood. My first job, the first surgery I saw, they have to anesthetize the patient, and then they open it up to get all the blood out. There’s a lot of blood in there. I remember going, “Man, I hope I do not get that out.”
People think hematomas are only from shaking their head really hard when they have an infection or things like that, but it is caused by leaking blood vessels, and other things can make the blood vessels leak. Certainly, trauma can be one of the things that causes it, but it is not the only thing that causes it. They’re often, not always, but they’re often something that needs surgery to fix because the pocket is so big. If you do not sew the pocket together, then it just fills right back up. There is nothing to stop it from filling up.
Emily, I agree. I always was under the understanding that it was not always due to trauma. There is one paper on that, and it is very old. It was a Japanese study where they did ear trauma to dogs. It was like ten dogs, and I think one of them developed a hematoma. I agree with the leaky vessels. I think it could even be immune-mediated for all we know.
It could be that the blood vessel cells that keep the blood vessel intact start to separate. The blood has nowhere to go but wherever else it can go. I do not think that study would fly anymore with ethics.
Thank God. When I read about it, I could just picture that. I do not even want to talk about it.
When I was a regular vet, before I started dermatology, we also would do things where we would put a little cannula or tube in the bottom of the ear and sew it in. You bring the blood, and you put this in, and then the owners would unscrew the cap to milk out the blood and unscrew the cap back on periodically, but obviously messy. The client wants to do it. You have to have a dog that tolerates this thing. It is like wearing an earring. If you have never had an earring in your ear, you’re going to be doing this.
Janet, we would not ask you to do that.
There are times you can do topical treatments and oral treatments to help with the inflammation-related issues.
I know what I wanted to mention too. I probably had maybe three cases in 30 years. Contact allergy to the actual medication. Talk about that.
Multiple. One of the most common contact problems, so you use a product on an animal, just like if you touch poison ivy four times, you’re fine. The fifth time, you break out. I know, I pulled a weed yesterday, and I have all these little vesicles on my hand.
I got it.
You do not always react right away. You react later. One of the most common things can be a reaction to the topical medication. That can either be the product you’re trying to treat the infection with. A lot of dogs can be sensitive to neomycin, which is an antibiotic. That’s one of the more common ones. They’re sensitive to something in the ear cleaner, and the most common is called propylene glycol. That’s a preservative that’s needed in these products so that they do not go bad really fast. It’s also the most common thing that sensitizes dogs to a contact reaction.
Sometimes when I see a dog, and I am like, “It sounds like everything was going well, and then something turned the corner,” the first thing I do is say, “Stop everything.” Let’s just use saline for cleaning and let’s see what happens. A lot of times they improve just because they’re not being tested with this product or this substance that’s causing more harm than good for that pet. It’s not super common, but I’ve seen it enough that I had this little list on the wall. Propylene glycol, glycol-free cleaners, because it did not happen all the time. Was it at the tip of my tongue, so to speak?
I always tell people when I dispense ear meds, if this looks worse to you in a day or two, stop it and call me. Sometimes, Janet, they’re so sensitive because by the time they get to Emily and me, they have had a bunch of products dumped in that ear. That’s the other thing. If they have overused a cortisone-containing product, then it thins the skin, and then you have got to stop everything and let that get back to normal.
I have a question for you as a two-timer.
What? A two-timer?
Yes. Better than a cougar.
When you enter a party room, what is your entrance song?
Vets do not go to parties first.
They do. I met Emily at a party.
I know, in Boston. They had bad appetizers.
I was going to say, one, you never tell anybody you’re a veterinarian because the first thing they do is they come up with all these, “My dog got spayed.” I’m like, “I’m a dermatologist.”
I am not even a veterinarian, but people know my sister is, and I’ll get texts, “Can you ask your sister about this?”
One of my relatives said, “My dog’s vomiting.” I’m like, “Dermatology, not gastroenterology.” Of course, I can give an answer, but a good entrance song.
What’s your favorite, like you would enter a party in?
Depends if I’ve had a pre-party cocktail.
You usually do, and make it a double.
When COVID was out, and we had our answering machine at work being used way more because we were down on staff, what song did we have? Something like Sting, Don’t Stand So Close to Me.
That’s really cute.
I actually have a Sting story. Went to see somebody who had a ticket to go see the Jimmy Fallon show, the taping, and you do not know who you’re seeing. You just go. We ended up deciding we’d split up. We were four of us, because you get better seats, because they want to fill the front. I’m sitting there, and a guy is sitting in there with The Roots, the band. He looks so familiar. They do that entrance song, and Jimmy comes out and does his thing. Jimmy sits down and says, “We want to thank our special guest,” and they use Sting’s real name, like Bob.
I should know because I love him dearly, and my husband will be embarrassed that I do not know it.
He has a name, and so the whole crowd goes nuts, and I’m like, “Who the hell is it?” Sting was already out there playing with him. It was cool. It was very cool. He is very talented. Was a good guest. I enjoyed it.
Who’s your most famous client, Emily, if you’re allowed to say?
I had a famous person for a bad reason I probably do not want to say.
We do have one of the Rolling Stones in Connecticut.
I’m not going to remember her name. I had somebody who was on a soap opera, like Guiding Light.
Our mom used to say Young and the Restless.
I never knew that.
She’s just saying, “I’m watching Young and the Restless,” and I’d be like, “What?”
I do not know that I saw any famous people. I did see the dog trainer who trained a lot of dogs for theater plays. I saw him with one of his dogs.
Emily, what are you doing this summer? You got any plans?
Veterinary Dermatologist Summer Safari
Actually, in about six weeks, we’re leaving for an African safari.
There are going to be four veterinary dermatologists.
Who else is going?
There is going to be a veterinary internist, a veterinary ophthalmologist from DC who is a friend of Val’s. Let’s not talk about veterinary medicine, one eye.
It’ll be so much fun.
.
You should say you’re a proctologist and then no one will talk to you.
That is going to be such a fun trip.
Two weeks of that.
People say it’s life-changing, actually.
We have got to wrap it up, Alice. We have got to say thank you to our audiences and thank you to Dr. Emily. I learned a lot about ears.
Janet, I’m just going to have people call you instead of me or Emily because why not? You’re learning on each episode about all these organ symptoms.
First of all, I cannot pronounce those words.
That’s okay. We did not say any big words about cholesteatoma.
Look, she’s like, “Stop using big words.” She likes words like treat.
Dog cookie, walk, biscuits.
Do not say daddy because I’m going to pick him up at the airport after this, and so they’ll get all excited thinking he’s home, but he’s not yet on the QT.
Anyway, thank you for tuning in. We appreciate our audience and keep sending in those questions to SOPPodcast.com.
Dr. Rothstein has sent us some really good pictures of good ears, bad ears, hyperplastic ears. I’ve thrown a couple on there myself, video otoscopies. Check it out at SOPPodcast.com.
If there is something I’ve learned from meeting all these fabulous veterinarians as an average pet owner and lover, it is that if you sense something is wrong, and it probably is, so you better make the appointment.
Anything out of their ordinary behavior, because dogs are creatures of habit just like we are, have it checked out. Thank you so much. Thanks for tuning in.
It’s been a pleasure, always.
Thanks, Emily. Bye, everyone.
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About Dr. Emily Rothstein
Dr. Rothstein was graduated with honors from the University Of Florida College Of Veterinary Medicine in 1988. She then completed a one-year internship in Small Animal Medicine and Surgery at Cornell University. After being in private practice for 6 years, Dr. Rothstein was accepted into a Dermatology Residency at Cornell University and became a member of the American Academy of Veterinary Dermatology. While at Cornell, she participated in numerous published clinical trials for new and improved treatments. Dr. Rothstein completed her residency in 1997 and was awarded diplomate status (board-certification) in the American College of Veterinary Dermatology (ACVD) in 1998. She founded Animal Allergy and Dermatology Service of Connecticut, LLC and recently retired from that after 25 years.
Dr. Rothstein has been actively involved in the ACVD for over 20 years: serving on the ACVD Board of Directors for 10 years, an Administrator of acvd.org, and Chairperson of the committee responsible for overseeing board-certification of new Diplomates in the ACVD. Currently, she serves on the ACVD Advisory Board of Directors and the Administrative Council for the World Association for Veterinary Dermatology. She is the Secretary for the World Congress of Veterinary Dermatology 10 (WCVD10). Dr. Rothstein enjoys being a writer contributing to VIN (Veterinary Information Network) and consulting for VESPECON. She received the ACVD-American College of Veterinary Dermatology’s Award of Excellence in 2025.