08 August 2022
Eleanor Wyatt
Job Title
Recurrent canine otitis externa (OE) remains one of the most common and frustrating challenges in general practice – with prevalence rates as high as 7.3% in the UK.11*
Not only is OE painful and distressing for the dog, but it often becomes a compliance minefield for owners, especially when long, complex treatment regimens are prescribed.
In a recent article, dermatologist Ellie Wyatt highlighted the importance of a comprehensive, evidence-based, and pet owner-friendly approach to managing OE, focusing on both clinical success and long-term antibiotic stewardship. Building on these insights, let’s address some misconceptions and explore best practice around OE management and how NeptraTM – an in-clinic, one-dose ear treatment – can help vets manage canine OE responsibly while improving the experience for dogs and their owners.
To effectively manage OE, Ellie recommends approaching OE holistically, using the ‘PSPP’ framework:
To this, she adds a fifth P: pain. Addressing a dog’s pain isn’t just an ethical obligation – it also helps prevent ear aversion.
When a dog presents with signs such as head shaking, ear scratching, or visible discomfort, a thorough clinical investigation is the essential first step. Otoscopic examination (if possible) and cytological assessment of the ear canal should be performed at the outset and repeated throughout treatment to monitor progress and guide decisions, according to dermatologist, Ellie.
Cytology remains a cornerstone of effective diagnosis. Even in dogs experiencing pain, sample collection is typically achievable – using a cotton bud for most cases, or a gloved finger in the vertical canal for those with heightened sensitivity. This simple step enables clinicians to identify whether secondary infection is present (when neutrophils are seen) and, crucially, to distinguish between rod-shaped and coccoid bacteria or yeast. Recording microbe numbers at each visit supports objective monitoring and treatment adjustments.
In everyday practice, a modified Romanowsky stain (such as DiffQuick) is commonly used for cytology. While this method does not differentiate between gram-positive and gram-negative bacteria, it provides valuable insight into the types and quantities of microbes and inflammatory cells present.
Culture and susceptibility testing can offer additional information, particularly in chronic or unresponsive cases. However, dermatologist Ellie Wyatt thinks it’s important to remember that the ear is not a sterile environment – bacteria grown in culture may not always be the infectious agents responsible for clinical signs. For example, cytology may reveal rod-shaped bacteria and neutrophilic inflammation, but culture could yield a Staphylococcus species as well, which may simply be a commensal. The real value of culture lies in identifying specific pathogens (such as Pseudomonas aeruginosa).
Susceptibility panels from commercial labs categorise resistance based on systemic antibiotic concentrations. However, with OE, topical therapy delivers far higher local concentrations – often overcoming acquired resistance and minimising systemic exposure. This approach also helps protect the patient’s broader microbiome from unnecessary antibiotic pressure.
Antibiotic stewardship is as important in topical therapy as it is in systemic treatment. Guidelines such as the BSAVA ‘PROTECT ME’ poster recommend first-line options like florfenicol or fusidic acid/framycetin for cases involving coccoid bacteria.2
While managing secondary infection is vital, long-term success depends on identifying and treating the primary cause of otitis. Failure to address underlying issues – such as foreign bodies or atopic dermatitis – often leads to persistent or recurrent disease. For example, a grass awn left in the canal or untreated atopic otitis will result in ongoing irritation and repeated infections.
In atopic cases, a course of systemic glucocorticoids (such as prednisolone at 0.5–1 mg/kg SID) at the start of treatment can help reduce inflammation, stenosis, and erythema. Topical steroids, included in many combination otic products, also play a key role in restoring a healthy ear environment. However, not all steroids are created equal – potency varies, with mometasone offering greater potency than prednisolone in topical use. Selecting the right combination product is therefore essential for optimal outcomes.
Ears are often cleaned at the start of treatment before applying medicated ear drops to maximise effectiveness, check for clinical signs of otitis media, and assess the canals and tympanic membranes during otoscopic examination (topical otic preparations are contraindicated in dogs with known tympanic membrane perforation). However, beyond that, dermatologist Ellie Wyatt acknowledges that the extent of the use of ear cleaners in cases of OE is often debated. If ears are cleaned too frequently or if they are kept wet, maceration of the skin may occur that can lead to a worsening of the otitis.
A recent study has shown that, when treating secondarily infected OE with a cleaner and daily topical product versus the topical product alone, there wasn’t a difference in outcome, except for in cases with infections with rod-shaped bacteria.3 Therefore, daily cleaning may not be necessary for treatment success in all cases, unless clinically indicated, especially when a single dose product is used.
Neptra is a one-dose, vet-administered treatment offering a combination of 3 active ingredients that work against Staphylococcus pseudintermedius and Malassezia pachydermatis (associated with over 70% of canine OE cases).4-7 This makes it suitable for most cases that walk through the practice door, after otoscopic and cytological assessment:
As a targeted one-dose OE treatment against the most common pathogens of OE cases, the administration of Neptra in clinic means broader spectrum antibiotics can be reserved for complex cases.5,8 It also avoids ‘leftover’ antibiotics lingering in owners’ homes, which may otherwise drive microbial resistance with inappropriate future use.
Treatment plans must be realistic for both pet and owner. Chronic OE can lead to ear sensitivity or ‘ear phobia,’ making daily at-home treatments stressful and challenging. One-dose, vet-administered treatments like Neptra eliminate this complexity and guarantee 100% compliance, reducing stress and supporting the pet–owner bond.9
As dermatologist Ellie emphasises, “It is easy to appreciate how this helps our pets but also preserves the human pet bond and improves quality of life as owners no longer have to chase and battle with their fearful companion9… “Treating ears should not bring fear to pets, owners or vets.”
Providing lasting action after one application, and with continuous clinical improvement until Day 28,10 Neptra offers relief without multiple treatments. This means vets can be sure their everyday OE cases are being treated effectively, and dogs and their owners are getting the relief they deserve, without the fear of complex daily treatments, preserving the owner–pet bond.
What percentage of UK dog owners chose a vet-administered single-dose treatment over daily drops at home?
Answer: 73%11
Solve everyday OE with just one dose – visit MyElanco to find out more about Neptra
