Otitis
The medical term otitis refers to an inflammation of the auditory canal (ear). The inflammation could occur in the outer ear (otitis externa), the middle ear (otitis media), or the inner ear (otitis interna). The infection is mostly bacterial or fungal. Anatomical features of Shar-Pei dogs such as their small, thick, equilaterally triangular ears set close to and well forward to the skull, along with heavily wrinkled heads predispose them to having very narrow auditory canals. This canal is partly cartilaginous and hairy, it makes a sharp horizontal bend from the vertical, and the vertical portion can be constricted by accumulation of mucin.

With such a narrow and convoluted auditory canal, Shar-Pei dogs are prone to getting ear infections – which means that they have an elevated polygenic disposition for otitis externa! Many others share this standpoint of mine that a genetic disorder is responsible for the Shar-Pei’s predisposition to otitis externa and/or otitis media.

It is quite apparent that too narrow an auditory canal can block-up easily. A blocked canal hinders (or possibly eliminates) the ear’s ability to clean itself, thus permitting bacteria and fungi to multiply and infect the host. Some lines of Shar-Pei appear to have a supplementary familial disposition to otitis. In most such instances, the dogs are offspring of pairs that have been mated repeatedly under the motto, “A Shar-Pei should have as many wrinkles as possible to boost sales” – what a delusion that is!

One of my Shar-Pei dogs, the male Pepper, came from one such proliferating operation – which is the reason why I have had to deal intensively with the dog’s tendency to get otitis.

I am aware of the fact that for years now the 1st German Shar-Pei Club 1985 (DSPC) has been seeking to eliminate such breeding practices. It set up a commission, comprising a VDH judge, a breeding manager or inspector, and an experienced breeder, to monitor mating of dogs in line with strict regulations. My opinion is that in the face of the Shar-Pei breed’s genetic disposition to illnesses, the pair to be mated should always be chosen to better the breed. This is the only way for us to jointly combat the genetic disposition of this breed to diseases like otitis and entropion, and the only salvation for our Shar-Pei dogs!

Otitis means agony for the dog. I consider it a form of cruel breeding that contravenes the law, if one ignores the particular disposition of Shar-Pei to this illness in selecting the sire and dam with the result that the offspring are predisposed to the disease.

In the following discourse, I shall delve into my personal experiences and research on otitis externa. In order to define the symptoms of otitis and understand how the disease progresses, we first need to take a look at the structure of this sensory organ. 

Structure of the ear
The ears are sensory organs of both hearing and balance. The structures for these functions are located in the outer, middle, and inner parts of the ear. The visible part of the outer ear is the pinna or auricle. This funnels sound waves into the outer ear canal and also allows the animal to localize the sound by rotating the pinna without turning the head. The sound waves travel to the eardrum along the canal that varies in length from 5 to 10 cm, depending on the animal’s size and breed. The diameter of the canal also varies greatly – it is narrower for Shar-Pei dogs than for similarly sized dogs. The canal is lined with glands that secrete wax, among other things.

The eardrum is a membrane that demarcates the outer ear from the middle ear. It has three tiny bones (ossicles) – the malleus, incus, and stapes – that mechanically transfer vibrations from the eardrum to the inner ear. The middle ear is connected to the top of the throat via a small passageway called the eustachian tube. 

The inner ear, also called the labyrinth, contains receptors for hearing and organs for the sense of balance. Mechanical vibrations are translated into electrical signals passed on to the respective parts of the brain via the cochlea for hearing and the vestibule for balance.

Causes of otitis externa
In the field of veterinary medicine, the causes of otitis externa are classified into predisposed and primary factors.

Anatomical predisposition of Shar-Pei dogs includes: 
¥    An auditory canal that is too narrow compared with other canine breeds
¥    Excessive wrinkles on the head
¥    Thick ears that are set close to and well forward to the skull

The primary factors for all breeds include:
¥    Ears with an extremely long canal and a prominent bend, which is the ideal environment for a microclimate and accumulation of secretions in the ear 
¥    Bacteria
¥    Fungi
¥    Ear mites (otodectes cynotis)
¥    Improper and excessive cleaning, or removal of hair in the ear
¥    Foreign objects like awns/bristles
¥    Injuries with superficial skin disorders
¥    Allergies
¥    Tumors

Otitis externa is seldom caused by bacteria alone, which also exist in healthy and clean ears. The bacteria produce an infection only if the environment in the ear becomes ideal for them to proliferate.

Symptoms of otitis externa
Severe pain and itchiness are the main symptoms of this disease. The dog responds to these negative stimuli in that it repeatedly scratches the pinna and surrounding area vehemently, and shakes its head hard. The disease can become serious enough that your Shar-Pei will just not be able to relax.

Excessive shaking of the head can cause swelling around the ear and even cracks may develop along the edges. The result could be necrosis (dying off) of the cartilage from lack of blood supply and disfigurement of the pinna. The pinna and canal also turn red and may be partly swollen, and a sticky brown-black or possibly white-yellow secretion appears in the canal and pinna. The ears look dirty and begin to stink horribly.

Swelling of the ear canal can cause loss of hearing too. Even touching the pinna or pulling it gently is very painful for the dog. Don’t be surprised if the dog becomes uncooperative by either running away, or possibly biting. Remember that this trauma really curtails the quality of life for your dog and is a source of extreme pain and agony.

Otitis externa can lead to serious complications if the infection spreads to the soft surrounding tissue of the middle ear (otitis interna) or inner ear (otitis media) and severely damages the eardrum. For example, it can result in deafness, imbalance, skewed positioning of the head, and meningitis.

Typically, these symptoms do not appear immediately and you may not notice behavioral changes usually until the infection is well advanced. Therefore, it is very critical to head for the vet as soon as you have even the slightest suspicion that your dog may have an ear infection.

Diagnosis 
The vet has to isolate other possible causes and past illnesses to identify otitis as the underlying disease. The following aspects are considered necessary:

¥    A clinical examination of the ear with an otoscope. 
¥    A microscopic examination of the secretion to establish the scope of colonization and infection from bacteria, fungi, and/or ear mites. If pseudomonadaceae are found, getting rid of them can be very difficult and lengthy.
¥    Preparation of a microbial resistance diagram by a lab from a specimen of the secretion, in order to determine the antibiotic resistance of the various bacteria and fungi. The proper medication to treat the infection can be prescribed only after this test.
¥    Tests for allergens, for example for sensitivity to medications and foods.
¥    An examination of the dog for metabolic disorders like diabetes. 
¥    A check-up for changes to the dog’s skin.
¥    Tests for autoimmune diseases like cutaneous LE (lupus erythematosus) of the ear, to see if these could be the cause of otitis externa. However, these mostly affect the outer side of the pinna and not the inside.
¥    Elimination of the possibility of a tumor in the ear canal, since this can produce therapy resistant inflammations.

One sees that diagnosing otitis can be very complicated. Consequently, vets don’t have an easy job of identifying the cause without the shadow of a doubt, in order to effectively treat the condition. If left untreated, otitis often turns into a long-term chronic problem. The only solution then is to continue treatment of the infection for months or possibly years.

Treatment
Dogs with otitis externa are usually treated as outpatients. The focus is on combating the bacterial infection and underlying cause, mostly with topical medications.

The first step involves cleaning the ear canal thoroughly, and applying cortisone ointments to subside the swelling. This is followed up with ear drops, lotions, or antibiotic creams to kill the organism and reduce the inflammation. Although bacteria are seldom the cause of otitis externa, they can overgrow and produce an infection – which is the reason for using antibiotics. Fungi of type malassezia are found in the ears of healthy dogs too, but more often in infected ears. These are treated with antimycotic ointments or drops that suppress fungal growth. Painkillers are also recommended along with soft and easy to chew foods to minimize the pain caused when chewing. 

Other risk factors include a sensitive ear canal and skin diseases such as eczema and metabolic disorders like diabetes mellitus. It is advisable to treat such diseases too. Up to 80% of dogs suffering from allergies tend to have ear infections too. Sometimes infected ears are the only recognizable signs of an allergy and could indicate a serious problem. An autoimmune disorder like discoid lupus erythematosus may be restricted to the ear and could cause otitis externa, but most often it is manifested as visible changes on the outer side of the pinna.

Tumors in the ear canal can produce therapy resistant inflammations, which require treatment. The prognosis for such tumors of mostly the glandulae ceruminosae (wax secreting glands), is typically cautious to unfavorable. Roughly half of them are malignant and remissions are common. Treatment involves surgical removal of the entire ear canal and middle ear.

Prevention
You can successfully prevent the onset of otitis externa by using certain medications to clean the ear canal regularly and properly. Antiseptic and fungal cleaners are particularly useful for Shar-Pei dogs, who are predisposed to the onset of otitis externa. This is because of the specific anatomical features of their ears and the difficulty in treating underlying diseases.

Personally I use Epi-Otic and cellulose or cotton swabs to clean the ears of my Shar-Pei every week. After that I apply an ear ointment or drops of Panalog or Surolan in the ear canal. Then I massage the vertical part of the ear canal from the outside, to ensure that the medication spreads evenly throughout the canal. I buy new medications each month.

Do not use q-tips to clean the ears, because you may push the ear wax further into the canal. If that happens, the wax is pressed together and it hinders self-cleaning by the ear – which is quite the opposite of what one should achieve.

The outer ear is generally self-cleaning. Cell layers growing outwards transport ear wax and any loosened flakes of skin and dead hair out of the ear. If these cell layers are damaged by improper cleaning of the ears with a q-tip, for instance, the self-cleaning process either stops or is ineffective. Ear wax and flakes of skin and hair thus collect and remain in the ear. These ideal feeding grounds for bacteria and fungi promote their reproduction and the risk of ear infections. 

Take your dog for regular follow-up examinations, to check the impact and side-effects of prescribed medications and your home remedies. Do remember to observe the expiration date of the medications.

Always keep in mind that otitis causes severe trauma in the form of pain and itching. As soon as you have the least suspicion of this illness, take your dog to a vet immediately! Also, stick to the prescribed treatment and advice.

N. B.
I have written the above material to the best of my knowledge and belief, solely for the use of visitors to this Web site. This information does not replace professional diagnostics, advice, or therapy from a vet. The information is presented here as accurately as possible and in good faith and trust in the professional integrity of the sources. I have not evaluated the statements about products and health conditions, whereby any details of diagnostics, therapies, and medications are not intended as recommendations of any kind whatsoever. Never give your dog any medicines or medicinal herbs without consulting your vet. Since I am not a qualified medical practitioner or vet, I do not accept any liability whatsoever for providing the information herein.

Hanspeter Kobold
Bremen, December 2007

This material is copyrighted by the author. All rights reserved. Reproduction in any form, in part or in whole, shall require the express prior written approval of the author. The author welcomes suggestions, comments, or criticism of any kind.