This free Veterinary CPD is produced by the Pure Animal Podcast. Dr Linda Vogelnest, veterinary dermatologist, discusses her approach to chronic cases of otitis externa. She splits her management into three steps.

1. The first 2-3 weeks focus on clearing the initial infection. 
2. The second stage aims to reduce inflammation and return the ear canals to normal. 
3. The last stage focuses on long term prevention of recurrence.

On initial examination, Dr Vogelnest often forego’s otoscopic examination in favour of cytology. Cytology provides crucial information to guide treatment and repeated samples allow progress to be monitored. But how comfortable should we be administering antibiotic drops without seeing an intact tympanic membrane? And isn’t it impossible in some patients to see the ear drum without sedation? Dr Vogelnest discusses her approach to medicating in these cases. She also stresses how important it is that owners administer the right volume of solution. Clean before drops, clean during drops, or clean after drops? We find out Dr Volgelnest’s views. Lastly, we hear more about preventative measures and a multimodal approach to these cases. These include allergen testing, skin barrier repair, owner adherence, diet, and long term medication options.