Cytology readily demonstrates the typical yeast organism, but on occasion, few or rare Malassezia organisms are found. I believe
these latter cases are a variant of the routine yeast otitis case and should be treated similarly. Generally, I advise topical
clotrimazole/betamethazone containing products or products that contain miconazole.
Most of these otic preparations are useful in treating the pruritus and pain and contain corticosteroids. In severe cases
I recommend oral corticosteroids as I do in cases of severe bacterial otitis. Systemic ketaconazole can also be useful in
severe or recurrent cases.
For maintenance, I prefer to search for the primary cause, reduce swimming and prescribe acetic/boric ear washes as a preventive
treatment for long-term management.
Many cases of otitis externa (and even media) can be routinely treated in general practice. The cases that should be referred
to a dermatologist (hopefully not a surgeon) are the ones that are recurrent in nature, resistant to treatment or need allergy
Dr. Vitale received his veterinary degree from Mississippi State University, College of Veterinary Medicine. He completed
a residency in veterinary dermatology at the University of California, Davis and is a diplomate of the American College of
Veterinary Dermatology. He is a clinical instructor/lecturer at UC-Davis and a staff dermatologist at East Bay Veterinary
Specialists (formerly Encina Veterinary Hospital), Bay Area Veterinary Specialists and San Francisco Veterinary Specialists.