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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 25187
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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Would a very deep ear infection cause my dog to constantly

Resolved Question:

would a very deep ear infection cause my dog to constantly lick and chew his paws; would this also cause sudden fit of scratching at the side of his mouth and shuffling on his bum.
it appears that he is in discomfort and constant visits to various local vets have not found an answer. my dog is Bruno, mixed breed with strong Rottweiler markings and a rescue centre dog of about 7-8 years old also neutered. When I first had him some 5 years ago, he did suffer with constant ear infections but there is no obvious sign of any now.
Submitted: 9 months ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 9 months ago.
Prurutic (itchy) extremities, face, and anus are symptoms pathognomonic (particularly indicative) of both atopy (allergies to environmental allergens such as pollens, molds, dust, and dust mites, etc.) and food intolerance. Reactive ears are commonly associated with these hypersensitivities and so a history of chronic otitis is also a consistent finding in these dogs. Hence, a deep ear infection wouldn't cause those symptoms but such an infection is too often seen concomitant with those symptoms. Atopic dermatitis can be identified with allergy testing - either through the blood or skin scratch. Food intolerance is discovered by hypoallergenic food trial. Food intolerance/allergy is best addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Bruno's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference because it avoids the possibility of my patient being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.Please respond with further questions or concerns if you wish.
Customer: replied 9 months ago.
the suggestion you make has already been investigated and various foods/drugs etc tried without success. Bruno's problem seem to have started with general ear infection shortly after I collected him from the rehoming centre.July 2009. The infection was treated with Suralin (not sure of spelling) and occasional "flare up" was also sorted with this product. In Apri 2012 I moved to my current address and from then Bruno started with bum shuffling, limb shaking, sudden fits of scratching the side of his mouth and licking/chewing front right paw and opposite left back paw. Visits to several local vets have treated him for various aspects of the symptoms without success. among diagnosis was mild epilepsy, food/environment allergy etc. The symptoms seem to appear in 2/3 week cycles and get worse and then slacken off. My own instincts gave me the thought that he had a tumour or cyst in his head that filled up and then discharged. I also took Bruno to the Vet.Hospital in Cambridge and he was examined by the top Neurologist and 2 students - nothing was found amiss! To satisfy my own concern I paid £1200 to have a head MRI scan - nothing amiss. I paid for Xrays of his teeth to see if problems were developing at and in the roots - nothing! I am unable to find the cause of him licking/chewing/trembling/shuffling and sudden fit of violent scratching at the left side of his mouth. My property is next to an electricity sub station - I even got them to check the electro-magnetic waves to see if this could be the cause - it wasn't! my one thought still goes back to something that is causing pain in Bruno's head - hence the question if original ear infection could be dormant were ear canal/drum connects with his brain? is it possible that such infection could result in the actions/symptoms shown by Bruno. Is he licking his feet for comfort from ache/pain? is he violently scratching at his mouth with sudden stab of pain from flare up deep in the ear?
Perhaps you will let me know your opinion...thank you
Expert:  Dr. Michael Salkin replied 9 months ago.
Thank you for the additional information. The MRI would have "seen" such an ear infection. Please note, too, that abnormal electrical discharges such as occur in epileptics or during complex partial seizures of any cause (also called psychomotor seizures) can't be detected by MRI. A positive response to an anticonvulsive, however, such as phenobarbital, levetiracetam, or zonisamide would suggest that such abnormality exists. I would consider such a drug trial in a patient such as Bruno. The same medications should also be helpful if Bruno were obsessive-compulsive (OCD). These dogs have mood/behavior disorders characterized by repetitive, invariant, patterned behaviors that are exaggerated in intensity, frequency, and duration given the inciting stimuli (i.e., expressed out of context). The behavior interferes with health and well-being. Other drugs to consider in OCD dogs are clomipramine, fluoxetine, paroxetine, and setraline. Please continue our conversation if you wish.
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 25187
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Vet Specialists are ready to help you
Customer: replied 9 months ago.
my apologies for late reply, pressure of busy working life! You mention OCD - I have also been along this track with a suggestion by another vet (who said Bruno had a 'behavioural problem)of trying over-counter product such as KalmAid or similar - vet did suggest there was stronger drugs that could be tried if this didn't work. I have even tried a dog behavioural expert (£30 per hr) who said Bruno was seeking attention and I was to talk to him more and say his name often in conversation!
I still return to my instincts that tell me there is something amiss in Bruno's head! When he has the sudden face scratching fits, he whimpers first as if there is a sudden pain that triggers the scratch. The pain then subsides and possibly aches causing the comforting licking and shuffling? When Bruno had the MRI, his symptoms would build up over a couple of weeks and then subside - if he was in remission when MRI was done, then I doubt anything would show? I am wondering if it advisable to have Bruno sedated to have a full, deep ear investigation and perhaps even Xray. It may be this further chat will trigger an alternative route to take from your experience?
Expert:  Dr. Michael Salkin replied 9 months ago.
Once again, I would expect the MRI to have visualized his middle and inner ear making an X-ray superfluous. I believe that you're at the point where trials of anticonvulsive or psychotherapeutic drugs are most appropriate.
Expert:  Dr. Michael Salkin replied 9 months ago.
Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.

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