Ear infections (otitis externa) in dogs in India: monsoon, breeds and treatment

Signs of Otitis externa

The 8 signs to watch for are listed below. Any one of them is a reason to consult your nearby vet; none of them is a diagnosis.

• Head shaking, repeatedly, often towards one side
• Scratching an ear, or rubbing the head along floors and furniture
• A foul, yeasty or sweet smell from the ear
• Brown, black or yellow discharge inside the ear flap
• Redness, swelling, scaly skin or crusting on the flap
• Pain, flinching or yelping when the ear base is touched
• A head held tilted to one side, which means go today
• One ear warmer, damper or darker than the other

Breeds on this site that document this condition

Each breed page below carries the figure for this condition with its denominator and its source. The 9 breeds listed are the ones on this site that document it, not a ranking of risk.

What a dog ear infection is, and how common it really is

A dog ear infection is otitis externa, inflammation of the external ear canal from the base of the auricular cartilage to the eardrum, with or without the ear flap involved. It is one of the most common reasons dogs are taken to a veterinarian, and in the largest study of it the one-year prevalence was 7.30 percent in a random sample of 22,333 dogs drawn from 905,554 under UK primary veterinary care in 2016, which is 1,631 dogs, or one in every 14 Royal Veterinary College.

That 7.30 percent is the only population rate on this page, and it was measured in the UK. A British primary-care caseload is not an Indian one. Indian dogs live in different heat and humidity, are presented to hospital later, and are counted against different denominators, so the Indian figures below are hospital caseloads rather than population prevalences and the two must not be read as the same kind of number. Read every row of the table for what it counted.

Those Indian numbers come from five separate veterinary hospitals and they are real, cited work Roy M, Kashyap R Kumar S, Hussain K, Sharma R, Chhibber S Parmar JJ, Rao N, Shah AI, Sadhu DB Nainika, Sharma P. Otitis externa in Dogs. None of them is indexed in PubMed, whose India-scoped otitis externa search returns zero records, which is why every ranking page writes about this condition as though India had produced no data at all.

The four kinds of factor a vet is actually sorting

Veterinarians sort the causes of otitis externa into four groups, and the group decides the treatment. Primary factors start the inflammation on their own, and they include hypersensitivity disease, ear mites and other ectoparasites, endocrine disease such as hypothyroidism, keratinisation disorders, foreign bodies and tumours; underlying hypersensitivity is the most common primary factor in dogs. Predisposing factors do not start the disease, they raise the risk, and they are the ones an Indian owner meets daily, since they include pendulous ears, stenotic or hairy canals, excess cerumen, frequent ear cleaning and changes in external temperature and humidity. Secondary factors are the bacterial and yeast overgrowth that arrives once the canal has changed, and MSD lists overcleaning among them. Perpetuating factors keep the disease going after the primary cause has been fixed, and they are the usual reason a recurrent ear never quite clears: biofilm-forming Staphylococcus and Pseudomonas, Malassezia yeast, a stenotic or calcified canal, and infection that has reached the middle ear.

This is what the phrase types of ear infections in dogs is really pointing at. The useful split is not bacterial against yeast, it is which layer of that four-part picture a given ear is stuck on, and chronic otitis, meaning disease that persists or recurs for three months or longer, usually means a primary factor nobody has found yet. The Indian evidence agrees on the organisms: at Anand, 102 pus samples from 67 dogs yielded 251 isolates across eight bacterial species with Staphylococcus dominant at 56.57 percent, and at Durg direct impression smears showed cocci in 76.1 percent of cases, bacilli in 47.6 percent and yeast in 19.0 percent.

When to contact your vet about a dog ear infection

Contact your vet the same week for any dog ear infection symptoms, and the same day if the dog is in pain, is holding its head tilted, has lost its balance, or has gone off food. Most ear infections do not resolve without treatment, and all of them need a veterinarian to look at the eardrum before anything goes into the canal.

Speed matters for a mechanical reason rather than an alarming one. Repeated inflammation thickens the canal lining, enlarges and dilates the glands and raises the humidity and pH inside the canal, which is exactly the environment secondary infection needs, so each untreated episode makes the next one easier, and a dog that scratches at one ear all week is not waiting it out, it is digging the canal open. PDSA puts the same point plainly for owners, that the quicker a dog is treated the faster the recovery is likely to be. Six changes move an ear from a weekday appointment to a same-day one.

• A head tilt, a wobble or circling, which suggest the disease has moved past the outer ear.
• Real pain on touching the base of the ear, or a dog that will not let the ear be handled at all.
• Ulceration, bleeding or a canal swollen shut, all recorded findings on otoscopic examination.
• A dog that has stopped eating or seems unwell, because untreated ear infections can progress to systemic illness.
• Sudden deafness or a dog that stops responding to its name, since conductive hearing loss follows exudate, stenosis and glandular change.
• Both ears at once in a dog that has never had this, the pattern in 52.23 percent of the 67 Gujarat cases, which points at an underlying cause rather than a one-off.

A second episode within weeks of a first is itself a reason to go back rather than to reach for what is left in the bottle. Recurrence after a documented resolution means a thorough review of the possible primary, predisposing and perpetuating factors, not a repeat of the same treatment.

Monsoon, humidity and what the Indian series actually show

The Indian series point at the rains, but they do not fully agree, and this page publishes the disagreement rather than picking the neatest number. Three of the four Indian studies that report season put the peak in the monsoon, and one puts it in summer Kumar S, Hussain K, Sharma R, Chhibber S Roy M, Kashyap R Nainika, Sharma P. Otitis externa in Dogs.

At Veterinary College Hebbal in Bengaluru, the retrospective and current review of hospital records found the rainy season carried the highest prevalence of otitis externa, followed by winter and then summer, with drop-eared dogs more susceptible than prick-eared and intermediate-eared dogs. In Jammu, where the study window ran only from August to December 2011, the highest occurrence fell in August at 28.33 percent of 60 cases, followed by October at 26.66 percent, and the lowest in December at 10.00 percent. Read that one carefully: a study that never sampled March to July cannot tell you whether summer is worse than the monsoon, and the honest reading is that ear cases fell steeply as the air dried out.

The strongest rainy-season signal in the Indian literature comes from the hills. At CSK Himachal Pradesh Krishi Vishvavidyalaya in Palampur, 2,476 dogs were screened between June 2022 and July 2023 and 81 were diagnosed with otitis externa, a hospital prevalence of 3.27 percent, and 59.25 percent of those 81 cases fell in the rainy months of July and August against 18.51 percent in summer, 12.34 percent in winter and 9.87 percent in autumn. Read the window before you read the number. June 2022 to July 2023 is fourteen months, so it contains two July-to-August rainy seasons and only one autumn, which lifts the rainy share on arithmetic alone. Corrected for that, the rainy bucket still covers three of the fourteen months and carries close to six cases in ten, so the signal is real but smaller than 59.25 percent makes it look.

Durg is the dissent, and it is a real one. There, otitis externa peaked in summer at 41.18 percent of 51 cases against 33.33 percent in the rains, and the authors say the seasonal pattern matches earlier Indian work reporting the highest incidence in summer, with late summer humidity giving bacteria and yeast an ideal environment. Chhattisgarh's pre-monsoon months are brutally hot and already humid, so a summer peak there and a monsoon peak in Bengaluru may be the same mechanism arriving at different times. What no Indian study supports is treating December as a safe month.

One limitation runs through all five Indian series and no ranking page mentions it. Not one of them was done in Mumbai or Pune in Maharashtra, in Chennai in Tamil Nadu, or in Delhi, Kolkata or Hyderabad, which is where most of India's pedigree dogs live. The evidence an owner in a coastal metro reads was gathered in Jammu, in Durg in Chhattisgarh, at Anand in Gujarat, at Veterinary College Hebbal in Bengaluru, Karnataka, and at Palampur in the Himachal hills Roy M, Kashyap R Parmar JJ, Rao N, Shah AI, Sadhu DB Chaudhary M, Mirakhur KK. Non-descript… Nainika, Sharma P. Otitis externa in Dogs. Four of those five sites sit well inland, and humidity is a predisposing factor wherever it sits, so a reader in Chennai or Mumbai should treat the ear routine as a year-round job rather than a seasonal one, and read the Durg summer peak as the warning it is.

Why humid air changes what happens inside the ear canal

Humidity is a predisposing factor, which means it does not start ear disease on its own but it raises the odds in an ear that already has something wrong. The mechanism is that changes in external environmental temperature and humidity alter the local canal environment, alongside excess hair, stenotic canals and excess cerumen. MSD lists excessive moisture in the ear canal among the predisposing factors directly. A pendulous ear flap lying flat over the opening turns that into a sealed, warm, wet chamber, which is why the same weather that a prick-eared street dog shrugs off produces a monsoon of ear cases in Cocker Spaniels and Basset Hounds.

The Gujarat series names the single most controllable trigger in the whole Indian literature. At Anand, most of the 67 otitis cases had a history of a bath seven to twelve days earlier, and the authors' stated conclusion is that the most common cause of otitis was bathing without ear plugging; their advice to owners was routine ear cleaning plus plugging the ears during baths to prevent moisture retention. That is a finding about Indian grooming habits rather than about Indian weather, and it is actionable today. Our guide to grooming a dog at home in India covers the bathing side, and monsoon care for dogs in India covers the season around it.

How veterinarians diagnose dog ear infections

To diagnose a dog ear infection, veterinarians take a history, palpate the ear, examine the canal through an otoscope and read a swab of the discharge under a microscope. Cytological evaluation of the ear contents is the single most informative diagnostic test, and it is what decides which treatment the ear gets.

Ear cytology is quick and it is not a laboratory send-away. The vet rolls exudate from the horizontal canal onto a slide, stains it, and reads it under oil immersion for keratinocytes, bacteria, yeast and white cells, which tells them whether they are looking at cocci, rods or Malassezia and therefore what class of drug the ear needs. Culture and sensitivity testing is used occasionally rather than routinely, to guide systemic therapy when that is indicated. Both Indian series that worked microbiologically did exactly this, and the Anand work is the reason an Indian ear is a thing to culture rather than to guess at, because its 251 isolates across eight species each had a different sensitivity pattern.

The otoscope is doing two jobs at once. It finds foreign bodies, ear mites, masses and exudate, and it lets the vet grade the canal for stenosis, erythema, erosion, ulceration and glandular change. A painful or blocked ear may need sedation for that examination, which is normal and not a sign anything has gone wrong. Five steps are what a first ear consultation usually contains.

1. History first, including when the last bath or swim was, since the Gujarat cases clustered seven to twelve days after a bath.
2. Palpation and a look at the flap, for self-trauma, redness, crusting and thickening.
3. Otoscopy of both canals, with a clean cone for each ear.
4. An assessment of the eardrum where it can be seen, for bulging, rupture or colour change, which governs what may safely be put in.
5. Ear cytology from the horizontal canal, read the same visit, with culture added only if the picture calls for it.

Why the eardrum cannot always be seen, and what that means

Often the eardrum is simply not visible, because exudate fills the horizontal canal, and assessing it can reasonably be left to a later visit once the active inflammation has been brought down MSD Veterinary Manual. That is a clinical judgement made with the dog in front of the vet, and it is also the reason a bottle of drops from a previous episode is dangerous: the owner cannot make that judgement. An intact eardrum does not rule out middle-ear disease either, and its absence suggests otitis media. Imaging is not routine, but computed tomography is preferred over radiography when the middle ear is a concern.

Extra tests belong to the chronic or one-sided ear rather than the first one. Allergy testing, ringworm testing, skin biopsy and x-rays are used for ongoing or unilateral inflammation or where the middle ear is suspected. If your dog is a breed with a documented predisposition, say so at the first visit, because that changes what the vet is looking for.

Dog ear infection treatment, in general terms

Dog ear infection treatment has three parts that run together: clean the canal, treat the infection and the inflammation topically, and find and correct the underlying cause so it does not come back. Topical therapy is the mainstay, and systemic antibiotic therapy for otitis externa is typically discouraged.

This page prints no dose, and it names no product as the right one for your dog. Most otic preparations combine an antimicrobial, an antifungal and a glucocorticoid, and the individual product is chosen on the cytology result, so an ear growing gram-negative rods may need a different class from one growing yeast. That choice, and the amount, belong to the veterinarian who has looked into the canal. What an owner can usefully know is the shape of the plan.

Cleaning comes before medicating, and it is not cosmetic. Topical medication is inactivated by discharge and wax, so vets clean and dry the ear before treating, and cleaning also breaks up the biofilm that protects bacterial colonies from any antimicrobial MSD Veterinary Manual. Hair around the ear is usually clipped for access, and a first clean is often done at the clinic with the owner watching, which is worth asking for MSD Veterinary Manual.

How long treatment takes, and what follow-up looks like

Treatment continues until the infection has gone, judged by re-examination and repeat cytology rather than by the ear looking better. Dogs with bacterial and yeast infections are examined and re-tested weekly to every other week until there is no evidence of infection, which takes two to four weeks for most acute cases; chronic cases can take months, and some need maintenance treatment indefinitely MSD Veterinary Manual. Budget for the recheck when you budget for the first visit, because skipping it is how an acute ear becomes a chronic one.

The chronic, stenotic or end-stage ear

A chronic ear is a different clinical problem from a first infection. Repeated inflammation produces severe glandular change, fibrosis, stenosis and calcification along the canal, which is end-stage ear disease, and the review that describes it says it can usually be avoided by treating the secondary and primary disease early. Referral to a veterinary dermatologist should be considered for every dog presented with recurrent otitis, chronic otitis or otitis media, where video-otoscopic evaluation and deep ear treatment, with or without myringotomy sampling, often produce the accurate diagnosis. At the far end sits surgery, and the Finnish survey is the clearest picture of it: American Cocker Spaniels are overrepresented among breeds needing total ear canal ablation for end-stage disease, and among 85 owner-reported affected dogs, 14 (16 percent) either had surgery (11 dogs) or were euthanised (5).

Can you treat a dog's ear infection at home, honestly

You cannot diagnose a dog ear infection at home, and the diagnosis is what chooses the treatment, so home care is the part before and after the clinic rather than a replacement for it. Every question Google India shows for this term is a home-treatment question, so they are answered here with what the evidence says rather than with a shrug.

The first honest answer is that an ear infection usually does not clear itself. PetMD, the page ranking first for this query, says most often a dog ear infection will not go away on its own, that all types of otitis require a veterinarian to evaluate the infection and the eardrum, and that if the eardrum is ruptured certain cleaners and medications can damage the middle ear. That is the whole case against self-treatment in two sentences, and it is the one home-treatment question any ranking page answers.

The second is that home remedies have a documented downside rather than a neutral one. MSD's professional text says irritating treatments such as home remedies and vinegar dilutions should be avoided because they cause swelling of the lining of the canal and an increase in glandular secretions, which predispose to opportunistic infections, and adds that substances which are not irritating in a normal ear can still irritate an inflamed one MSD Veterinary Manual. Powders used after plucking hair can form irritating masses and should not be used. Over-the-counter wax removers are for the vet to approve, not the owner to try.

The third is about the bottle left over from last time, which is the commonest Indian home treatment of all. At Anand, some cases carried a history of long-term medication that had not responded to routine antibiotic therapy, which is what self-medication looks like in a caseload, and because each of the 251 isolates there had its own sensitivity pattern, last month's drops are a guess going into a canal whose eardrum nobody has looked at MSD Veterinary Manual. Four things are genuinely useful to do at home, and none of them is medication.

• Look and smell, both ears, every day in the rains, since owners are told to check regularly for temperature change, discoloration and the sudden presence of moisture.
• Dry the ear flap and the visible canal after every bath, swim and wet walk, the step the Gujarat authors put ahead of everything else.
• Write down the date of the last bath and the first head shaking, because the Anand cases clustered seven to twelve days after a bath and that history helps the vet.
• Clean only with what your own vet has recommended, and only as often as they said, because frequent ear cleaning is itself listed as a predisposing factor and overcleaning as a secondary cause.

What treatment costs in India, and what nobody publishes

No Indian veterinary hospital publishes a rate card for otitis externa, so the honest cost of treatment in India is built from a consultation price and a retailer's range, with both labelled for what they are. Bonbeno prints only figures read from a page we opened.

A standard consultation at a good clinic in India costs Rs 500 to Rs 1,000, which is the entry price of finding out what is wrong. Treat that as one data point rather than two, because the same range appears word for word on a general insurer's blog, and two sources that agree to the rupee are one source. A first visit for an ear usually buys the examination, the otoscopy and the cytology, and the rechecks that follow are separate visits.

For treatment itself, the only Indian figure this page could find sits on a retailer's breed blog, and that page contradicts itself. Its health-cost table prices otitis at Rs 2,500 to Rs 8,000 per treatment with Rs 500 to Rs 1,500 a month for prevention, while a highlighted callout further down the same page says treatment costs Rs 8,000 to Rs 15,000 per episode. The same callout claims veterinary dermatologists report one in three Beagles in humid Indian regions get at least one significant ear infection a year, and names no study, no sample and no dermatologist. We publish both ranges because both are on the page, and we believe neither over the other.

Prevention is the one Indian price with a real product behind it. Virbac's Epiotic antiseptic ear cleaner, sold in India with salicylic acid, PCMX and a sugar-based anti-adhesion blend in its stated composition, was listed on 23 September 2026 at Rs 134 for 50 ml (MRP Rs 136) and Rs 230 for 100 ml (MRP Rs 234). Every rupee figure on this page was divided by 84.38 and by 74 and none produces a round dollar amount, so none of them is a converted American price.

The ranking pages are no help here either. Of the four opened for this page, only PDSA carries a cost heading at all, and it prices British care for British readers PetMD, Dog Ear Infections VCA Animal Hospitals. If a clinic near you publishes its own list, that list beats every figure above, and it is worth asking for before the first recheck rather than after.

Preventing dog ear infections, and how to clean your dog's ears

Preventing dog ear infections in India comes down to keeping the canal dry and looking at it often, because the strongest predictor is conformation you cannot change and the strongest controllable trigger is water left in the ear. There is no screening scheme, no DNA test and no registry for otitis externa; otoscopy and ear cytology at the clinic are the only tests.

Start with the sentence that no ranking page is willing to print. The veterinary dermatology review states directly that few effective preventive measures exist for otitis externa, and that what genuinely helps is thorough ear examination at every physical examination so that mild and early cases are found, plus client education and frequent follow-up. In other words, catching it early is the prevention, and the routine below exists to make catching it early possible.

The authors of the 22,333-dog study are equally specific about technique, and their advice runs against Indian habit. They advocate cautious, low-harm approaches, naming ear cleaning with a dry paper cloth, judicious use of ear cleaners with antimicrobial properties, and avoidance of overzealous ear-cleaning or ear-plucking, and they ask owners of predisposed breeds to check regularly for malodour and exudate. MSD adds that hair should not routinely be removed from the canal if it is not causing a problem, because doing so can induce an acute inflammatory reaction, while clipping hair from the concave side of the flap and around the opening does improve ventilation and cut humidity.

The monsoon ear routine for an Indian dog

Here is how to clean your dog's ears and keep them dry through an Indian rainy season, following the owner instructions in the MSD manual and the Gujarat authors' advice. Ask your own vet to run through it once with the dog on the table before you do it alone.

1. Look into both ears daily from June to September and at least twice a week the rest of the year, checking for redness, odour, discharge, warmth or sudden damp.
2. Never use cotton swabs or anything that pushes debris deeper, and use real cotton balls rather than synthetic ones.
3. Use only the ear cleaner your vet recommends, filling the canal, massaging the base until you hear it squish, then letting the dog shake its head.
4. Wipe out what comes up with a cotton ball wadded into a tube, and stop when the cotton comes out clean or shows blood.
5. Plug the ears before every bath and dry them thoroughly after, the single measure the Anand authors put first after finding most cases had bathed seven to twelve days earlier.
6. Keep the canals dry and ventilated after swimming, using a drying agent only if your veterinarian recommends one for a dog that swims often.
7. Book the appointment on the first head shaking, rather than waiting to see whether it settles.

Two Indian details finish the routine. Ear mites and other ectoparasites are a primary cause of otitis externa in their own right, and in Jammu parasitic otitis accounted for 31.66 percent of the 60 cases, so a dog's parasite cover is part of its ear care; our guide to dog ticks in India covers the product classes and the year-round routine, and the same monsoon weeks that fill clinics with ears also fill them with tick fever. Second, weight matters: dogs at or above their breed and sex mean bodyweight had 1.45 times the odds of otitis externa compared with dogs below it, which makes a lean dog an ear intervention as well as a joint one.

Ear shape, breed, and why the Indian breed tables mislead

Breed and ear carriage were the two highest-ranked risk factors for otitis externa in the only study large enough to separate them, and the effects are big. Against breeds with erect ears, breeds with pendulous ear carriage had 1.76 times the odds (95 percent CI 1.48 to 2.10) and breeds with V-shaped drop ears 1.84 times the odds (1.53 to 2.21).

Three group effects sit alongside ear shape and matter for what Indian buyers are choosing now. Poodle types carried 1.91 times the odds of non-poodle types (1.57 to 2.32), spaniel types 1.24 times the odds of non-spaniel types (1.05 to 1.47), and designer types overall 1.63 times the odds of crossbred dogs (1.31 to 2.03). Crossing two drop-eared parents does not dilute the risk. Dogs under 10 kg had lower odds than every heavier category, male dogs 1.21 times the odds of females, and every age group over a year carried higher odds than dogs under one.

The German Shepherd problem, and why a hospital table is not a risk table

Every Indian series puts a popular breed at the top of its list, and that is a fact about Indian dog ownership rather than about ears. In Jammu the German Shepherd led with 18 of 60 cases (30.00 percent), ahead of the Labrador at 11 (18.34 percent) and the Cocker Spaniel at 9 (15.00 percent). At Durg the German Shepherd led again with 31.37 percent of 51 cases, ahead of the Labrador at 19.6 percent and the Spitz at 17.64 percent. At Anand the Labrador led with 24 of 67 cases (35.82 percent), and the Bengaluru review found non-descript and Labrador Retriever dogs most affected. At Palampur the Labrador led again with 19 of 81 cases, ahead of the German Shepherd at 12 and the Pomeranian and the mongrel at 10 each, with the Gaddi, the Himachali livestock-guarding breed, taking 4. Put beside the UK data, where the German Shepherd sits at 1.12 times crossbred odds with a P value of 0.512, none of that is evidence that a German Shepherd's ears are at unusual risk. A hospital breed table counts the breeds that walk through that hospital's door.

Two cautions follow. Erect-eared dogs are not exempt, and the Jammu authors note an earlier report finding otitis more common in breeds with erect and hairy ears at 42.3 percent than in pendulous-eared breeds at 38.5 percent, a result that runs against the UK conformation data and is published here because it exists. Palampur is the tiebreaker and it sides with the UK: 53 of its 81 cases (69.13 percent) were pendulous-eared dogs against 25 (30.86 percent) erect-eared. Age is real too: Durg found 45.10 percent of its cases in dogs of five years and above, and the UK study found every age band over one year at higher odds than puppies. If you own a Labrador Retriever, a Beagle or a Pug, the ear check is the daily habit, not the coat.

Living with a dog whose ears keep coming back

Ongoing care for a dog with recurrent otitis externa means treating the underlying cause rather than the discharge, and accepting rechecks as part of the routine. Chronic otitis means disease that persists or recurs for three months or longer, and it is a different clinical problem from a first infection.

The reason an ear recurs is almost always a factor nobody has found. Perpetuating factors are often the main reason for treatment failure in dogs with recurrent otitis externa, and middle-ear infection is one of them: otitis media occurs secondary to chronic otitis externa in up to 50 percent of cases, and material sitting in the middle ear keeps reseeding the outer one. Neurological signs such as head tilt, nystagmus, ataxia and cranial nerve deficits can appear once the middle or inner ear is involved. That is why a second or third episode earns imaging and a referral rather than a third bottle.

Hearing is the quiet cost. Dogs with otitis externa can develop conductive hearing loss from exudate, stenosis or glandular overgrowth, and sensorineural loss from ototoxic medication, and cleaning debris out of the canals produces measurable improvement. An older dog that has stopped answering to its name may be losing its hearing to its ears rather than to its age.

What the breed studies say about the long run

Two breed studies describe what recurrent ear disease looks like across a life. In Finland, owners of 151 American Cocker Spaniels reported that 85 (56 percent) had suffered otitis externa; in 46 percent of those with an age recorded (33 of 72) the first signs appeared before one year of age, and in 24 percent (20 of 85) the signs recurred within a month or continued despite treatment. In the UK, English Cocker Spaniels had 14.66 times the odds of aural discharge (95 percent CI 7.73 to 30.90), 3.59 times the odds of a recorded ear disorder and 1.40 times the odds of otitis externa against other dogs. The same paper carries a finding worth taking to your vet: it does not support allergic skin disease as the main trigger in that breed, since both the prevalence and odds of atopic dermatitis and allergy were low, while foreign body carried 2.60 times the odds and grass awns in the canal are reported as more frequent in this breed than in others.

Five questions are worth asking at the second episode, and they are the questions a dermatology referral would start from.

• Which primary factor have we ruled out, given that hypersensitivity is the commonest one in dogs.
• Has the eardrum been seen since treatment started, because assessment is often deferred to a later visit.
• Is this ear bilateral or one-sided, since one-sided inflammation is a reason for extra tests including imaging.
• Should we culture this time, given that every isolate in the Anand series had its own sensitivity pattern.
• Is a referral appropriate now, which the dermatology review says should be considered for every recurrent, chronic or middle-ear case.

A dog whose ears are painful and keep coming back is a real ongoing expense in India, where treatment prices are not published and rechecks are billed one by one, so read the running cost honestly before taking on a predisposed breed and look at pet insurance in India with the exclusions in mind. The Labrador evidence puts the scale plainly. Across a random sample of 2,074 dogs from 33,320 Labradors under UK veterinary care, otitis externa was the most common disorder in the breed at 10.4 percent in a single year, and it split hard by colour, from 12.8 percent in black dogs and 17.0 percent in yellow dogs to 23.4 percent in chocolate dogs. Beagles ran at 11.18 percent (95 percent CI 10.17 to 12.19) in a random sample of 3,729 from 19,906, with ear disorders as a group at 13.62 percent.