ABSTRACT: Many owners report that they find it difficult to administer ear drops to their dog and this article discusses otitis and the problems of treatment. It focuses on what can be done to prevent dogs from becoming averse to having their ears examined and drops applied, providing practical tips on how to prevent these problems from developing. By making ear examination and medication a positive experience, before the dog has a painful ear condition, dogs can learn to accept ear examination as a normal and pleasant part of their daily routine.

I am sure we are all familiar with the owners who come in and say, “My dog hates having those ear drops put in” or “1 can’t get the drops in, unless we pin him to the floor or catch him while he is asleep”.

But how many of us are proactive and go that step further to question owners about what exactly they are doing with the drops, or show them how to apply drops and cleaners correctly when we dispense those medications? How many of us consider the impact that a negative experience can have on patients who may need repeated treatment for their ear disease?

In a recent survey of first-opinion veterinary surgeons (Blackwell & Perrins, unpublished data), one third of respondents reported that a high proportion of owners find ear drops difficult to administer to their dog, with more than a quarter of their patients requiring muzzling for ear examination – suggesting that this poses a significant concern for both pet owners and veterinary surgeons.

This article will discuss otitis briefly, but will then focus on the treatment of these cases and what we can do to deal with dogs that are averse to treatment. It will provide practical tips on what can be done to prevent these problems from occurring.

The term ‘ear coaching’ is often used to describe these techniques; however, we will also discuss ways in which we can make ear examination and medication a more positive experience in order to prevent the need for ear coaching. As nurses in practice, you are the individuals in whom owners confide and share their concerns. You are, therefore, also the people who can educate and advise owners on how to use these products correctly.

What is otitis and why does it happen?

Otitis is defined as inflammation of the ear. It can affect the external part of the ear canal, known as otitis externa; or the middle ear, known as otitis media. In some cases, infection can even spread to the inner ear and this is known as otitis interna. We will focus on otitis externa.

Otitis externa is a very common clinical presentation by dogs in general practice, and it can be acute or chronic. It has numerous primary causes and predisposing factors (Tables 1 & 2). Once established, perpetuating factors such as bacterial and yeast infections can delay its resolution and contribute to disease progression. Common clinical signs of otitis externa are pruritus or pain, which may be manifested by head rubbing or shaking and ear scratching. Often there is also an odorous discharge and, on occasions, the dog may carry its head to one side. The pinna may also be inflamed (Figure 1).

Figure 1: Inflamed pinna with evidence of brown discharge

How do we treat it?

When dealing with cases of otitis, we need to treat any secondary infection that is present and also to try to identify and correct the primary cause. Initially, when a dog presents with otitis, the vet will take a history and perform a clinical examination. If possible we will also perform an otoscopic examination. Problems can arise even at this first investigation step.

Often the ear is painful and full of pus and discharge. If the otitis has an acute onset, it is vital to rule out the presence of a foreign body, but if a patient is very resistant to otoscopy and it is felt the procedure is essential at that time, then the patient should be sedated to be examined, so as not to create a negative experience and in order that a thorough ear assessment can be carried out.

Often taking a sample from the ear for cytology can aid determination of the cause of otitis and also enables treatment to be monitored (Table 3). Treatment is generally continued until one week past negative cytology and/or resolution of the clinical signs. Sometimes the use of an ear cleaner may be recommended as a long-term measure.

For these reasons it is vital that ear examination and treatment becomes a positive experience for both the owner and patient.

Make it a positive experience

This can be achieved by using plastic syringes to administer the eardrops in difficult cases. This will avoid the frightening noise and blast of air associated with squeezing drops out of a bottle. It also enables an accurate dose to be administered and prevents cross-infection of the other ear.

It is important, however, to make sure that owners are aware that they don’t need to insert the syringe right into their dog’s ear; and to ensure that drops/cleaner are at room temperature before they are administered.

Above all else, nurses should take responsibility for the situation and demonstrate to the owner exactly how they should be using the cleaner or drops.

Ear coaching

Most dogs will at some point in their lives need ear treatment or cleaning of their ears. Having something suddenly put into their ears can be frightening and some dogs react very badly to having ear drops administered – particularly if their ears are painful – making treatment difficult or even impossible, and leading to pain and distress.

By gently getting dogs used to having their ears examined from a very young age, before there is a problem and whilst they are not in pain – and associating ear examination with a positive reward – it will be far easier for both owners and veterinary surgeons should the dog require treatment in the future.

Note, however, that if there is any possibility that the dog might currently have painful ears, then do not attempt this process. Veterinary treatment to alleviate any pain or discomfort is vital before any attempts are made to handle the dog’s ears, because painful experiences are likely to result in the dog’s becoming fearful of being handled in this way!

Accustoming dogs to handling and examination

Ideally this should be started with young puppies, perhaps as part of puppy socialisation classes. The dog should be relaxed and calm at all times when having its ears touched. Begin by very gentle stroking of the ears, ‘paired’
with something positive like a tasty treat, so that the dog associates having its ears touched with something pleasant.

This process should be carried out gradually, and in small steps. The owner should start by very briefly touching the outside of the pinna, whilst at the same time giving the dog tiny pieces of a really tasty treat. If the dog is relaxed with this first stage, the owner can very slowly increase the time that the ear is gently massaged – most dogs really enjoy having their ears gently rubbed! Sessions should be short (less than a minute) and each stage should be repeated at least four times.

The owner must always ensure that the dog chooses to be stroked/handled in return for a tasty treat, rather than them commanding it to “Stay”, or using restraint to prevent it from moving away. Adding in a new cheerful phrase such as “Ear time” whilst doing this will let the dog know that it’s time to have its ears examined and nothing to worry about.

If the dog is happy to have the outside of the pinna touched for up to a minute, the owner can begin to briefly and gently slide their fingers under the pinna and stroke underneath the ear flap – just for a second or two to begin with.

In dogs with floppy ears, the owner can begin to lift the pinna. This should again be very gentle and brief to begin with, gradually working up to being able to lift the pinna right up and turn it back exposing the ear canal before delivering the treat.

Teaching the dog to sit or lie down will allow drops to be administered while it stays still.

The next stage is for the owner to actually look inside the ear. He or she should initially only glance at the ear canal for a second or two, gradually increasing the time after four successful sessions. Make sure that the dog becomes accustomed to having both ears examined.

Next introduce an empty syringe as something positive. Ask the owner to hold the syringe whilst they give their dog treats. Soon the dog will see their owner pick up the syringe and come forward happily in anticipation of a treat.

As long as the dog is relaxed, the owner can begin to hold the syringe next to the dog’s ear so that it becomes accustomed to this position. Then the owner can stroke the ear whilst holding the syringe.

If the dog is happy with this, the owner can begin to pull the plunger in and out – gradually decreasing the distance between syringe and ear over several sessions.

Finally the owner can begin to accustom their dog to the sensation of liquid in its ear by using ear cleaner in the syringe. Start by just administering one drop while the dog is relaxed, then slowly build up, one drop at a time, to the full amount required.

After doing these steps the owner, can massage the outside of the ear. It is often a reflex for the dog to shake its head or scratch, but that’s acceptable as long as it only lasts a few moments. If the dog continues to show signs of discomfort – shaking or rubbing its head – then advise the owner to discuss this with their vet.

If the dog becomes worried at any stage of this process then the owner should go back to the previous stage and proceed more slowly.

Sadly, some dogs may already have a negative association with painful ears and restraint for ear treatment and in many cases may show avoidance or aggressive behaviour when people attempt to examine them. For these dogs, the process is different. Techniques involving desensitisation and counter-conditioning, tailored to the individual case, can be used to change the dog’s perception of the event and you are advised to contact your nearest clinical behaviourist for help on how best to proceed with such cases. 


Emily Blackwell Bsc PhD CCAB APBC

Emily is the Dogs Trust Lecturer in Canine Behaviour and Welfare at the University of Bristol. She is a certified Clinical Animal Behaviourist and director of the behaviour referral service at Bristol Vet School.

Natalie Perrins


Graduating from the Royal Veterinary College in 2001, Natalie worked in small animal practice for two years before returning to the RVC to undertake a three-year residency in Veterinary Dermatology. Natalie attained her RCVS Certificate in Veterinary Dermatology in 2006 and was awarded her European Diploma in Veterinary Dermatology in 2009. She currently works for Langford Veterinary Services.

To cite this article use either

DOI: 10.1111/j.2045-0648.2012.00151.x or Veterinary Nursing Journal Vol 27 pp 106-108

• VOL 27 • March 2012 • Veterinary Nursing Journal