By Dr Daisy A. May, Veterinary Surgeon
At first, you thought it might be nothing.
I mean, all dogs scratch at their ears a bit, right?
But the last few days, you’ve noticed a drastic uptick in the level of itching. In fact, it’s like your dog can’t leave the ear alone. And now she’s started shaking her head all the time to boot, and seems a little miserable.
What started out as an ear that looked maybe just a little red when compared to it’s twin, is now a hot, raw mess which emits a foul smell when you tentatively lift the ear flap to take a peek. Heartbreakingly, when you do so, your poor fur baby lets out a soul-wrenching yelp.
And what the heck is that nasty brown stuff in her ear canal?!
Now fully convinced that there is a problem, you hesitate no further, grab your phone and dial up your local vets. You explain to the kind receptionist that your dog seems to have an ear infection, and you need an appointment.
Rendezvous scheduled for that afternoon, you sit back, and let the relief sink in.
But then, slowly and inevitably, you begin to wonder how much the afflicted ear is going to cost you. It’s already been a difficult month; your car broke down, and you need to pay some medical bills of your own.
You grab your phone again, and google: ‘vet bill for ear infection’.
And that’s where I come in.
Hi. I’m Daisy, a GP vet working mainly with dogs and cats. I’ve been in first opinion veterinary practice in the UK for the last 4 years, and have welcomed many a sore and stinky ear into my consult room.
Today we’re going to discuss what you should expect to pay for the average ear infection, as well as what exactly this money is buying, and a couple of special cases where costs could end up being substantially more than initially expected.
My hope is that this helps you to prepare practically, financially and emotionally for your dog’s vet bills in the event of an ear infection.
Shall we get started?
What Do Ear Infections In Dogs Usually Cost?
Rather than just provide anecdotal figures from personal experience, I thought I’d start by looking at what pet insurance companies are paying out, on average, for canine ear infection claims.
I figure looking at insurance company claim data is probably the best way for me to emulate a scientific “study” into what the average ear infection costs.
US pet insurer ‘Fetch’ have revealed that outer ear infections (also medically known as “otitis externa”) typically cost between $100-$175 to treat, although obviously this comes with the caveat that treatment costs will vary depending on the state, location and veterinary practice.
I have to say that to me, this figure appears a little on the low side; I would have expected the average claim payout to be a bit higher than this.
UK pet insurer ‘Many Pets’ on the other hand, have reported that their average claim payout for ear infections in 2022 (January-September) was £218.44. They also note that veterinary practices in large cities, and those in the South-East of the UK tend to charge more, because their running costs are comparatively higher.
£218.44 seems more realistic to me.
It certainly might be possible to treat a minor ear infection, especially a first-time (non-recurrent) ear infection for $100 or the equivalent, particularly if your vet practice is outside of major cities, and is independent of the larger chains (note that independent practices often have lower prices).
But for most ear infections, with $100 in your pocket you’d be hard pressed to achieve cure.
In my experience, I would guesstimate costs at the following:
First time, minor ear infection that is caught and treated relatively early: £60-120 / $80-160.
More severe ear infection that is not immediately presented for treatment: £400-600 / $550-900.
Chronic (longterm) or recurrent (keeps coming back) ear infection: see “special cases” at the end of the article.
Pseudomonas or proteus ear infection (“sticky” bugs): these infections can reach the low thousands fairly easily. See “special cases” at the end of the article for an explanation of costs.
Where surgical treatment (Zepp’s procedure and/or TECA-BO) are required: £650-5000 / $700-$4000+ (see “special cases” at the end of the article for an explanation of costs).
Breakdown Of Costs For Ear Infection
Vet consultation fee: UK £40-60 / USA $50-250
At the upper end (ie, $150-$250) this would be to see a specialist ie a veterinary dermatologist; I have certainly never come across a GP vet charging more than £65/$85 for a consultation.
The consultation fee should include an ear exam using an otoscope, as long as your dog will allow this without sedation. In my experience, about 50% of dogs will need some form of sedative to allow proper, thorough otoscopy, especially if they have a painful, infected ear.
Sedation to perform otoscopy (ear exam) if needed: UK £150-300 / USA $75-$350
Usually towards the lower end for small dogs, and the upper end for large dogs; cost may be way less than these figures if an oral sedative proves effective for your dog, so definitely ask your vet whether this is an option).
In-house cytology of an ear smear: UK £0-£50 / USA: $0-$60
The reason this one starts at zero, is that some vets won’t charge at all for this very basic and practically free test, and others will already have included it within the consultation fee.
In-house cytology is where your vet takes a cotton bud swab from your dog’s ear, rubs the gunk on a glass slide, and then looks down a microscope to establish what microbes (yeast, bacteria, mites etc) are growing down your dog’s ear.
This is a crude way of guiding treatment, although not as good as culture and sensitivity (see below).
In-house cytology takes less than 10 minutes. I will always do this step during the consult; and your vet should too!
Sending an ear swab to the lab for culture and sensitivity (if needed): UK £100-200 / USA $110-220
Culture and sensitivity (‘C&S’) is a lab test where the microbes causing the ear infection are grown at the lab, and then a variety of different antibiotics are tested to see what works for that infection (and just as importantly, what doesn’t work).
C&S is particularly important to undertake in cases where your vet has reason to believe the infection might be resistant to one or more antibiotics, for example, chronic or recurrent ear infections.
It usually takes about 5 days to get results from a C&S test once it is sent to the lab.
Ear flush (if needed): UK £125 approx IN ADDITION to the sedation or general anesthetic cost / USA $150 approx IN ADDITION to the sedation or general anesthetic cost
An ear flush is necessary if your dog has a large amount of discharge (brown, yellow or greenish smelly goo) in their ear(s) as a result of the ear infection. Antibiotic ear drops won’t work very well (if at all) in an ear that is full of gunk, so it is necessary to flush all the goo out first.
Because this requires flushing deep in the canal, and because the dog is usually painful, this is done under sedation or general anesthetic.
Ear medication: UK £30-150 / USA $35-175
Usually in the form of steroids (oral or topical) and daily antibiotic or anti-fungal drops; or sometimes your vet will instil a long-acting treatment into the ear canal instead.
You should also factor in the cost of 1-2 further vet visits to check that the infection has cleared.
Of course, if your dog needs sedation every time to allow ear examination, this could get very expensive. In this situation, a decision will need to be made by you and your vet whether you are willing to risk skipping rechecks.
This risk here is that the infection may not be fully cleared when you stop treatment, and could come back in the near future.
Key point: you cannot tell whether an ear infection has 100% gone away or not just from looking at the ear with the naked eye. Otoscopy and cytology are required to make this call.
When Might An Ear Infection Cost More Than This?
There are a few special cases where I would unfortunately expect it to cost more than the above in order to banish that abhorrent red, gungy ear for the long term.
Special Case 1: Atopic Dogs
If your dog is generally itchy, especially at certain times of year or after eating certain foods, you may have yourself an atopic (allergic) pet. Chronic and recurrent ear infections are super common in dogs with allergies, and a vital part of keeping ear infections at bay in these pups is to control the coexisting allergies.
If the allergies aren’t kept under control at all times, more often than not the ear issues will keep coming back.
I recommend in this instance that you familiarize yourself with the following article, as soon as you’ve finished this one:
Special Case 2: Pseudomonas And Proteus Ear Infections (the “sticky” bugs)
Pseudomonas and to a lesser extent proteus are the bain of your vet’s life when it comes to treating ear infections. The reason these two distinct bacterial causes of ear infections are such a nightmare, is that they are both experts at forming something called a “biofilm” inside of your dog’s ear.
A biofilm can be thought of as an incredibly sticky, protective goo layer that firmly adheres the colonies of bacteria to the inside of your dog’s ear(s), and protects them from the effects of ear cleaners and antibiotics.
Pseudomonas and proteus can also form biofilms on objects, such as your vet’s otoscope, or the plastic nozzle of an ear cleaner bottle. In this way, these sly little invaders can jump from one ear (or even one dog) to another.
Pseudomonas is also doubly difficult to treat because it is a master chameleon. It is capable of very quickly adapting to it’s environment, and can become resistant to the antibiotic your vet is using to treat the ear infection within days of starting treatment with that antibiotic!
Because of this, it is necessary to carry out culture and sensitivity testing every couple of weeks whilst treating a pseudomonas ear infection in order to check that the antibiotic being used is still – well – useful.
So, with repeated C&S testing and because it is often necessary to treat for several weeks or even a few months to get rid of pseudomonas otitis, the costs can very easily reach the low thousands.
Special Case 3: Multidrug Resistant Ear Infections
We’ve already touched on this concept a little bit above when discussing pseudomonas, but pseudomonas certainly isn’t the only bacterium that is skilled at changing it’s skin and becoming immune to the tools in our medical arsenal.
In fact, pretty much every bacterium has the potential to become antibiotic resistant.
The more frequently a dog has a course of antibiotics, the more likely that a resistant population of bacteria has developed down their ears. This is because bacteria usually need to be exposed to the antibiotic, in order to develop resistance to it.
And where a course of antibiotics does need to be used, it is super important that it’s used at the right dose, and for a long enough period of time (eg, twice daily for one week).
It is soul-destroying when owners confess to me that they’ve taken their own initiative and been using old out-of-date antibiotic drops down their dogs ears once or twice a week to try and prevent an infection developing.
This is not a high enough dose, nor a high enough frequency to rid the pet of an infection; all it’s doing is encouraging resistance!
So. In cases where antibiotic drops aren’t working, or only partially working (ie, the ear infection goes away but then comes right back a few weeks or months later), an antibiotic resistant ear infection might be to blame.
In these instances, the very first thing that should be done is a culture and sensitivity test, to determine what bacteria are growing down your dog’s ears and which antibiotics are and aren’t likely to be useful.
In a few cases, we come across ear infections caused by bacteria that have become multi-drug resistant, ie, have developed immunity to several of our antibiotic options.
These infections can be very difficult to treat, because we actually only have a handful of antibiotic options that are safe to use down the ear without an unacceptably high risk of deafness, ear damage, or even neurological side effects.
So, once that handful of options is taken away from us, things become tricky and often very time-consuming.
For this reason, and because these cases frequently necessitate specialist input, multidrug resistant ear infections can quickly become expensive to treat.
Special Case 4: Where Zepp’s Procedure or Total Ear Canal Ablation (TECA) Surgeries Are Required
If your dog has suffered with a really chronic (long-term) or recurrent ear infection that just seems to keep coming back no matter what you do, and your vet has ruled out drug-resistant bacteria as a possible case, you may wish to consider one of these surgical treatments in an effort to achieve a more long-lasting, permanent solution to the problem.
After all, it’s no fun visiting the vets 3-4 times a year and forking out for repeated courses of ear drops; and nor is this fun for your dog, nor good for their health.
Zepp’s Procedure (Aka Lateral Ear Canal Ablation or ‘LECA’)
The Zepp’s procedure (or ‘LECA’) is a surgery which removes a triangle-shaped chunk of tissue from the outer wall of the ear canal, greatly increasing airflow/ventilation to the ear canal.
This decreases the level of moisture/humidity in the ear canal, and decreases the temperature, in turn making the ear canal a much less friendly environment for bacteria and yeast to thrive in. It also improves natural drainage and reduces secretion accumulation.
Because poor airflow and poor drainage contribute anatomically to chronic and recurrent ear infections, this surgery can help prevent the infection from coming back.
Now, on one hand, I have personally had patients who struggled for years with recurrent ear infections, including one instance where pseudomonas was to blame, who have had a Zepp’s procedure and then never suffered with their ears again.
However, on the flip side, a quick review of the available literature suggests that the Zepp’s procedure has a drastically less good success rate overall when compared to TECA surgery (below), and in fact Zepp’s procedure success rates in cocker spaniels (specifically) are less than 15% due to the underlying breed-specific skin and ear conditions with which they are often afflicted.
At least one reputable source reports that Zepp’s procedure has a high failure rate when used to treat anything but congenital ear canal stenosis (being born with very narrow ear canals) or for ear tumor removal.
So, even though I’ve seen this procedure work well in the past, I would probably hesitate to recommend it to owners going forward, especially if TECA is an option instead.
Be aware too that if your dog has atopic/allergic skin this will still need to be managed on an ongoing basis.
Typical cost for Zepp’s Procedure: UK £650-£1400 per ear / USA $700-1200 per ear
Total Ear Canal Ablation (TECA)
TECA surgery can be thought of as a step up from the Zepp’s procedure. Whilst the Zepp’s procedure leaves the majority of the ear canal intact, TECA surgery involves the complete removal of the ear canal, leaving only the hearing organs (situated in the inner ear) in place.
During the procedure the middle ear (also known as the tympanic bulla) should be inspected carefully by the surgeon, and any diseased tissue should be removed. If the middle ear tissue also needs to be removed, then at this point the surgery is more accurately described as a “TECA-BO” surgery; the “BO” part stands for bulla osteotomy.
TECAs and TECA-BOs get very expensive partly because they are such specialist surgeries, and partly because a CT or MRI scan is typically needed prior to the surgery in order to guide the surgeon.
TECA or TECA-BO surgery (your surgeon will decide what is more appropriate for your dog) gives the highest likelihood of cure/complete, lifelong success when managing cases of chronic or recurrent ear infections in dogs.
NOTE that the ear “flap” is not removed in either the Zepp’s procedure or the TECA, and actually the ear doesn’t look too dramatically different after either procedure. Your dog certainly won’t be left with a big old hole in their head, which is perhaps the concern I hear most often from worried pet owners!
With a Zepp’s procedure your dog’s hearing should be pretty much unaffected, or even improved compared to an infected ear full of gunk. With a TECA however, your dog’s ability to hear will be reduced following the surgery, producing an effect similar to wearing ear plugs, or being underwater.
Typical cost for TECA or TECA-BO surgery: UK £1800-£2500 per ear / USA $2000+ per ear
I hope you found this helpful and please feel free to drop any questions in the comments section below 🙂
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