Middle and inner ear infections in cats

Middle and inner ear infections in cats are less common but more serious than outer ear infections. They are usually the result of the spread of infection from the outer ear. Most cases resolve with medication if treated promptly. However, if the inner ear nerves become affected, cats may be left with permanent damage.

Otitis means inflammation of the ear, usually associated with infection. Ear infections are defined by the part of the ear they affect. These are the externa (outer ear), media (middle ear), and interna (inner ear). In this article, we discuss otitis media and interna. Follow the link to find out about otitis externa and ear mites.

Overview

What are middle and inner ear infections in cats?

The middle ear is located behind the eardrum and serves as the link between the ear canal and the inner ear. It contains the essential organs for hearing. Meanwhile, the inner ear plays a vital role in maintaining balance and contains nerves that establish connections to the brain.

Middle and inner ear infections in cats are not common:

They are usually caused by the spread of infection from the outer ear (otitis externa). Less commonly from a benign polyp in the middle ear.
Spread is usually due to damage to the eardrum, which allows infection to pass through from the outer ear.
Most often a bacterial or fungal infection. Infections can be due to a foreign body in the ear, ear mites or underlying allergies.
When treated quickly, most cases resolve within 6-8 weeks.
If not treated appropriately, it can lead to recurrent outer ear infections.
If the inner ear nerves are affected, permanent damage, such as deafness or facial changes, can occur.
Any age or breed of cat can develop a middle or inner ear infection but they are more common in cats with chronic outer ear infections.
Ruptured ear drums are common with middle and inner ear infections but usually heal within 2-3 weeks.

Middle and inner ear infections in cats can be very painful but usually respond well if treated quickly. Speak to one of our Joii vets as soon as possible if your cat has any ear problems.

Symptoms

Symptoms of middle and inner ear infections in cats

Some cats with very mild infections may not show any signs. Symptoms include those that are seen with outer ear infections but can be more severe.

Common initial signs can affect just one ear or both and include:

Head shaking, pawing or scratching their ears
A brown, red, yellow or black discharge in the ears
Red, smelly, painful ear
Pain when eating or opening their mouth
Drooling from side of mouth
Vomiting

If it progresses to the nerves in the inner ear, signs include:

Head-tilt
Loss of balance, walking in circles and incoordination
Deafness
Changes to the eyes: eyes flickering (nystagmus) or pupils with different sizes
Horner’s syndrome and dry eye can result from middle or inner ear infections.

Risk

Are some cats more at risk of middle and inner ear infections than others?

Any cat, regardless of age or breed, can develop a middle or inner ear infection. But cats with chronic outer ear infections are most at risk. This includes:

Breeds at greater risk due to their ear shape: Scottish Fold, Himalayan, and Persian cats.
Regular exposure to moisture, such as too frequent or incorrect cleaning.
Immunocompromised cats, such as those with FIV or FeLV, are at a higher risk of developing ear infections.

Diagnosis

How are middle and inner ear infections diagnosed in cats?

Middle and inner ear infections are usually difficult to diagnose. Especially if the eardrum is still intact. A physical exam with a special scope is the first step.

Other tests include:

Swabbing any discharge in the ear canal to determine what type of infection is present
A special procedure called Myringotomy. Obtains sterile fluid from the middle ear.
Blood and urine tests
Imaging: x-rays, CT or MRI

Vet treatment

What’s the treatment for middle and inner ear infections in cats?

Antibiotics or anti-fungal medications are needed for middle and inner ear infections for at least 3-6 weeks. These are usually taken by mouth or by injection. Hospitalisation is sometimes needed for severe cases of otitis interna if they can’t eat or drink.

Other treatments include:

Flushing the middle ear (if the ear drum is damaged)
Anti-inflammatory medication
Anti-nausea medication
Pain relief
Surgery: in cases with middle ear fluid build-up, bone infections, and if any growths are present

Home treatment

How to help your cat with a middle or inner ear infection at home

Middle and inner ear infections cannot be treated with home remedies. You can help your cat recover by:

Using the medication as advised by your vet. Don’t skip doses. If you are struggling to give any medication, let your vet know right away. An alternative may be an option.
Frequent vet rechecks. They are essential to make sure the infection is going away.
Checking your cat’s ears regularly: if the symptoms are getting worse, speak to a vet as soon as possible.
If your cat has a loss of balance: hand-feeding and resting to avoid injury
A buster or inflatable collar helps to prevent self-trauma to the skin around the ears.
Feeding your cat a diet specifically made for cats with ear problems or allergies. Such as Hills Prescription Diet d/d.

Prevention

Tips on how to prevent middle and inner ear infections in cats

Speak to a vet as soon as ear problems begin. Ear disease is easier to treat in the beginning. Before the ear becomes thickened or develops resistant infections.
Make sure your cat is up-to-date on parasite preventatives for fleas and mites.
Reduce moisture: keep ears as dry as possible at all times.
Keep the hair around the entrance to the ear as short as possible to allow good ventilation.