Middle and Inner Ear Inflammation (Otitis Media and Interna) in Cats

Otitis media and interna are defined as inflammation of the middle and inner ear, respectively. These terms are often used as synonyms for middle and inner ear infections.

The inner ear is involved in regulating the body’s ability to balance. As such, if the inner ear is inflamed or infected, this system can be disrupted, which can lead to dramatic symptoms like stumbling or falling down. Although most forms of ear infection are not life threatening, cats showing symptoms of inner ear infection require prompt veterinary assessment to rule out more serious conditions.

Middle and inner ear infections (otitis media and interna, respectively) are uncommon in cats and occur less often than in dogs.

Any age, breed, or sex of cat can be affected. Cats with an ear infection in the outer ear (otitis externa) are predisposed to developing middle and inner ear infections. Any cat with symptoms of otitis or having balance issues needs to be examined by a veterinarian as soon as possible.

Additional symptoms and degree of severity are related to the underlying cause and how long the infection has been present.

If the underlying cause of middle and inner ear infections is from an upper respiratory infection, sneezing and nasal discharge may also be present. If sepsis is a cause, high fever, severe lethargy and rapid breathing may be seen.

Middle and inner ear infections in cats are usually caused by spread of infection from elsewhere in the body. Infections can be bacterial, viral, or fungal, and can spread as an extension of an external ear infection, through the blood, or from the nasal passages.

Foreign bodies (such as grass awns), polyps, and tumors can also predispose cats to chronic inflammation, which can eventually cause infection. Malformation of the ear canal, throat, or soft palate can also predispose cats to otitis media. Inner ear infection is most often caused by an extension of a middle ear infection.

Middle and inner ear infections in cats are less commonly associated with the spread of outer ear infections when compared to dogs.

Symptoms depend on which portion of the ear is affected. Middle and inner ear infections can occur simultaneously.

If the inner ears are affected on both sides, the above symptoms will not be seen. Instead, cats typically develop a wide based, crouched stance, due to their inability to balance properly.

Diagnostic tests to identify a middle or inner ear infection include:

• Physical exam
• Otoscopic exam
• Diagnostic imaging
• Bloodwork
• Culture or cytology of fluid within the ear canal

Treatment primarily consists of a thorough ear cleaning, often done via endoscopy while the pet is sedated or anesthetized. Other treatments include:

• Topical and oral antibiotics
• Antifungals
• Anti-inflammatories
• Anti-nausea medications
• Repeated drainage of fluid from the ear
• Surgical intervention

Treatment for primary causes and secondary symptoms also need to be addressed if present.

Treatment typically lasts at least 4-8 weeks. Prognosis is generally good with appropriate treatment, but depends on the underlying cause. If the infection has spread to bone or the brainstem, the prognosis is poorer and cats often have permanent neurological symptoms.

Early and aggressive treatment of an outer ear infection may prevent some cases of middle or inner ear infections.

Middle and inner ear infections are not contagious.

Middle and inner ear infections are uncommon, and occur less frequently in cats when compared to dogs.

• Oral and topical antibiotics
• Anti-inflammatories
• Ear flushing
• Culture
• Surgery