Dog help: any vetanerians in the house?

[amirm]

Need help from the medical professionals on the forum. Our 10 year old Samoyed developed some yellow discharge in one ear. Took him to our vet when that happened a few weeks ago. Vet said he had excess yeast and bacteria and put in a one-time medication in there that was supposed to last 2 to 3 weeks. Well, the issue came back mid last week so we took him in again. Same diagnosis so they decided to prescribe (Pivetal brand) Mozotic 15 mg once a day. We put that in his ears for two days but all of a sudden realized that our dog would no longer listen to our voice signals, his name, etc. Did some controlled testing of hiding and calling his name, etc. and he absolutely cannot hear anything. The pamphlet from the drug company says deafness can be a side effect so we stopped giving him the medication.

This was the weekend with the vet office closed. The drug company pamphlet said something about rinsing his ear which we did twice with an over the counter liquids.

The vet office opened today so we took him in. The vet examine him but saw nothing wrong with his ears. The membrane was intact which she worried could cause this hearing damage (as best as she could see). There was still fluid, indication of yeast and maybe residual Mozotic. She says she has been prescribing this 2 to 3 times a week for 7 years but has not had a single instance of it causing hearing damage. She thought one of her colleagues my have had one instance of this but that is it. They are going to contact the drug company and see what they know.

For now, she said to wait 6 to 7 weeks to see if the hearing returns. She gave it 50-50 odds. She also prescribed some antibiotic in case there is middle or inner ear infection (she said it would not do much for outer ear). And told us to not put anything else in his ears just in case.

I am thinking that the only thing that would cause hearing damage in both ears would have been the medication. The healthy ear never had any discharge although the vet said there was some yeast it that one as well. If it is a drug interaction, can it be this rare?

He is healthy otherwise and doesn't scratch, tilt his head, etc. But needless to say, we feel so bad for him.

Do we have anyone here that would have some insights into this? I know dogs are different than people but if we have ENTs/MDs that have some knowledge here, I would appreciate hearing about it.

Thank you so much.

 

[Ron Texas]

So sorry about your dog.

 

[PKK]

Hoping the lovely gets better. Part of the family. Hope your Revel's don't get the blame

 

[GShepard]

I looked at the prescribing information. The hearing loss is usually temporary. Probably better odds of it getting better than the 50-50 your vet gave.

I hope your dog gets better soon.

 

[Madlop26]

So sorry to hear that Amir, every time Doctors prescribed a medication has to balance the risk/benefit ratio, the risk of ototoxicity with gentamicin is around 2.5%, and if you have it, around 50% chances of recovery. As many medications, gentamicin may have saved millions, but made deaf several hundred thousands. Usually, the risk is higher at high dose, long period of treatment and if you have kidney problems, i wonder what the dose per kg given.

 

[amirm]

Thanks you all. When I get medication myself, I always ask about risks, side effect, etc. But for some reason I didn't eve think to ask about this for our dog. Definitely something to be mindful about in the future.

 

[JSmith]

For now, she said to wait 6 to 7 weeks to see if the hearing returns. She gave it 50-50 odds. She also prescribed some antibiotic in case there is middle or inner ear infection (she said it would not do much for outer ear). And told us to not put anything else in his ears just in case.

Sorry to hear about this mate, pets become part of the family and it's distressing when things like this occur.

It is quite possible that a middle ear infection is causing this deterioration in hearing, or even a blockage (like simple wax build up) that may subside.

I note I read this here;

The use of these components has been associated with deafness or partial hearing loss in a small number of sensitive dogs (e.g, geriatric). The hearing deficit is usually temporary. If hearing or vestibular dysfunction is noted during the course of treatment, discontinue use of Gentamicin Sulfate, USP; Mometasone Furoate Anhydrous, USP; and Clotrimazole, USP, Otic Suspension immediately and flush the ear canal thoroughly with a non-toxic solution.

MOZOTIC TM OTIC SUSPENSION(Gentamicin Sulfate, USP; Mometasone Furoate Anhydrous, USP; and Clotrimazole, USP, Otic Suspension)

I certainly hope it is temporary.


JSmith

 

[MCH]

Need help from the medical professionals on the forum. Our 10 year old Samoyed developed some yellow discharge in one ear. Took him to our vet when that happened a few weeks ago. Vet said he had excess yeast and bacteria and put in a one-time medication in there that was supposed to last 2 to 3 weeks. Well, the issue came back mid last week so we took him in again. Same diagnosis so they decided to prescribe (Pivetal brand) Mozotic 15 mg once a day. We put that in his ears for two days but all of a sudden realized that our dog would no longer listen to our voice signals, his name, etc. Did some controlled testing of hiding and calling his name, etc. and he absolutely cannot hear anything. The pamphlet from the drug company says deafness can be a side effect so we stopped giving him the medication.

This was the weekend with the vet office closed. The drug company pamphlet said something about rinsing his ear which we did twice with an over the counter liquids.

The vet office opened today so we took him in. The vet examine him but saw nothing wrong with his ears. The membrane was intact which she worried could cause this hearing damage (as best as she could see). There was still fluid, indication of yeast and maybe residual Mozotic. She says she has been prescribing this 2 to 3 times a week for 7 years but has not had a single instance of it causing hearing damage. She thought one of her colleagues my have had one instance of this but that is it. They are going to contact the drug company and see what they know.

For now, she said to wait 6 to 7 weeks to see if the hearing returns. She gave it 50-50 odds. She also prescribed some antibiotic in case there is middle or inner ear infection (she said it would not do much for outer ear). And told us to not put anything else in his ears just in case.

I am thinking that the only thing that would cause hearing damage in both ears would have been the medication. The healthy ear never had any discharge although the vet said there was some yeast it that one as well. If it is a drug interaction, can it be this rare?

He is healthy otherwise and doesn't scratch, tilt his head, etc. But needless to say, we feel so bad for him.

Do we have anyone here that would have some insights into this? I know dogs are different than people but if we have ENTs/MDs that have some knowledge here, I would appreciate hearing about it.

Thank you so much.

Hey Amir, my wife is a vet and read the case of your dog. She said she finds it unusual and would suggest to get a second opinion. Also, she would take x-Ray or better MRI of the head. Said the MRI can get expensive, but excludes other reasons. Hope it helps.

 

[restorer-john]

I blame the Klippel. Making all those loud noises in the garage for hours has deafened the poor thing.

Seriously, I hope his hearing comes back.

 

[Blumlein 88]

Sorry to hear this. I've used that same medicine on my dog before without issue. Hope everything clears up in the end.

 

[r042wal]

Amir, my Golden Retriever is prone to ear infections from swimming in the lake. We put drops in his ears with tissues to help clean them out. Sometimes even an anti-biotic because retrievers have deep ear canals and are prone to this. I am on dog #2 and have 23 years experience with this issue.

When you put drops in their ears, whether cleaning solution of antibiotics, I am sure it blocks the ear canal and makes it a little more difficult for the dog to hear. You can get rid of the yeast but want to make sure there is no redness or irritation around the drum.

Based on what I've read, you should be OK. Sounds like plenty of great resources on your site for info. Any dog lover in my books can do no wrong. We are very dedicated and responsible people. Cheers from Canada!

 

[Keith_W]

Need help from the medical professionals on the forum. Our 10 year old Samoyed developed some yellow discharge in one ear. Took him to our vet when that happened a few weeks ago. Vet said he had excess yeast and bacteria and put in a one-time medication in there that was supposed to last 2 to 3 weeks. Well, the issue came back mid last week so we took him in again. Same diagnosis so they decided to prescribe (Pivetal brand) Mozotic 15 mg once a day. We put that in his ears for two days but all of a sudden realized that our dog would no longer listen to our voice signals, his name, etc. Did some controlled testing of hiding and calling his name, etc. and he absolutely cannot hear anything. The pamphlet from the drug company says deafness can be a side effect so we stopped giving him the medication.

This was the weekend with the vet office closed. The drug company pamphlet said something about rinsing his ear which we did twice with an over the counter liquids.

The vet office opened today so we took him in. The vet examine him but saw nothing wrong with his ears. The membrane was intact which she worried could cause this hearing damage (as best as she could see). There was still fluid, indication of yeast and maybe residual Mozotic. She says she has been prescribing this 2 to 3 times a week for 7 years but has not had a single instance of it causing hearing damage. She thought one of her colleagues my have had one instance of this but that is it. They are going to contact the drug company and see what they know.

For now, she said to wait 6 to 7 weeks to see if the hearing returns. She gave it 50-50 odds. She also prescribed some antibiotic in case there is middle or inner ear infection (she said it would not do much for outer ear). And told us to not put anything else in his ears just in case.

I am thinking that the only thing that would cause hearing damage in both ears would have been the medication. The healthy ear never had any discharge although the vet said there was some yeast it that one as well. If it is a drug interaction, can it be this rare?

He is healthy otherwise and doesn't scratch, tilt his head, etc. But needless to say, we feel so bad for him.

Do we have anyone here that would have some insights into this? I know dogs are different than people but if we have ENTs/MDs that have some knowledge here, I would appreciate hearing about it.

Thank you so much.

Amir, I have a lot of experience giving intravenous Gentamicin but less with Gentamicin ear drops. I can tell you that ototoxicity (i.e. toxicity to the hearing and balance organs) is rare with intravenous Gentamicin, because we carefully monitor the levels and kidney function while we are giving it. Just FYI the typical dose is 5-7mg/kg rounded to the nearest multiple of 40mg, so a 50kg person would get 240mg. Ear drops are a different story, levels are not monitored, and despite much lower doses being given, ototixicity is more common, although I do not know how common. I did a literature search for you and I found this paper, which is a review of ototoxicity from Gentamicin ear drops. It looks like they don't know either

I agree that if your dog has developed hearing loss from both ears, it is unlikely to be from an ear infection in one ear.

I also agree with your vet - once hearing loss has developed, the only recourse is to cross your fingers and hope it comes back. There have been some studies trying to reverse the hearing loss by giving antioxidants but there is no evidence that this works.

It's a good thing there was no cochlear toxicity as well (I am guessing not, since you don't report your dog walking like a drunk and falling over). That would be truly miserable.

Best of luck to you and your dog.

 

[PatentLawyer]

Sending positive thoughts for your pup.

 

[gene_stl]

Gentamicin is an aminoglycoside antibiotic. When these are given to humans intravenously they can cause hearing damage so often the dr or hospital will order a hearing test and a kidney function test because aminoglycosides can damage both of these. Other aminoglycosides are Amikacin and Vancomycin and others. You can find plenty of info on them by Googling the word aminoglycoside. You will note that Neomycin is also one and is absorbed less which is why it is available OTC as an oinkment. I would stop using the Mozotic and switch to Neosporin which has three antibiotics in it.

Clotrimazole and other antifungals are available OTC as athletes foot and jock itch medications. Neosporin would fight the bacterial infection but not the yeast. You could add one of the antifungals. If it were my dog I would use some Miconazole ointment to fight the yeast. Possibly terbenafine (Lamisil)

I agree that it seems unlikely that a topical application could damage the dogs hearing but anything is possible.

Finally I know of human cases where people had temporary hearing loss which was stopped by steroids both topically and systemically. I also have a friend whose primary care doc did not treat hearing loss and tinnitus with steroids and an ENT told him it was probably responsible for the hearing loss becoming permanent. He was in his late sixties.

I would ask the vet for some systemic steroid although that could make it more difficult to fight the infection(s). The Mometasone Furoate is a steroid. You could spritz a little FloNase in there. It is a topical steroid and is extremely powerful and effective at stopping inflamatory processes.
.

 

[Keith_W]

I would ask the vet for some systemic steroid although that could make it more difficult to fight the infection(s).

That's putting it mildly. Giving an immune suppressant in context of an active infection is usually a big no-no and to be avoided whenever possible. What is the motivation for the steroid? It won't reverse Gentamicin toxicity. If it's for inflammation caused by the infection, then treat the infection. If Amir's vet is having difficulty knowing which antibiotic to give, then do a swab and culture.

Disclaimer: I am a physician (I treat people). I'm not a vet.

 

[tmtomh]

Wish I had some insight to offer. Wishing the best for your dog.

 

[amirm]

I did a literature search for you and I found this paper, which is a review of ototoxicity from Gentamicin ear drops. It looks like they don't know either

Thank you so much. This agrees with what my Vet explained:

Our review suggests that aminoglycosides containing ear drops (such as gentamicin or neomycin) can occasionally cause hearing loss if administered in a perforated dear drum for a long period of time. There is also evidence for vestibulotoxicity from gentamicin topical drops.

I specifically asked her why the tear/hole was important and whether the worry was that the drug would go past it and she said yes.

Today we have noticed a change in that he appears to be occasionally responding to louder, higher frequency sounds. He is so good at reading body language (and following the reactions of his sister) that it is hard to know if he is really hearing something or not.

It is a strange feeling to come home and not having him come and greet you and stay sleep. The level of guilt is quite high, worrying that we may have had a hand in this happening (even though the Vet assured us there is nothing we did).

 

[gene_stl]

Upon thinking about this it seems more likely that the dogs infection got into the inner ear of both sides. So the treatment would likely be systemic antibiotics, both germicidal and fungicidal. A perforation is also a possibility and would get the topical medicine to both sides where it could cause mischief. But since it is unlikely that an mri was done on the doggie a bilateral inner ear infection or sinus infection sounds like the answer.

note that the oinment as well as most otic and especially ophthalmic oinkments have both antibiotics and steroids. I have always thought of this as paradoxical. The steroid does not prevent the infection from being healed although most topical antibiotics are strong ones.

 

[Keith_W]

It is a strange feeling to come home and not having him come and greet you and stay sleep. The level of guilt is quite high, worrying that we may have had a hand in this happening (even though the Vet assured us there is nothing we did).

Remember this: you gave your dog treatment with the best of intentions, on advice from a health professional. So you should not feel any guilt. You did not know that this was even a possibility until it happened. Should your dog's vet feel any guilt? As a health professional myself, I can tell you that this kind of reaction is rare but possible, and I presume that this treatment is standard practice for this condition in dogs. If you treat x number of patients, a certain number of them will develop complications from the treatment. This is unavoidable, it is purely statistics. You do your best to be aware of these complications, dose carefully, monitor carefully, but these things still happen.

It is the same with any human endeavour. Everything you do or don't do is a calculated risk, and it is up to professionals to advise you of that risk. Sometimes the risk assessment is an easy one (i.e. with your dog - if you don't treat the infection, statistics say the outcome will be much worse). Sometimes it's difficult, e.g. do you give an terminal patients aggressive lifesaving treatment when you know that their current illness will provide them a kinder and easier death than to let them continue and suffer a more painful fate later on.

I am sure you know all this already, but sometimes even forum owners need a bit of consolation Don't beat yourself up over it. Because if it happens again, you know you would be doing the same thing - seek advice of a vet, accept advice in good faith, and give treatment to your dog. Maybe not with another aminoglycoside though.

 

[Blumlein 88]

Remember this: you gave your dog treatment with the best of intentions, on advice from a health professional. So you should not feel any guilt. You did not know that this was even a possibility until it happened. Should your dog's vet feel any guilt? As a health professional myself, I can tell you that this kind of reaction is rare but possible, and I presume that this treatment is standard practice for this condition in dogs. If you treat x number of patients, a certain number of them will develop complications from the treatment. This is unavoidable, it is purely statistics. You do your best to be aware of these complications, dose carefully, monitor carefully, but these things still happen.

It is the same with any human endeavour. Everything you do or don't do is a calculated risk, and it is up to professionals to advise you of that risk. Sometimes the risk assessment is an easy one (i.e. with your dog - if you don't treat the infection, statistics say the outcome will be much worse). Sometimes it's difficult, e.g. do you give an terminal patients aggressive lifesaving treatment when you know that their current illness will provide them a kinder and easier death than to let them continue and suffer a more painful fate later on.

I am sure you know all this already, but sometimes even forum owners need a bit of consolation Don't beat yourself up over it. Because if it happens again, you know you would be doing the same thing - seek advice of a vet, accept advice in good faith, and give treatment to your dog. Maybe not with another aminoglycoside though.

Plus 1 on this.

Having cared for my parents in recent years until their lives ended I experienced this several times with each. I don't have any wisdom to dispense other than what Keith said. It is on target. Very hard to see when you are in the middle of it. With some distance it is easier to see and accept. Our pets become part of our family too.