Otitis media (middle ear inflammation) usually results from infection spreading from the external canal or a foreign object piercing the eardrum. Inflammatory polyps (growths) are a common cause in cats. Infection spreading through the bloodstream is rare.
Otitis media can lead to otitis interna (inner ear inflammation), causing balance problems and deafness. These are more serious than otitis externa, and damage might not be reversible.
Signs of otitis media include head shaking, rubbing or scratching the affected ear, and tilting or turning the head toward the affected side. Signs of external ear infection might also be present.
Facial nerves run through the middle ear, so facial changes also can occur: facial nerve paralysis, a pupil that stays small, drooping eyelid, sunken eyeball, or the animal's third eyelid (the thin pale-colored membrane in the corner of the eye closest to the nose) popping out on the same side. With otitis interna, the cat may tilt its head toward the affected ear and show poor coordination, trouble rising or walking, and side-to-side eye movements. If inflammation spreads to the brain, signs such as head tilt, deafness, lack of coordination, drooping lips, or inability to blink may appear. Balance, walking, or jumping problems warrant a prompt veterinary exam.
Diagnosis
Your veterinarian may diagnose otitis media when the eardrum is ruptured, either by a foreign object or long-term inflammation. It is difficult to diagnose when the eardrum isn't ruptured.
Otitis interna is suspected when middle ear signs occur along with balance loss. If external ear inflammation is present, the vet will test for mites, foreign objects, or bacterial infection. Middle ear samples might be cultured. X-rays, CT, or MRI can detect middle or inner ear inflammation or bony changes behind the ear.
Treatment
Antibiotics may be given by mouth or through injection due to the risk of damage to hearing and balance. Anti-inflammatory medications can decrease pain and nerve inflammation. Ear mites are treated with antiparasitic drugs. Otitis media with an intact eardrum usually responds well to antibiotics. With long-standing inner ear inflammation and a ruptured eardrum, success is less likely. If medical therapy fails, surgery might be needed.
Local nerve problems can persist even after infection clears. Inner ear inflammation often improves with a longer course of antibiotics, but some signs might last for life. Allow time for your pet to adapt to any ongoing nerve-related issues. Early treatment improves outcomes, so schedule a checkup promptly if you notice signs of ear infection or changes in head position or movement.
Also see professional content regarding otitis media and interna.
