Ear Infection not better w/treatment - ideas? experiences?

Hello all - please please help me and my cat Sam!

He's got a middle ear infection w/likely ruptured eardrum that just doesn't seem to be getting better. Have been treating in accordance with vet recommendations, but my guy seems to be doing worse at this point - lethargy, anti-social behavior, and low appetite for even his fav foods. It scares me to see him doing so poorly - he was better than this before treatment and I'm not sure what to do from here :-(

For those who want the short version

Sam is acting lethargic, anti-social and won't eat much...all out of the blue after 4 weeks of conventional treatment with oral and topical antibiotics. What should I do?

Has your cat gotten over a bad middle ear infection that didn't resolve quickly with standard treatments?
How did you achieve a good outcome?
What procedures, meds, alternative therapies helped?



For those who like details: the full history:
6 months ago - Had him treated for an ear infection in right ear (w/ Animax ointment), which seemed to resolve the issue.

1 month ago - His right eye was not blinking! Took him into a different vet, and who told us it was facial nerve paralysis from a big ear infection. Both ears were infected, with the right one being more severe. Our vet gave us Baytril Otic drops and oral clindamycin after testing a swab for bacteria and yeast (yes to both), and told me to continue with the artificial tears in the eye that doesn't blink.

Recent negative turn - Took him in to the new vet for two recheck appointments so far. At first, was told he was looking better and he seemed to have more movement in the eyelid area. Came back again, and vet was concerned that it wasn't looking better than the previous recheck. Vet suggested I finish the last dose of the clindamycin and then switch to Zithromax (25mg daily), as it was effective against another possible bacterial culprit. After taking him home from the vet that day, he didn't seem to be doing well. I figured he was probably just tired. He received the last dose of the clindamycin, and continued to seem increasingly lethargic and less hungry. Next day I switched him to Zithromax. Tendency toward lethargy and loss of appetite continued.

What I've done to try to stop his decline - Saw that his ear was red/inflamed deeper inside and causing him to scratch. Stopped the Baytril Otic, as the doc suggested it might be causing sensitivity in the ear canal because of the silver (though vet didn't say to do this explicitly). The ears looked substantially better. I put a couple of drops of jojoba oil in the ear canal, to soften wax and allow him to shake it out - this seemed to help get nasty stuff out and decreased redness. But the problems continued - only low level appetite, hiding behavior, sleeping lots and only getting up occasionally go to the cat box. I stopped the Zithromax today (it has a long half-life), because he looks so terrible and wouldn't eat anything. Am worried that it was causing nausea, stomach pain, or taste distortion that made him reject his favorite foods. It's been 36 hours since his last dose and symptoms all remain. The Baytril was last given 2.5 days ago.

Remaining conventional ideas, which all seem bad:
1. Ear cleaning under sedation - vet was not excited about this, said there could be vestibular problems even from simply cleaning with saline
2. Try Animax again, since it seemed to (at least for a while) work before, especially in clearing any pus/wax out of the ear canal - but what if this caused the problem in the first place, either by spreading the infection to the middle ear or because it was administered to a ruptured eardrum? This doesn't seem likely to entirely fix the middle ear problem.
3. Prednisolone orally at a small dose to reduce inflammation - don't want to do this because he seems sickly and I don't want to decrease immune response if he's fighting infection...also the risk of diabetes scares me.



What would you do if you were me? I'm planning on talking to the vet soon, but, as I said, I don't know what to do because all options the vet has given me look bad...and I just want to see Sam move around and act normal again as soon as possible. I'm worried sick myself!

Any shared ideas, experiences, etc. would be greatly appreciated!!!

Update: Sam's life is still rough. He isn't eating today and we have started the Animax, the vet confirmed that antibiotics could cause problems when used for so long in some cats, so she told us to suspend the Zithromax for a few days too.

CatNurse22 - good to know about the video otoscope! I was wondering how they would know what they were doing in there.

stephanietx - our vet did tell us about this sort of treatment, but because of the nerve paralysis it was a bad candidate for Sam

Thanks for the ideas so far! Still looking for an answer about how to help him, now with food and water especially. Or even just some vibes if you don't have any ideas - a very rough day today for us...hopefully the Animax will help soon.

Update 2: Took Sam into the vet today, mostly because of concern re: dehydration and eating. Got him some subcutaneous fluids, and the vet on duty said he looked fine but was running a slight fever and said to put him back on the Zithromax...which I haven't started quite yet because I worry his slight improvements in sociability could be from the rest from the meds, but who knows? Will take temp again first for sure, now that we don't have anxiety and a long hot car ride first. Vet said that the ear looks pretty inflamed, but since she didn't see him before I'm not sure what I make of that new data (looks same or better to me). Also got the appetite stimulant mirtazapine, but am trying every other trick in my bag first before resorting to this (side effect can be kitty anxiety - not what we need now!).

at129 - The Fancy Feast Fish & Shrimp flavor has been by far the most successful, so thanks for the tip! We bought a bunch of different things, but it seems that's what he's most interested in, who'd have thought?!

otto - thanks for mentioning Tresaderm, I'll look into it, and I'll keep the ENT idea in mind if this isn't working shortly. As for being in pain, I presume he must feel crummy, but he spends most of his time being peaceful and laying around...if only he could speak english! Any ideas about what I could do differently if he was in pain?


Well friends, that's all for now, but if you have any more tips for increasing food/water intake, ear infection experiences, etc. please pass them on...
Anything that might be helpful will be greatly appreciated!

otto - you are right about the quantity issue!

We started to syringe feed Sam last night, and found that after we got him a few good tastes via the syringe, he went for the stuff that had spilled on the towel. Got the hint and then started just squirting pea sized amounts of recovery food directly onto the towel and he devoured 35ccs. Not a long term solution when we want him to eat on his own, but hey, better than nothing!!!

Am probably about to give him a dose of the mirtazapine, but have been putting this off because of the horror stories I've read on the internet of howling anxiety racked kitties. But I figure if I do it now, my vet will be open if he has a serious problem. Will let you know how that goes...


Thanks for the support guys, it really helps to hear your experiences & tips for recovery, and also to just know that people are rooting for us!!

So Sam is holding steady, acting a wee bit more like his old self, but is still tired and fighting this thing off.

Last night, I went to see him and found a substantial (half dollar sized) amount of blood under his worst ear. He'd been laying on that ear with his head turned upside-down, and the blood was very bright red and had some small amount of clotted/mucus-y blood as well. However, Sam seemed completely unaffected by this. In fact, he ate his largest meal ever shortly after we discovered it. There was also no blood in the ear, unless I mushed it at the bottom, in which case a slightly pink tinged fluid moved out of the bottom of the ear and he was mildly irritated. Maybe the oil in the Animax kept it from leaving any trace as it exited? Will be calling the vet when they are back in the office Tuesday, but would be interested if anybody can share info about their own experiences on this front!

Also, for those who might benefit from knowing: the mirtazapine worked well, with about 30 minutes of mild confusion from him two hours after taking 1/8 of a pill, which then subsided and ended up with him eating (though not absolutely devouring) some Fancy Feast. I would recommend that people who are hesitant to try this med because of the intense side effects consider reducing the dose...I was very glad I did, as he vocalized a bit after receiving it, and I imagine he would have had more side effects with a larger dose. That said, he's only at 8.5lbs right now, so with a larger cat this might be different, always ask your vet.


Anybody know what might have happened with the ear? Similar experiences anyone?

I've assumed that either his ear drum ruptured (this was something my vet and I assumed had already happened because of the facial paralysis) or there was a bunch of bloody junk in there that couldn't escape because the ear canal was too swollen before he received the steroid in the Animax. Either way, I'm already giving him antibiotics (in the ear and orally), so I think that's all an emergency vet would do...and he seems fine.

Help or vibes much appreciated!