"What is the solution?" the lady asked. "In any case, give my dog the anti-itch injection."
I did explain to her that an ear surgery may be needed to provide ventilation and drainage as the ear pinnae showed hyperpigmented markings of chronic scratching. She said I had not mentioned it before. I showed her the illustration I had in her case file, of the ear surgery called lateral ear canal resection.
It is good practice to illustrate the surgery and keep a record. Owners have short memories and in this case, I had the evidence of having explained to her. Another cause could be bilateral endocrine alopecia.