The toy poodle had been scratching her ears since puppyhood. The ears at the entrance to the ear opening were as rough as leather, greyed and blackened through much scratching. She was only 4 years old. Such cases would have ulcers and some foreign bodies inside. In the horizontal canal. Very difficult to dislodge. When the owner consulted the vet, the usual ear drops and medication. After around 2 months, the same ear scratching, head shaking and pain comes back again.
Best treatment for chronic otitis externa - ear resection surgery.
Alternative conservative treatment - 2 steps. Bring down inflammation. 5-10 days later, irrigate ear.
As this dog had high triglyceride level and one liver enzyme was high, I advised wait for a few weeks. Slim the dog down to 3.5 kg (presently 4.6 kg). I don't advise surgery as anaesthesia will be risky.