Anatomically, the ear canal is divided into three sections: external, middle, and inner portions. Otitis media refers to inflammation of the middle portion of the ear. Unlike in people, otitis media in dogs and cats commonly occurs as an extension of an external ear infection. Unresolved external ear infections break through the ear drum, pushing the infection into the depths of the middle ear. Pets with otitis media develop excessive waxy and or pus-filled discharge, odor, hearing loss, and pain around their ears; they may shake their head or rub their ears. Diagnosis of otitis media begins with a close inspection of the ear canal using an illuminated otoscope. Large amounts of discharge, infection or the presence of a foreign body may preclude diagnosis until the debris can be removed. Otitis media is a painful condition; deep sedation and/or general anesthesia may be required for visualization of the deeper portions of the ear to make a definitive diagnosis. Treatment of otitis media must address the infection (topical and oral antibiotics and/or antifungal medications), inflammation (cleaning the ears of debris and anti-inflammatory medications), and underlying causes (e.g.: hypothyroidism, allergies, and foreign bodies). Pets with severe or non-responsive otitis media may require imaging (e.g.: x-rays or CT scan) to determine the full extent of the disease. Resolution of severe infections often necessitates surgery to mechanically remove the infection or tumor. Frequent recheck examinations ensure that the infection resolves completely. Your veterinarian will discuss strategies with you to prevent recurrence.