Successful long-term management of otitis secondary to chronic inflammatory conditions, such as atopic dermatitis, requires ongoing regular anti-inflammatory treatment to maintain remission and prevent relapses of infection. Successful long-term management of otitis secondary to chronic inflammatory conditions, such as atopic dermatitis, requires ongoing regular anti-inflammatory treatment to maintain remission and prevent relapses of infection. Such proactive therapy (the lower orange line) gives a much better prognosis. Reactive treatment of each bout of infection (the upper red line) gives short-term relief, but misses the ongoing inflammation in the absence of infection. This allows chronic inflammatory changes to develop that will result in more frequent and severe infections. These cases will eventually need a total ear canal ablation Tim Nuttall In Practice 2016;38:17-21 Copyright © British Veterinary Association. All rights reserved.