Q. We adopted a 3-year-old cat from our local no-kill animal shelter about three months ago. He has had a problem with scratching his ears and violently shaking his head since we brought him home. The shelter said they had treated him for ear mites not long before we adopted him. He has been back to the vet four times and although they did not see mites in the smear they tried several different mite treatments. They also placed him on antibiotics for two weeks, which didn't help at all. The most recent treatment they tried was Revolution™ to the back of his neck every two weeks for three treatments. We have completed two of the three applications. The scratches on his head and ears are finally healing and the fur is growing back, but he still shakes his head so hard he falls over. Also I do occasionally see him scratching.

Other than this he appears to have adjusted to his new home very well. Please advise if you have any other suggestions on helping him with the head shaking and the possible cause.

A. There are several other reasons for the ear problems other than ear mite infection, such as polyps or tumors in the ear canals or allergies. When I see a chronic ear problem it is important to perform a thorough examination of the ear canals. A thorough examination requires sedation because these ears are often painful and cats will simply not allow you to see all the way down to the eardrum if they are awake. 

If he does not have any structural reasons to be bothering his ears, then starting a workup for allergic skin disease is in order. Often starting a hypoallergenic dietary trial for 8 weeks will eliminate enough allergens to resolve any skin problems, including ear itchiness (aural purities). Skin testing and/or blood testing may be needed as well.