My dog has an ear infection with a bloody discharge from his nose.

Question: 

My dog has horrible ear infection in one ear with Pseudomonas. It has been treated for 3 years without success. Two vets have recommended TECA. When he is on Ciprofloxacin and Cephalexin together he has less odor but some drainage. As soon as he stops taking the he flairs up and his nose gets very congested with bloody mucus coming out of his nose. Could the Pseudomonas be in his nose too?

Answer: 

Chronic inflammation and infection in the ears will frequently induce architectural changes within the ear canal predisposing it to future infection. For that reason, the only means of resolving many recurrent ear infections is to actually surgically remove the ear canal, i.e. perform a TECA.

The more challenging question is whether the nasal condition will resolve after the TECA. The reduction in the nasal discharge in response to antibiotics indicates that infection is also present in the nose. However it would be unexpected for infection in the ear to directly affect the nose. Most infections within the nose are secondary to other nasal conditions such as 'allergies', tumors, foreign bodies and structural abnormalities. So you need to assume that the two problems are unrelated and have the nasal condition evaluated further.

Option one would be to have the TECA performed and see if the nasal condition resolves. If it doesn't, then further evaluation of the nose will be necessary. The second option would be to have the nasal condition evaluated first (rhinoscopy, imaging, biopsy) prior to the TECA. The presence of an unrelated nasal condition might affect your decision to pursue a TECA.