Otitis Media, More Common Than You Think
Macduff is a 13 year old MC DSH. He was presented for acute onset of tetraparesis, worse on the right side with right sided torticollis. Conscious proprioception and voluntary motion were diminished on the right side. No nystagmus or other cranial nerve signs were visible. Macduff has a long history of recurring URI symptoms that seem to be worse in the spring but improve with antibiotics. He has had a right head tilt in the past. He is strictly an indoor cat. Neurolocalization is to the vestibular system with bilateral involvement of the middle/inner ear or brainstem or both. An MRI was performed. See images. Bilateral otitis media was diagnosed with evidence of infiltrates in the nasal cavity with some turbinate destruction and involvement of the right frontal sinus. Bilateral ventral bulla osteotomies were performed and purulent material was found in both bullae although no bacterial growth was found. Cup forceps were used to biopsy the nasal cavity. Cultures were performed. No growth was found in the bullae but Pseudomonas aeruginosa was grown from the nasal cavity. Zeniquin was prescribed for the Pseudomonas infection. Long term follow up with reimaging of the skull will be necessary. Signs of otitis media in either cats or dogs can be similar to signs of otitis externa with scratching, head shaking or exudate in the ear canals. Lethargy, anorexia or pain on opening the mouth can occur. Neurologic signs such as head tilt, ataxia, nystagmus, weakness, facial paralysis or Horner’s syndrome may be present. The diagnosis of otitis media/interna is made on cross sectional imaging such as CT or MRI. Radiographs of the skull are of little value. It is very important to diagnose otitis media early in its course for several reasons. First the pet’s quality of life is markedly affected because of pain, dizziness, etc but extension of the infectious process into the brain can easily occur thru the external acoustic meatus if the problem is not diagnosed and treated. I have also had cases of rupture of the bulla with extension of the infection into the surrounding soft tissues. Myringotomy can be performed to recover material for culture and sensitivity as well as cytology. Antibiotics can then be prescribed based on sensitivity. My personal experience is that ventral bulla osteotomy is usually necessary to resolve otitis media. Follow up cross sectional imaging is usually required because the signs may diminish markedly after osteotomy although some infection may remain.