PDA

View Full Version : PSOM Question



Pat
20th February 2011, 12:34 AM
Hypothetical question:

If one were doing a screening MRI on a dog with no symptoms, and PSOM is found - what is the proper course of action? I had assumed that one would want a myringotomy and flush done even if PSOM was just an incidental finding, but I'm now reading that nothing should be done if there are no symptoms.

Feedback please?

Pat

RodRussell
20th February 2011, 04:12 AM
Hypothetical question:

If one were doing a screening MRI on a dog with no symptoms, and PSOM is found - what is the proper course of action? I had assumed that one would want a myringotomy and flush done even if PSOM was just an incidental finding, but I'm now reading that nothing should be done if there are no symptoms.

Feedback please?

I must have missed the suggestion that nothing be done about PSOM. It is progressive, so if there are no symptoms (of psom) and the tympanic membrane is not yet bulging, you could wait until it does bulge, but if you do nothing, ulitmately the the tympanic membrane may rupture and a hearing loss likely would be assured.

Blondiemonster
20th February 2011, 04:29 AM
Hello. My blondie had her ears flushed twice. I would say if the psom is not symptomatic flush it, because the dog is under anesthesia already, and its not worth it to wait until it gets worse and then have to do anesthesia again. Its a minor procedure. In dogs with sm its hard to say what's caused by what when psom is also present. My blondie seems happier now her ears r flushed again, the psom came back after 6 months, full force. There was tons of "goo" coming out of her ears even for days after the eardrum was "cut". Quite a bit of fluid.. We are considering eartubes @ ohio state if symptoms return. Every time her SM seems aggrevated by psom returning. She stopped doing airguitar scratching since her ears have been flushed for instance. I do believe the psom was clearly visivle on both mri's she has had.

Tania
20th February 2011, 04:23 PM
Dougall was diagnosed with psom two years ago. We have scanned each year. The latest mri scan revealed "There is still a middle ear effusion of the right ear; however the left ear appears to have sponaneously cleared which is most unusual ".

We are closely monitoring him.


This is worth taking a look at too....(NAC is often used as a cough medicine because it breaks up the disulfide bonds in the mucus and thus liquefies it, making it easier to cough up. It is also this action of breaking disulfide bonds that makes it useful in thinnning the abnormally thick mucus or Cystic Fibrosis patients)

http://www.cavaliertalk.com/forums/showthread.php?35435-PSOM-and-NAC-Supplement&highlight=psom

Pat
20th February 2011, 05:41 PM
"PSOM does show up on MRI but the ear can also be examined with a special scope under general anaesthesia. The mucous plug can be flushed from the ear but often this procedure must be repeated more than once to be successful. Neurologists who regularly do MRIs on cavaliers say some degree of PSOM is often present. Many neurologists and vets advise leaving the condition unless it is causing distress or severe deafness, as the flushing procedure is invasive, requires anaesthesia, and has some potential though rare complications. Be sure to ask your vet or neurologist to talk through these aspects of treating PSOM."

The above is from this site. I had assumed that if PSOM was an incidental finding on an MRI, you should go ahead and do a myringotomy since the dog is already under anesthesia. But reading the above made me ponder the question. I am wondering if it might be like anal gland expression - I've not had a Cavalier that required regular emptying of anal glands, and I was chatting with a groomer friend yesterday about that since another friend commented she has to have her two Cavaliers' anal glands expressed every couple of weeks. The groomer commented that sometimes if "you never get started emptying glands, you never have a problem."

That leads me to wonder - if you have an older Cavalier where PSOM is an incidental finding on an MRI done for breed research purposes (no symptoms) and you flush the ear - are you setting yourself up to have to have repeat MRIs and myringotomies because you have intervened? In other words - do you "leave well enough alone"?

Pat

Not sure that the cases of Blondie and Dougall can be used as illustrations - weren't these dogs MRI'd to get a diagnosis because of symptoms rather than for purposes of a research study?

Tania
20th February 2011, 06:11 PM
[QUOTE=Pat;381597
Not sure that the cases of Blondie and Dougall can be used as illustrations - weren't these dogs MRI'd to get a diagnosis because of symptoms rather than for purposes of a research study?

[/QUOTE]


Agree Dougall is unusual and I would not suggest for one moment this is normal. We scanned Dougall because Molly had been diagnosed with sm.

If it had not been for Molly, Dougall would not have been scanned. We assumed he was a quiet dog and later a quiet dog with back problems.


Dougall has not showed any symptoms, his first scan revealed cm and not psom. His 2nd scan revealed psom. His 3rd scan revealed psom in one year and had vanished from the other. Dougall has never displayed typical psom symptoms.



That leads me to wonder - if you have an older Cavalier where PSOM is an incidental finding on an MRI done for breed research purposes (no symptoms) and you flush the ear - are you setting yourself up to have to have repeat MRIs and myringotomies because you have intervened? In other words - do you "leave well enough alone"?




Maybe you are right !

Pat
20th February 2011, 06:42 PM
Ah - so then Dougall would be a similar case - I didn't realize that you scanned him for informational purposes rather than in response to symptoms. And you have the resources to keep scanning him every year for informational purposes (I don't have the resources at current US prices to do that). Did you ever have a myringotomy done or are you just monitoring? If you are just monitoring - I presume that you haven't done myringotomy at the advice of your neurologist? What reasons did neurologist give for not doing a myringotomy (assuming this wasn't done)?

I would guess that there isn't a lot of data yet because there really aren't many people that are able to MRI every year for informational purposes.....so perhaps spontaneous "remission" does occur but we just don't know about it in these Cavaliers with little/no symptoms that just aren't MRI'd repeatedly? Does that make sense?

As far as "maybe I am right" - I really have no answers or guesses at all. I had assumed that you should take care of PSOM if you find it, but then I read the quote I gave from this site - which is what got me started trying to reason through this subject. I hope Karlin will also read this and give her thoughts.......hopefully today!

Pat

Cavaliers2kiss
20th February 2011, 06:44 PM
Pat,
Lacey's PSOM was discovered by her dermotologist/allergy vet. It was not done by MRI. She put a scope down her ears and somehow blew the picture up on the wall. Two ears were bulging and her ears were flushed under anesthesia.

That was two years ago and her ears were checked in the same manner last week. Both ears were fine. So the procedure doesn't neccesarily cause it to happen again.

Tania
20th February 2011, 07:11 PM
Ah - so then Dougall would be a similar case - I didn't realize that you scanned him for informational purposes rather than in response to symptoms. And you have the resources to keep scanning him every year for informational purposes (I don't have the resources at current US prices to do that). Did you ever have a myringotomy done or are you just monitoring? If you are just monitoring - I presume that you haven't done myringotomy at the advice of your neurologist? What reasons did neurologist give for not doing a myringotomy (assuming this wasn't done)?

Pat

Dougall (cm) did not show any signs of discomfort so it was felt that for the time being it should be left alone and monitored closely. I have being trying to avoid any invasive procedures but appreciate and acknowledge this may have to happen.

Our main concern is the sensitivity in his back, it is always there but every now and again he has a severe episode, this can be so bad you can't touch him :(

Molly who has sm. Does not have psom !

Pat
20th February 2011, 07:22 PM
Dougall (cm) did not show any signs of discomfort so it was felt that for the time being it should be left alone and monitored closely. I have being trying to avoid any invasive procedures but appreciate and acknowledge this may have to happen.

Thanks! And your neurologist is Clare so that was her advice in this particular case? So that goes along with what I read here on CT under PSOM and quoted.

For Lacey - was she showing symptoms of discomfort which is why you had her ears scoped?

Pat

Tania
20th February 2011, 07:29 PM
Thanks! And your neurologist is Clare so that was her advice in this particular case?

Yes this is what we agreed. Thank you for all your help and information.:razz:

Cavaliers2kiss
20th February 2011, 07:48 PM
Yes, Pat. Lacey's ears were driving her crazy before the surgery. It's my understanding that PSOM can cause deafness. I'm just guesssing, but the ears probably need to be bulging for that kind of damage though.

Pat
21st February 2011, 10:48 PM
FWIW, the neurologist (Simon Platt) said that we would NOT automatically do a myringotomy and flush if PSOM was an incidental finding on a screening MRI where there are no symptoms. Fortunately, there was no PSOM found so there was no decision to be made. I am tired but happy.

Pat

Karlin
21st February 2011, 11:02 PM
That is what I have always heard as well from neurologists with an asymptomatic dog.

Rod, I am not aware that PSOM is always progressive -- it certainly is not always symptomatic and myringotomy does have risks. I was advised NOT to do it on an otherwise asymptomatic or mildly affected cavalier by two neurologists and several vets that I have spoken to over the years. I will ask Clare Rusbridge if she sees much change in PSOM on repeat MRIs and am going to go have a look at my MRIs for Leo and Jaspar, done about 5 years apart. I don't think there was much change if any in that time for Leo at least.

Jaspar is now symptomatic and going deaf so I will look into the procedure. Leo and Lily all have PSOM but no issues I can see, or deafness. Lucy who is deaf, has no PSOM at all.

Nicki
19th February 2012, 08:58 PM
Revisiting an old thread, both Geoff Skerritt and Glasgow vet school told me they do not treat PSOM unless the dog in discomfort or exhibiting deafness.


My Tommy has been going deaf over the last few months and has been scratching at his ears - enough to cause knots. I took him to visit with my vet last week who specialises in ear problems. He scoped Tommy's ears, the the tympanic membranes are bulging, membrane is opaque so you can hardly see the anvil bone which is usually visible. So he is going in this week to have an myringotomy.

From reading it appears that it does recur, and 2nd surgeries are often required. 3rd surgeries are unusual and I could not find any evidence of 4th procedures.


I know that the scanning centre at Cambridge have seen cases where PSOM has disappeared in follow up scans, but until more dogs are repeatedly scanned then the data will be limited.

Brian M
19th February 2012, 10:00 PM
Hi Pat

If you recall when Daisy had her MRI last August when he diagnosed SM an PSOM then a murmur ,he was concerned only
with SM and his comment PSOM seems to have no effect and is not bothering her so leave alone.

A question while you are here ,you mentioned a bit ago going from COQ 10 to Ubiquinol if so did you and what strenghth Ubiquinol .I
have kept Rosie and Lily on COQ 10 100 mg and Poppy and Daisy on Ubiquinol 50 mg .

Nicki
2nd March 2012, 04:51 PM
:updte: Tommy's surgery was very successful, the exudate was very think and difficult to remove [it is very viscous mucus] but fortunately the vet persevered! The tympanic membrane [eardrum] heals over within 5-7 days, and he just had some pain relief for a few days.

Tommy's hearing returned within 24 hours, he is feeling much better, and livelier, no more scratching - and rolling over for belly rubs again! So we are delighted that we went ahead with the operation.

murphy's mum
2nd March 2012, 05:39 PM
Very glad to hear this Nicki, it's always a relief when these things turn out so well :)

Sydneys Mom
2nd March 2012, 05:53 PM
Happy to hear this and happy that he is feeling better. Give Tommy a belly rub from me.

Sabby
2nd March 2012, 06:03 PM
So pleased all went well. Tommy must be feeling a lot better.

Karlin
2nd March 2012, 06:05 PM
Great news!! :D

RodRussell
3rd March 2012, 12:48 PM
... Rod, I am not aware that PSOM is always progressive -- it certainly is not always symptomatic and myringotomy does have risks. I was advised NOT to do it on an otherwise asymptomatic or mildly affected cavalier by two neurologists and several vets that I have spoken to over the years. ...

I missed this post until now. PSOM is progressive in the sense that it does not exist at birth and eventually begins to exist and then becomes observable, at least via MRI or CT scans. But perhaps it is not always rapidly progressive, or once it comes into existence, it does not continue to progress.

It is important information that some neuros do not recommend surgery immediately.

Nicki
3rd March 2012, 08:52 PM
Thank you everyone.

I had an e-mail from my vet last night:

Otitis media is painful - speaking from personal experience - and given the bulging tympanic membranes visible on exam of Tommy's ear canals, it is likely myringotomy has released middle ear pressure allowing him some considerable relief.


Leaves me wondering if more dogs should actually be having the surgery?

Tania
3rd March 2012, 09:09 PM
Leaves me wondering if more dogs should actually be having the surgery

leaves me wondering how many dogs are in pain and the owners assuming they are not !