Page 2 of 4 FirstFirst 1234 LastLast
Results 11 to 20 of 35

Thread: Bentley has an appt: UPDATED w/PSOM info 3/22

  1. #11
    Join Date
    Mar 2005
    Location
    Dublin, Ireland
    Posts
    23,879
    Post Thanks / Like
    Blog Entries
    15

    Default

    This is her info sheet on PSOM:

    What is PSOM?

    PSOM is a form of otitis media (inflammation of the middle ear) that seems to affect the Cavalier King Charles spaniel (CKCS) in particular. Due to the mucoid nature of the disease and the fact that it is uncommonly associated with disease of the external ear canal, the condition has been referred to as PSOM or "glue ear".

    What are the signs and symptoms of PSOM?

    PSOM has been described in 43 CKCS dogs in one retrospective study in the veterinary literature (Stern-Bertholtz W, Sjostrom L, Wallin Hakanson N. Primary secretory otitis media in the Cavalier King Charles spaniel: a review of 61 cases. J Sm Anim Pract 2003; 44: 253-256). The presenting signs described from most to least common included pain localized to the head and neck, neurological signs (ataxia [incoordination], facial paralysis [drooping of the ear or lip, drooling saliva, inability to blink the eye], nystagmus [involuntary rapid movement of the eyeball], head tilt, seizures), itching around the ears, infections of the external ears, impaired hearing, and fatigue. These are some of the same signs seen with syringomyelia or progressive hereditary deafness which are diseases also identified in the CKCS. At the current time, there are no specific clinical signs that are associated with PSOM only.

    How does PSOM differ from the more common infectious otitis media?

    The biggest difference between PSOM and infectious otitis media are the prior infections of the external ear (otitis externa) seen in dogs with infectious otitis media. Infectious otitis media is usually due to an extension of an infection of the external ear (otitis externa) through the ear drum (tympanic membrane) into the middle ear. The most common clinical sign of infectious otitis media is recurrent otitis externa, which may manifest as discharge from the external ear, odor, redness of the external ear, pawing or rubbing the ear, head shaking and pain on palpation of the ear. In some instances, neurological signs may be present, as described for PSOM.

    How does PSOM cause hearing loss?

    There are two types of hearing loss, one is conductive and the other is sensorineural. Sensorineural hearing loss is due to an abnormality of the cranial nerve responsible for hearing, while conductive hearing loss is due to something impeding the ability of sound to get into the inner ear to the cranial nerve. The mucus present in the middle ear in CKCS with PSOM can cause conductive hearing loss by impeding sound from getting to the inner ear. Once the mucus is removed, hearing is restored. Hearing loss may recur if the mucus accumulates in the middle ear again. In the aforementioned study, the middle ear had to be flushed of mucus on more than one occasion in most dogs. Therefore, at the present time, we are unsure of the recurrence rate of PSOM after a middle ear flush.

    Can hearing loss due to PSOM cause behavioral problems or changes?

    Hearing loss in children due to secretory otitis media (SOM), a disease that appears to be similar to PSOM, has been associated with changes in speech, language, cognition and behavior. Therefore, it is possible that the hearing loss due to PSOM in the CKCS could result in behavioral problems or changes.

    How do I know if my CKCS has PSOM?

    As stated above, the clinical signs can be quite variable. Neurological signs described above or acute loss of hearing would be an indication to seek veterinary attention.

    What should I do if I think my CKCS has PSOM?

    The first step would be to schedule an appointment for your CKCS with your veterinarian for evaluation. However, diagnosis of PSOM and distinguishing the clinical signs from other diseases usually requires the expertise of a veterinary neurologist and/or veterinary dermatologist. Your veterinarian should be able to help you find a neurologist and/or dermatologist in your area who can further evaluate your CKCS.

    Is PSOM unilateral or bilateral?

    It appears that most CKCS have bilateral involvement, but it is possible for the disease to be unilateral.

    What is the age of onset of PSOM?

    In the above retrospective study, most of the dogs (86%) were between 3 and 7 years of age at presentation, but the ages ranged from 2 to 10. At the present time we are unsure if it occurs in puppies, and do not know how long it has to be present before clinical signs occur.

    How can PSOM be diagnosed?

    At the present time, the best test for diagnosis of PSOM is a CT scan or MRI. However, these tests will only tell you if there is material (fluid, mucus, pus, or a mass) in the middle ear. Plain radiographs (x-rays) may be helpful, but are not as sensitive as CT or MRI, meaning that a dog may have material in the middle ear, but it would not be identified on the radiograph. To specifically identify the material seen on the CT scan or MRI as mucus, a myringotomy (incision into the ear drum) must be performed if the ear drum is intact. For these procedures as well as the myringotomy, the dog must be under general anesthesia. Most of the CKCS with PSOM have an intact, bulging ear drum. However, a non-bulging tympanic membrane does not rule out the disease. A video otoscope is preferred to the conventional hand-held otoscope for the ear examination, since the video otoscope magnifies and illuminates the ear canal and ear drum to allow for a more thorough evaluation of the ear canal and a complete view of the ear drum. However, a normal ear exam does not rule out PSOM. Functional auditory tests may be useful in the diagnosis of this disease and include brain evoked auditory response testing (BAER, or hearing test) as well as impedance audiometry (testing to determine the status of the ear drum and middle ear), but to date the predictive value of these tests has not been studied. We are in the process of getting funded for a study to evaluate numerous tests for the diagnosis of PSOM.

    What happens if PSOM goes undiagnosed for an extended period of time?

    Currently we do not know how long a CKCS may have PSOM before clinical signs occur, so we are unsure if any complications may occur the longer the disease is present. Further, it is possible that the condition may be present in some dogs who may never show any clinical signs of the disease.

    How can PSOM be treated?

    Treatment is aimed at removal of the mucus from the middle ear. This is done by flushing the mucus out of the middle ear with the aid of a video otoscope or operating microscope and suctioning the mucus out of the ear canal. The mucus can be challenging to remove from the middle ear and external ear canal. In most instances, the mucus appears to be sterile, however, I recommend culturing the mucus to determine is there is a secondary infection present in the middle ear.

    Are there any medical treatments for PSOM?

    In the aforementioned study, after the middle ear flush, a number of treatments were utilized (topical and oral corticosteroids, topical and oral antibiotics, mucolytics), but their efficacy in prevention or treatment of the disease is unknown. To date, the only treatment with known efficacy is middle ear flushing.

    What complications may occur as a result of flushing the middle ear?

    Complications secondary to the ear flush include facial nerve paralysis, Horner's syndrome (elevation of the third eyelid), balance problems (falling over, difficulty rising), and deafness. These complications are usually uncommon and can be minimized by having this procedure performed by a veterinary dermatologist that has experience in middle ear flushing.

    What is the cause of PSOM?

    At the present time, the cause of PSOM is not known. Due to its similarity to secretory otitis media in children, there may be an underlying Eustachian tube dysfunction causing the disease. The Eustachian tube is the structure that connects the middle ear to the nasopharynx and allows equalization of pressure (ventilation) in the middle ear with atmospheric pressure, drains secretions produced within the middle ear into the nasopharynx, and protects the middle ear from nasopharyngeal sound pressures and secretions.

    Is PSOM a genetic disease?

    It would appear that this breed is genetically predisposed to developing the disease, but the mode of inheritance in not known.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  2. #12
    Join Date
    Mar 2005
    Location
    Ohio
    Posts
    710
    Post Thanks / Like

    Default

    Thank you, Karlin, for the information! I think I may contact Dr Cole, it certainly couldn't hurt to gather the information.
    ~not knowing how near the truth is,
    we seek it far away~

  3. #13
    Join Date
    Mar 2005
    Location
    San Diego, California
    Posts
    8,700
    Post Thanks / Like

    Default

    Barb - please know I am thinking about you and Bentley and hoping you find out what is going on.
    Cathy
    Loving mom to Jake, Shelby and Micah

  4. #14
    Join Date
    Sep 2005
    Location
    Virginia
    Posts
    233
    Post Thanks / Like

    Default

    Good luck tomorrow, Barb. Spencer and I will be thinking of you.
    Spencer and his mom, Whitney

  5. #15
    Join Date
    Mar 2005
    Location
    Ohio
    Posts
    710
    Post Thanks / Like

    Default

    Thanks, Cathy and Whitney. I'll be sure to post about the appointment tomorrow as soon as I get home.

    I do think I'm going to call Dr Cole about the PSOM study at OSU. OSU is a bit more than a couple of hours from my house. I would definitely be willing to drive down there!
    ~not knowing how near the truth is,
    we seek it far away~

  6. #16
    Join Date
    Jun 2006
    Location
    Ohio
    Posts
    9,165
    Post Thanks / Like
    Blog Entries
    4

    Default

    Quote Originally Posted by BarbMazz
    Thank you, Cathy. How does one go about getting involved with a study like this?
    Here is a link with contact information
    http://www.vet.ohio-state.edu/95.htm
    I don't know the name of their new neurologist, but everyone there is very kind and helpful.

    Dr. Lynette Cole and Dr. Andrew Hillier are in Dermatology, and they are doing the PSOM study. They work closely with the neurologist, who does the MRIs for the PSOM study.

    I met several cav owners while there who get MRIs and check up for their cavs having SM.
    Cathy Moon
    India(tri-F) Geordie(blen-M)Chocolate(b&t-F)Charlie(at the bridge)

  7. #17
    Join Date
    May 2005
    Location
    Minneapolis
    Posts
    1,718
    Post Thanks / Like

    Default

    I'm really sorry you're dealing with all of this, but good for you for doing your homework and staying on top of it. Please keep us posted. Good luck!
    Jen, Abbey (Tri Cavalier) & Gus (White Min. Schnauzer)

  8. #18
    Join Date
    Mar 2005
    Location
    Ohio
    Posts
    710
    Post Thanks / Like

    Default Bentley's vet visit; UPDATED

    Just home from the vet. She checked him over really well. She watched the video, and agrees that something is definitely going on. His ears are both very clean and clear, which I knew. She said it's now up to me; to MRI or not to MRI.

    She was not familiar with PSOM, and took the literature I gave her to look over. Here's a general PSOM question; do the dogs affected with this get outer ear infections that lead into this? Or, can they have PSOM when their ears look very clean, and they've NEVER had an outer ear infection?

    I guess I would like some opinions.... If you were me, would you call OSU about the PSOM study? Would you MRI? For those of you who haven't, could you please watch the video I posted and let me know what you think?
    ~not knowing how near the truth is,
    we seek it far away~

  9. #19
    Join Date
    Mar 2005
    Location
    Dublin, Ireland
    Posts
    23,879
    Post Thanks / Like
    Blog Entries
    15

    Default

    Your questions are in the info sheet I posted I think. Outer infections do not lead to this; it is within the inner ear and hence the ear needs to be punctured and drained, often more than once, to get the glue-like matter out. The ';plugs' can be large or small. Plugs seem very common in CKCS -- they show up regularly on MRI scans. Both Leo and Jaspar have them.

    I would go to OSU if you can -- either get on the study or consider a separate MRI. If you can get the MRI done and get on the study this would be very helpful to you and would at least get a major expense covered. What you do at that point I suppose depends on the results, what the study would include, and what route you wish to take.

    I would say you DO need to see a neurologist and OSU is the best place to go in your region. As a neuro will review the study MRIs this is an ideal way to get the MRI done and a full consult. Also you would be helping research.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  10. #20
    Join Date
    Mar 2005
    Location
    Ohio
    Posts
    710
    Post Thanks / Like

    Default

    Thank you, Karlin. That's what I thought about the PSOM; I wanted to make sure I was reading the literature correctly.

    I put a call in to Dr Cole since I posted last. It would certainly be silly not to, and if Bentley would be accepted into the study it would be super, both for him and to further research.

    I'll post again as soon as I hear from Dr Cole.

    I so appreciate the fact that you've taken the time to put this literature up here, Karlin. What would any of us do without this resource?!? Please don't ever go away!
    ~not knowing how near the truth is,
    we seek it far away~

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •