PSOM Question

[Pat]

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]

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]

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]

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/s...highlight=psom

[Pat]

"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]

[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]

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]

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]

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]

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