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Psom

Love my Cavaliers

Well-known member
Oz was at the neurologist last week and he thinks that most of his pain is due to PSOM. He is going to take a look in his ears under sedation on Wednesday and if he finds anything, he'll drain it. I've read that the procedure may have to be repeated multiple times so some don't recommend even doing it. But Oz truly seems miserable if anyone even touches his ears. He shrieks in pain. I have to be really careful taking his snood off after he eats or I'll set off a screaming fit. He rubs his ears after every meal and when he scratches, its his ears, not his neck. He's on 100 mg gabapentin 3 times a day, 10 mg omeprazole, and 5 mg famotidine (for his IBD). He doesn't seem to have lost any hearing. Has anyone else had a dog be so miserable because of PSOM? His MRI (years ago)showed CM, no SM. Maybe it's a combination of CM and PSOM? He does scratch less since he's been on gabapentin, but the shrieking when his ears are touched has not eased up. Has anyone had a dog that's gotten relief from draining the ears? Thanks!
 
I'm sorry Oz is having problems. I hope they can give him some relief after his procedure on Wednesday. Keep us posted.
 
Oz was at the neurologist last week and he thinks that most of his pain is due to PSOM. He is going to take a look in his ears under sedation on Wednesday and if he finds anything, he'll drain it. I've read that the procedure may have to be repeated multiple times so some don't recommend even doing it. ...

None of our cavaliers have had PSOM, but I've read a lot about it. I cannot imagine not doing the procedure, called a myringotomy. The disorder is progressive. The wad of mucus very likely will keep getting larger. At some point, it can do serious damage to the inner ear plus eliminate the ability to hear. The myringotomy procedure is not as complicated as it sounds. There is a YouTube video of it here: http://www.youtube.com/watch?v=nu0i2EvIaU8&feature=youtu.be

I have read comments of several owners of cavaliers which have had this procedure, and the only negative comments I recall were that for some dogs doing a myringotomy once does not prevent the mucus plug from growing back again. But most commenters wrote that their dogs only needed it done once.

If any of our cavaliers is diagnosed with PSOM, I would not hesitate to have a myringotomy performed (as long as the dog is otherwise healthy enough for the procedure) by an experienced and board certified veterinary specialist.
 
Thanks Rod. That makes me feel better about doing it. I was going to have it done anyway as he is in so much pain whenever his ears are touched, but seeing the video helped a lot.
 
Oz had his myringotomy today and did just fine. He had two huge grape size gobs of thick mucus in his right ear but only a minimal amount in his left ear. He is home sleeping like a baby now. Time will tell whether it has made a difference. Hopefully! I asked his neurologist about the chances of it recurring and he smiled and said "He is a cavalier!" Although he did add that because there was minimal mucus in his left ear, that might bode well for it not recurring.
 
I hope he does well. I'm going to be interested in the outcome as our Bentley has PSOM, as well, and I think it gives him more trouble than the other issues. Unlike many, though, he absolutely LOVES having his head area massaged. I suspect that his hearing has diminished somewhat. When we had him MRI'd in Feb they said the ear surgery isn't always successful and the mucous sometimes returns. Since we had just spent $1600 on the MRI we weren't willing to take on the surgery. He's doing OK with Gabapentin and a small amount of Prednisone.
 
Oz has still been sleeping, sleeping, sleeping since the myringotomy! I will keep you informed about whether it makes a difference for him. I sure hope so. The shrieking when his ears are touched is horrible. He's on pain meds for the next five days, but after that I'll let you know.
 
This is so timely, BB has been having major head rubbing and pain that seemed to be ear related but no infection could be found. We just went to the neurologist this AM to be looked at for SM and the MRI showed PSOM in both ears but much worse in the right ear. She is on pain medication (Gabapentin and Tramadol) until she can be seen by the Dermatologist/Ear specialist but the Doctor spoke highly of the procedure and prospects for relief/recovery. It is so nice to have the information provided by this group and the site that Ron mentions above to reference - thanks to everyone and my family is happy to know what has been causing the discomfort along with the next steps for our sweet baby!
 
Oz has been doing great since his myringotomy -although it's only been two days, but no shrieking so far and almost no scratching. He is still on pain meds though. One thing though is that his hearing is diminished since the procedure. His neurologist told me that might happen before the procedure; he said that for Oz everything sounds like he's underwater. It should only be temporary. I sure hope so as I already have one almost totally deaf cavalier (Maddie). She's a dream though, never causing trouble. Oz on the other hand likes to go out in the yard and bark at anything and everything. He stops when I tell him to, but if he can't hear me .....
Let us know how BB gets along if you decide to do it.
 
Thank you for the information. I will make sure to ask about the potential for hearing loss, we will likely do the surgery since she is quite a bit of pain and discomfort. I will update next week and likely have some questions!
 
Last week (Thursday), BB had myringotomy on both ears. She is still healing and on pain meds (Gabapentin 100 mg 3x, Tramadol 50 mg 1x), in addition she is on a topical ear solution and prednisone. How long did it take for Oz to stop rubbing his head/ears following the procedure? Do you know if there should be no head rubbing? BB has had minimal rubbing, itching but still enough that it is noticeable. Obviously she has had surgery and will be in some discomfort but wondering if the meds should fully eliminate all or just most of the head rubbing? We go back to the vet in another week for a check up but I wanted to see what your/others experience was with the healing period following the myringotomy.

An interesting point from our experience, the vet put BB on steroids for 3 days before the procedure saying that they see more success and less negative side effects by doing this before the surgery.

Thanks!
 
We are about 6 weeks post myringotomy and to tell the truth, I really don't see much difference in Oz. I did immediately, but his behavior and pain slowly returned. We have not been back to see his neurologist since his one week post-op visit. He still yelps whenever anyone touches him near his ears, rubs his ears constantly on the carpet, and yelps when I take his snood off no matter how gentle I am. He does scratch less though - one positive. Unlike BB, Oz seemed to be much better right after surgery and then it slowly returned. He did have diminished hearing after surgery though, but he is back to normal now. (Phew!) I hope BB's healing continues to get better and that her long term results are better than Oz's are. Write back in about 4-6 weeks and let me know please.
 
BB just had her follow up appointment and some interesting details on BBs follow up appt...

- COMS (Caudal Occipital Malformation Syndrome) can make the Cavalier more sensitive to itch and pain around the head (makes sense but was not an obvious connection)
- her ear drums are healing but have not completely grown back yet, this is considered good to continue to allow drainage during the healing process
- Synotic was added to help with the itching of the ears
- Continue the Gabapentin 3x, Tramadol 2x and 600 mg NAC a day
- In 2-3 weeks recheck again and if there is no improvement in the ear sensitivity then back to the neurologist to look at longer term treatment of COMS

Posting this to help anyone dealing with PSOMs and CM/SM like symptoms, I am still hopeful for the longer term prospect for BB and her pain relief. I hope that Oz is doing better!
 
Thanks for the detail -- information on specifics is always very useful to others who may face a similar decision. I guess the results can be really variable and neurologists say the procedure generally has to be done a few times in most dogs, though some will respond immediately. I had a myringotomy done a few years back on Jaspar; I was hoping his hearing would return (I've yet to have a cavalier without some hearing loss by age 6 or so :( -- it is extremely common -- but he was almost totally deaf by around age 8.

This might be of interest to those with dogs with SM, the author kindly gave me permission to use it years back. NB my website is about to undergo a major update as much info is now old...(though the basics and treatments pretty much remain the same).
 
Hope BB is starting to do better. I'm very interested in following your thread as I am almost certain Lucky has PSOM. He had an MRI that clearly shows fluid in his middle ear, but no surgery was performed to remove it (our neurologist is treating it as an infection for a one month trial). We have the scratching, but what got us to the diagnosis of middle ear infection was severe dry eye caused by a disruption in the nerve supply near the middle ear. These little dogs sure like to keep us on our toes. I am hoping Lucky can get a myringotomy soon so he'll feel better. I hope BB is lots better soon.
 
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