Psom and myringotomy would love your opinion

Hi there I am new to this forum but so glad I found it.
i have enjoyed reading about everybody's babies.
i have a 10 year old little guy. For over a year now he has had a hard time picking up his head and I've noticed his ear was always yucky. It is very hard to find a vet that knows about the health of cavaliers. Upon my own research lol, I came to the conclusion he had glue ear.
I took him to see a dermatologist and he verified that he had psom. He put him on synotic drops and told me he needed a bilateral myringotomy. He also needed an antibiotic for his skin. Apparently he is allergic to fleas. I was shocked to hear the price of $2200 which includes a ct and cultures of the mucous plug. Then to find out he might need this every year. As far as I know my pup doesn't have any heart issue or hip issues, he does have dry eye.

The derm I saw is only at the clinic 3 days a month and he is not there anymore after June. Would that be a concern of yours if you were having the procedure done?

i spoke with texas a&m. They will do the same thing for the same price, $2000,they are 3 hours from me.

Another option is a derm an hour and a half away from me, they said they do the procedure often and don't need to do a ct, she was very informative and said they can usually tell by examine wether the procedure is needed, their cost is $700-900.

I don't want to make it about money, but I am really confused as to who to go with.
also, is a ct highly recommended. Should I be concerned about him having this done at 10 years old? The synotic drops have cleared up the sticky stuff in his ear but he still doesn't like to pick his head up.
I would love to hear any opinions or advise.
Thank you so much

Blah. I'm sorry. I wrote you a whole reply and now it's gone.

Basically, I would want to find out more about the surgery price difference. There are 2 methods of doing the drainage, one goes through the ear, the other makes a small incision in the neck. Any vet should be willing to explain the procedure they will be doing to you in simple terms. Things like "we'll put him under, make a small cut here, use a <piece of equipment>, blah, blah, the mucus plug is removed by <method>. The whole procedure will take ~X minutes, and he'll need this, that, or the other in post-operative care. He'll spend X number of nights at the clinic (I'd imagine it's 0-1) afterwards, and then he can come home". They may have a technician do the explanation, they may show you some of the equipment, or not. But they should be receptive and provide explanations for anything. They should also be able to explain what they will see on the CT scan, and how it helps them, and if in the future maybe the one CT could be reused, or if the CT would need to be repeated.

Then I'd ask about 2 other things, pre-surgery bloodwork- he'll need this at his age before they give anaesthesia, any vet who is willing to forego this I wouldn't do business with, the cost is maybe $30-50. The other thing is asking about pain management during and after the procedure. Traditionally vets (and doctors, especially paediatricians) didn't give any pain meds while the patient was unconscious, but studies show that humans and animals experience pain while knocked out. Then of course post-operative pain should be managed as well. In the US at least, this was often the reason why some vets were much cheaper than others for various surgeries, pain management is more than just an injection or a pill, it's monitoring while they wake up, watching for pain symptoms, deciding what and how to dose, and then continued monitoring (man hours).

I don't have personal experience with PSOM, but there is some information here, if you haven't already found this source. http://www.cavalierhealth.org/psom.htm

Good luck and keep us updated.

My Lucky has PSOM and we had the myringotomy.

FYI - your dogs dry eye could be caused by his PSOM. A sudden onset of severe dry eye is how I finally was able to get to the diagnosis that Lucky had PSOM (and yes, I was the one who actually diagnosed it … our Neurologist sent him home with a month supply of antibiotics after seeing a mucus filled middle ear … ).

Why is a CT recommended? We didn't have a CT. And based on conversations with my dermatologist who is very good and very familiar with Cavaliers, she didn't even need the MRI to do the myringotomy. They have a video otoscope where you can see the ear drum bulging in a dog with PSOM. In case it helps, I can post photos from Lucky's myringotomy or just do a search look for my post about Lucky's PSOM.

Anyway, Lucky's dry eye was caused by pressure from the ear pushing on the 7th cranial nerve. His eye is much much better now that the middle ear is free of mucus. Do you have pet insurance? I did, and that helped a lot. The neurologist's MRI cost us $2700, and the Dermatologists myringotomy cost about $2500. Ouch. But we live in the Northeast where everything is more expensive … Insurance helped a lot.

Good luck.

Thank you for the information,
I will keep all that in mind.
We are getting blood work done and I agree it is important.

Thank you, Lani for your input.
It was helpful to hear your story. I am worried about putting him through the surgery.
no unfortunately we don't have pet insurance and when I was looking into insurance I was discouraged by reading he most likely would not be covered because it is a pre existing condition.
How long did luckys stay at the vet the day of surgery?
i was told it was a day surgery.

Lucky was 8.5 when he had his surgery, with a grade 2/3 murmur (although that progressed to a 4 at our visit last weekend, so it might have actually been a 4 when he had surgery about 2 months ago). So I understand your concern about putting a 10 year old through it. That said, we were really at a point where we had no choice. He was in such pain and I was afraid he'd cause permanent damage to his eye from rubbing his face on the carpet. (he had 0% tear production and could literally not close his eye).

Anyway, our path was a long and winding road but Lucky did well with the surgery. He had a myringotomy. The neurologist for some reason mentioned he'd do a bulla ostenectomy (or something like that …). That is the more invasive surgery when they cut through the head into the ear canal. I consulted with my vet and gave info on PSOM (which he'd never heard of). He agreed Lucky most likely had PSOM. Based on conversations with my vet and the dermatologist who I went to (an excellent specialist very well versed inwho worked with Dr. Lynnette Cole at U of Ohio on early PSOM research), there was no need for such an invasive surgery. A myringotomy is just a little hole drilled through the ear drum, and besides being a little dopey that afternoon after the surgery, he was fine after.

He had the surgery in the morning and I picked him up that afternoon at around 3:00. I just needed to put special drops in his ear and give him pain meds for a few weeks after the he surgery. I also now give him NAC as a supplement to help thin any new mucus since I would really hate to put Lucky through another surgery. Lucky's neurologist didn't do the surgery, just the MRI and sent us home with antibiotics, so we had to pay for two procedures and poor Lucky had to be put under twice. That said, he is so much better now than before the surgery. He used to rub his head on the carpet and shake his head violently, now he is much more calm and the dry eye he had from the PSOM is much better. (he was not able to close his eye because of the PSOM and he also drooled - it caused partial facial paralysis).

I am happy to answer any questions and if it would help you to talk in person, just PM me and I'll send you my phone number.

FYI - I found this Facebook "group" right when I was researching to help Lucky. You'll see my posts there in response to this infographic about PSOM. One of the vets who leads this group (Dr. Rhodes) is Lucky's dermatologist. She posted a photo of the myringotomy procedure so you can get a better sense of what it is. Compared to what you think of as surgery, this is really pretty non-invasive. I hope the link works.

https://www.facebook.com/CanineSkin...6810927412773/799613470132517/?type=1&theater

She also took photos of Lucky's myringotomy so I can find them and post for you if it helps.

Thank you so much Lani,
everything you have said has been very helpful. I like to be informed as much as possible. I am going to look at the Facebook link. Thank you very everything.
i am glad that you have had a good experience with luckys surgery. So glad he is doing better. Sounds like you found a wonderful dermatologist. That always makes us feel better.
Yes I'd love to chat more, I'll pm you thank you for the offer.

FYI - here is a link to the photos from Lucky's Myringotomy (his left ear only). It's two pages top left is the beginning with the bulging eardrum and the bottom right is after the surgery. It was still a bit red and inflamed but she also provided a picture at his follow up and then it was perfectly normal, no more redness or inflammation.

https://www.facebook.com/photo.php?fbid=10153655634669552&l=a7f8916cb8