Summary A 13‐year‐old Appaloosa gelding was referred for evaluation of a left‐sided facial nerve paralysis. On clinical examination, the gelding exhibited muzzle deviation to the right, dropped left ear and blepharospasm of the left eye. A Schirmer tear test revealed 66% reduction in tear production in the left eye and a focal corneal ulcer (0.7 cm by 0.7 cm) was present ventrally in the left eye. Endoscopic examination of the upper airways and guttural pouches showed no abnormalities. Computed tomographic examination revealed an accumulation of soft‐tissue attenuating material within the tympanic bulla, consistent with otitis media. Medical management with 30 mg/kg trimethoprim sulfadiazine and 2.2 mg/kg phenylbutazone orally twice a day for 6 weeks was unsuccessful. The non‐perforated tympanic bulla was fenestrated from the left guttural pouch using diode LASER transendoscopically, under standing sedation, to allow drainage of the inner ear. Mucopurulent fluid drained from the tympanic bulla cavity. Endoscopic examination 6 months post‐surgery showed that the fenestrated site had healed over, with no evidence of inflammation at the site. A very mild muzzle deviation to the right was still present 6 months' post surgery but the horse was able to prehend and masticate without difficulty. The procedure was successful, and the clinical signs improved significantly post‐surgery.

Both lesions possess very similar radiological and histological features and are therefore hard to distinguish from each other (Bryant et al., 2012). Radiographically these cysts appear as expansile and osteolytic lesions contained by a thin 'ballooned' bone layer with an internal 'soap-bubble' appearance. The margin frequently represents expanded periosteum, whereas its characteristic compartmentalised centre is the resultant of numerous small internal septa (Craig et al., 2016). Those not associated with a joint can be as-

Background There is wide variability in radiographic grading systems in thoracolumbar spinous processes in horses. The aim of this study was to determine the agreement of grading different parameters, and combinations of those, in radiographs of the spinous processes of the equine thoracolumbar spine in the scope of a pre‐purchase examination. We hypothesized that agreement is variable and interpretation of these radiographs is difficult. Methods Radiographs of the thoracolumbar spine of healthy horses (N = 100) were assessed by three observers. Spinous processes were separately graded for interspinous space width, modelling, radiopacities, radiolucencies and isolated opacities dorsally. Inter‐ and intra‐observer agreement was assessed for individual and combinations of parameters. Results Agreement (inter‐ and intra‐observer) was good for the following parameters: interspinous space width, isolated opacities dorsally, beak‐shaped formations craniodorsally and modelling cranioventrally. The agreement increased slightly for a sum of specific parameters such as radiopacities, modelling, dorsal abnormalities and related abnormalities involving increased opacity, modelling and osseous cyst‐like lesions. Agreement for the total radiographic abnormalities per back was moderate. Conclusions Grading of thoracolumbar radiographs in horses without back pain showed good inter‐ and intra‐observer agreement for specific parameters and these should be used in future grading of spinous processes. Limitations should be considered in pre‐purchase examinations.