Retrospective study of the presentation, diagnosis and management of 16 cats with otitis media not due to nasopharyngeal polyp

Swales, Nicola; Foster, Aiden P; Barnard, Natalie

doi:10.1177/1098612x17746282

Cited by 14 publications

(20 citation statements)

References 15 publications

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“…12,13,26 Otitis media/interna was diagnosed when compatible changes, affecting the middle and inner ear, were identified on MRI or CT imaging and further supported by otoscopy and myringotomy when performed. 9,19,27 A middle ear polyp diagnosis was considered when advanced imaging demonstrated a pedunculated, well-demarcated, soft tissue mass in the region of the nasopharynx. 10,11,28,29 Intracranial empyema was diagnosed based on the combination of compatible MRI findings and CSF abnormalities.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 Accurate neuroanatomical localisation can aid the clinician in formulating a prioritised list of differential diagnoses, determining a diagnostic plan and prognostication, with causes of central vestibular syndrome having been attributed, in referral hospital populations, with a poorer prognosis than peripheral disease. 5,7 Idiopathic vestibular syndrome and otitis media/interna are widely regarded as the most frequent causes of peripheral vestibular syndrome in cats, 3,6,8,9 with neoplastic lesions of the middle ear also reported. 10,11 Central vestibular syndrome has been reported secondary to intracranial neoplasia, 5 feline infectious peritonitis (FIP), 12,13 ischaemic infarcts, 14,15 thiamine deficiency 16–18 and intracranial empyema.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

Grapes

Taylor‐Brown²,

Volk

et al. 2020

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis. Methods In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling. Results The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3–250.0; P = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5–344349142.0; P = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2–1000; P = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0–45.7; P = 0.047) and wide excursions of the head (95% CI 1.0–45.7; P = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5–50.0; P = 0.015). Conclusions and relevance Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

Grapes

Taylor‐Brown²,

Volk

et al. 2020

Journal of Feline Medicine and Surgery

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“…Medical management for bacterial otitis with neurological signs, respiratory signs and thickened bulla wall not due to a nasopharyngeal polyp was reported to be sufficient to resolve clinical signs 14) , but medical management for the presented case did not resolve clinical signs. Post-operative complications after bulla osteotomy have been reported to include Horner's syndrome, paralysis of the facial nerve and otitis interna 15) .…”

Section: Discussionmentioning

confidence: 66%

呼吸障害とホルネル症候群の徴候を呈した若齢猫の鼻咽頭ポリープに対して外科的切除を行った1例

Suzuki

Okuda²,

Nakagawa

et al. 2021

Japanese Journal of Veterinary Anesthesia & Surgery

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An 18 month-old cat presented with sneezing, nasal congestion, nasal discharge and clinical signs of Horner's syndrome. There was no improvement following medical treatment. A nasopharyngeal polyp was seen originating from the right tympanic bulla on a CT image. Resection of the polyp via soft-palate incision resolved the respiratory clinical signs, but the neurological signs remained. Based on MRI findings, inflammatory tissue was removed from the right tympanic bulla via ventral osteotomy one month after the first surgery. No further clinical signs were noted and many neurological signs were improved following surgery. The tissues resected from these surgeries were histologically diagnosed as an inflammatory polyp. The present case suggests that inflammatory polyps involving the bulla and nasopharynx may cause Horner's syndrome and upper respiratory disturbance in cats, possibly requiring surgery at both sites. A sample for a PCR test, obtained from the nasopharyngeal area sixteen months following surgery, was positive for Mycoplasma felis, but it was not concluded that Feline mycoplasma infection caused the inflammatory nasopharyngeal polyp in the cat.

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“…Less commonly, otitis media occurs as an extension of otitis externa and it also has been suggested that a potential cause could be haematogenous spread. 5 The clinical signs of otitis media overlap with otitis externa. This can make the diagnosis challenging.…”

Section: Introductionmentioning

confidence: 99%

“…Otitis media in cats most commonly presents as a result of a nasopharyngeal polyp (NPP), from pharyngeal or upper respiratory infection which has extended up through the auditory (Eustachian) tube, following auditory tube dysfunction or obstruction, or associated with a sterile mucositis/sinusitis. Less commonly, otitis media occurs as an extension of otitis externa and it also has been suggested that a potential cause could be haematogenous spread 5 …”

Section: Introductionmentioning

confidence: 99%

Clinical Techniques: When and how to do a myringotomy – a practical guide

Cole

Nuttall

2021

Veterinary Dermatology

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A myringotomy is a surgical incision made in the tympanic membrane (TM). This gives access to the middle ear for sampling, flushing and instilling topical therapy. It should be considered whenever the TM is intact and there is clinical evidence of otitis media, abnormal TMs and/or abnormal diagnostic imaging. Samples should be collected for cytological investigation and culture, and then the external ear should be cleaned and dried (if required). Myringotomies should be performed under general anaesthesia and, wherever possible, using a video otoscope; the enhanced view and instrument ports facilitate the technique and reduce the risk of complications. The myringotomy incision should be made in the caudoventral quadrant of the TM using an appropriately sized urinary catheter to collect samples and flush the middle ear cavity. A thorough understanding of the anatomy, technique and potential ototoxicity of topical therapy is needed to minimize the risk of neurological and other complications. The TM usually heals within 35 days if kept free of infection.

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Retrospective study of the presentation, diagnosis and management of 16 cats with otitis media not due to nasopharyngeal polyp

Cited by 14 publications

References 15 publications

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

呼吸障害とホルネル症候群の徴候を呈した若齢猫の鼻咽頭ポリープに対して外科的切除を行った1例

Clinical Techniques: When and how to do a myringotomy – a practical guide

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