Bilateral tympanic membrane rupture in a cat

RE: Bilateral tympanic membrane rupture in a cat

Charlotte Marshall — Sun, 27 May 2018 19:23:01 GMT

We have had a couple of dogs go temporarily deaf after ear drops. They did recover their hearing though. I assumed they had ruptured ear drums and that was why. Not my cases though so not sure of all details.

RE: Bilateral tympanic membrane rupture in a cat

Liz Barton — Sat, 26 May 2018 13:29:03 GMT

[quote user="Kate Richardson"] anyone know off the top of their head which ear cleaner would be safest to use for cleaning this cats ears given the ruptured TMs [/quote]

Malacetic quite irritant and therefore poor tolerance for repeated cleaning; sniff it and it makes your eyes water!

Trizaural seems much better tolerated; no adverse reaction on the sniff test!

RE: Bilateral tympanic membrane rupture in a cat

Evelyn Barbour-Hill — Fri, 25 May 2018 23:51:43 GMT

[quote user="Kate Richardson"] so want to start some gentle ear cleaning. [/quote]

Cerumaural.

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Fri, 25 May 2018 19:01:54 GMT

[quote user="Kate Richardson"]so want to start some gentle ear cleaning. [/quote]

Why not try some/any of the human wax softeners or treatments available without a script?

We had something called Sebumol which worked well but Willows Francis has long gone.......

Google "Sebumol" as the modern stuff may be the same?

RE: Bilateral tympanic membrane rupture in a cat

Mark Hedberg — Fri, 25 May 2018 18:46:45 GMT

Malacetic or Trizaural?

RE: Bilateral tympanic membrane rupture in a cat

Kate Richardson — Fri, 25 May 2018 18:10:36 GMT

Running out of time before on hols for a week- anyone know off the top of their head which ear cleaner would be safest to use for cleaning this cats ears given the ruptured TMs (for Owner to use at home)- cat is much more comfortable, horners slowly (very) resolving, cytology showed no bugs, owner doesn't want to go ahead with any surgery/ear flushing under GA, but getting a build up of ceruminous material and mild inflammation which will likely lead to secondary infection, so want to start some gentle ear cleaning.

RE: Bilateral tympanic membrane rupture in a cat

Sarah Wheadon — Wed, 09 May 2018 14:18:48 GMT

Extrapolating from human experience, which I know may be a little dodgy, it's not painful once the TM has ruptured. It's really, really painful prior to rupture. Also one of my children has lived with a chronically ruptured TM for years (due to be repaired soon though) which has caused a slight reduction in hearing, but recurrent bouts of infections usually post URTI's.

RE: Bilateral tympanic membrane rupture in a cat

Evelyn Barbour-Hill — Wed, 09 May 2018 13:52:22 GMT

[quote user="Kate Richardson"]Is TM rupture painful per se[/quote]

I see no reason why having a hole in the tympanum should be painful.

RE: Bilateral tympanic membrane rupture in a cat

Thomas Johnson — Wed, 09 May 2018 11:51:28 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"]Equally no improvement with prednisolone. [/quote]

Prednisolone never works very well, if at all, initially so, as a indicatory aid, is useless.

[/quote]

Here I'm afraid I will have to disagree with you, I find that oral prednisolone at a suitable dose, usually 1mg/kg for anti-inflammatory, works as well and as quickly as an injection of dexamethasone.

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Wed, 09 May 2018 11:14:36 GMT

[quote user="Kate Richardson"]Equally no improvement with prednisolone. [/quote]

This will be deleted for turboing but it is important, IMHO, so read it before it is.

Prednisolone never works very well, if at all, initially so, as a indicatory aid, is useless.

A shot of your favourite short-acting version will give you a definite response in 24 hours or not.

It also encourages owners to comply with further treatment, as they see the immediate improvement.

RE: Bilateral tympanic membrane rupture in a cat

Kate Richardson — Wed, 09 May 2018 10:25:34 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"]

and can anyone give me any rough idea of percentages of cases that it will/won’t heal?

[/quote]

I can't.

Which brings us to the question, how much does it matter?

[/quote]

Good question. Is TM rupture painful per se or is it only painful prior to rupture when you've got a build up of pressure in the middle ear due to fluid/pus accumulation? In my case, is the head shaking and aural irritation due to pain from the TM rupture or due to the low-moderate grade inflammation/infection (cytology now pending) in the external and middle ear canal? There was no improvement in the cat with meloxicam and cat is bright and happy and well otherwise, I suspect not due to pain. Equally no improvement with prednisolone.

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Wed, 09 May 2018 00:32:00 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"]

and can anyone give me any rough idea of percentages of cases that it will/won’t heal?

[/quote]

I can't.

Which brings us to the question, how much does it matter?

[/quote]

How common is a "deaf cat" and has it had "ear problems".

Don't think I have ever seen one???

RE: Bilateral tympanic membrane rupture in a cat

Evelyn Barbour-Hill — Tue, 08 May 2018 22:43:35 GMT

[quote user="Kate Richardson"]

and can anyone give me any rough idea of percentages of cases that it will/won’t heal?

[/quote]

I can't.

Which brings us to the question, how much does it matter?

RE: Bilateral tympanic membrane rupture in a cat

Kate Richardson — Tue, 08 May 2018 21:41:34 GMT

Another question- is it possible the tympanic membrane will still not heal even if we flush the middle (either via oto- endoscopy or blind flushing) and can anyone give me any rough idea of percentages of cases that it will/won’t heal?

Thanks again in advance

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Mon, 07 May 2018 23:59:30 GMT

[quote user="Liz Barton"]What - no gromit?![/quote]

No, not even the drum..... [don't think grommets were even invented then??]

Mine was an obvious infection with an incredible amount of yellow pus [no A/Bs as I recall

RE: Bilateral tympanic membrane rupture in a cat

Liz Barton — Mon, 07 May 2018 23:41:33 GMT

[quote user="Anthony Todd"]no other treatment as I recall.[/quote]

What - no gromit?!

RE: Bilateral tympanic membrane rupture in a cat

Evelyn Barbour-Hill — Mon, 07 May 2018 23:12:55 GMT

[quote user="Liz Barton"]I may be stating the obvious here... but I have also had to rupture the TM (on advice of a term specialist). Tympanum was intact but bulging with yellowish/angry appearance and sure enough when ruptured the infection was released. [/quote]

Oh yes indeed, a very satisfying thing to do. Usually jolly painful and possibly pyrexic when that's the presentation. It doesn't seem to be a terribly common presentation though.

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Mon, 07 May 2018 23:03:39 GMT

[quote user="Liz Barton"]Tympanum was intact but bulging with yellowish/angry appearance and sure enough when ruptured the infection was released. [/quote]

I had my tympanum lanced under GA ether dripped on open mask, in my bedroom by two doctors when I was about 10, circa 1948.

Yellow pus drained and was cleaned out daily by my mum for a few weeks, no other treatment as I recall.

Things have moved on......

RE: Bilateral tympanic membrane rupture in a cat

Liz Barton — Mon, 07 May 2018 22:14:27 GMT

[quote user="Evelyn Barbour-Hill"]If the tympanum is intact the blobby end of the instrument can be bounced gently on it. If the tympanum is not intact you feel the blobby end arrested by hard bone. [/quote]

I may be stating the obvious here... but I have also had to rupture the TM (on advice of a term specialist). Tympanum was intact but bulging with yellowish/angry appearance and sure enough when ruptured the infection was released.

RE: Bilateral tympanic membrane rupture in a cat

Kate Richardson — Mon, 07 May 2018 21:22:43 GMT

Thanks

RE: Bilateral tympanic membrane rupture in a cat

Evelyn Barbour-Hill — Mon, 07 May 2018 18:59:16 GMT

[quote user="Kate Richardson"]Evelyn Barbour-Hill can you describe more how you do this- just gentle flushing (with warmed saline?/Hartmans?) and allow debris to rise to the the surface or do you apply suction as well? Am just cautious given the ease with which this cat developed Horners. Why are spreull needles frowned upon- not sure we have one but remember using them in the past. [/quote]

At a little bit warmer than room temperature. Fluid no.1, no.9, no.11 if there's a bag that needs using up.

This is in the textbooks, I'm sure, but here goes: after auroscopic inspection, of course, and auroscopic cleansing of the external ear (solvents, flushing, instruments): you hold the pinna so as to get the external canal as near straight as can be attained, and you ease the Spreull needle down the canal. Hold it gently with finger and thumb, because you need sensitivity. If the tympanum is intact the blobby end of the instrument can be bounced gently on it. If the tympanum is not intact you feel the blobby end arrested by hard bone. Then you attach your 20 or 35ml syringe (20ml is more manageable), withdraw the instrument a tiny smidgeon and sluice the fluid in – I have no way of describing how hard. Not very hard. Err on the side of caution, but remember you are trying to loosen inspissated stuff. Be sensitive. Do two or three more syringefulls. Your nurse should keep a couple lined up and should keep refilling them till you tell her to stop.

Then with another syringe on the Spreull, which you have withdrawn a little, you can suck a bit of fluid from the external canal (don't try to suck from the bulla), but I find it much more useful to turn the cat over and let gravity drain the canal. Sometimes at the first session debris comes out with the fluid (once or twice I've obtained a very satisfactory gob of thick gloop), but after that probably not.

Repeat the process once or even twice more and that's quite enough for that session.

You should have a proper throat pack in, as a lot of fluid may go down the Eustachian tube – in fact that is what you want to see, it indicates success.

I have a feeling Spreull needles are frowned upon or condemned because they are, y'know, old fashioned and metal and rigid and not disposable; and of course it is possible to rupture the tympanum if you are not sensitive enough (I'm sure I have done so a few times); but then I don't think you would get the sensitive feel, the difference between a soft tissue bounce and a tap on hard bone, if you were using something very soft and flexible (and of course, even something flexible could still pop the tympanum).

Iatrogenic Horner's syndrome, temporary or permanent, is always a risk – less if you are sensitive and careful, but always a possibility. But then Horner's syndrome is always a risk in any effective therapeutic intervention in the middle ear (and, of course, is also a risk if otitis media is not effectively treated.)

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Mon, 07 May 2018 18:19:56 GMT

These days I think I'd use the softest plastic or rubber cannula around.

I wonder whether, with the absence of ear mites generally, the ones modvets see are totally different from dinovets, who saw so many more, but all based solely around ear mites and their irritation?

RE: Bilateral tympanic membrane rupture in a cat

Kate Richardson — Mon, 07 May 2018 16:26:09 GMT

[quote user="Evelyn Barbour-Hill"]

Going back to the OP:

Repeated copious saline flushing of the middle ear. This requires GA of course, but only at a light plane and for a short time. The procedure is easy if you know what you are doing. I still use a Spreull needle, but you might not want to because it's a bit frowned upon.

[/quote]

Evelyn Barbour-Hill can you describe more how you do this- just gentle flushing (with warmed saline?/Hartmans?) and allow debris to rise to the the surface or do you apply suction as well? Am just cautious given the ease with which this cat developed Horners. Why are spreull needles frowned upon- not sure we have one but remember using them in the past.

RE: Bilateral tympanic membrane rupture in a cat

Liz Barton — Mon, 07 May 2018 07:51:15 GMT

[quote user="Anthony Todd"]

Chasing cytology, whilst noble, will IMHO only reveal the obvious response to irritation, mainly ear mites which then were almost pandemic in cats and [mainly] puppies for first vaccs.

[/quote]

Ear mites are much less of a problem thanks to modern acaricides (we see plenty of cases in adult cats in a shelter setting, but good response to treatment in almost all cases).

Cytology is increasingly important with the continuing rise in resistant bacteria, especially nosocomial infections people pick up and pass to their pets for us to deal with! If we don't get good initial response within a week, or if the ear is very purulent on first presentation, we always do a quick in house cytology. For the sake of 10 minutes you can instantly see if the ear is full of large rods e.g. pseudomonas, and send off for culture if appropriate. It is rare we have to do this in cats; most respond well to empirical treatment. But it's always done if we're dealing with persistent middle ear infections, alongside saline flushing.

Treatment may well have been easier in the past, due to fewer superbugs and more mites!

RE: Bilateral tympanic membrane rupture in a cat

Anthony Todd — Sat, 05 May 2018 11:54:36 GMT

[quote user="Liz Barton"]My advice is to avoid the use of topical medications in the cat![/quote]

and the previous paragraph.

I, and every vet I knew treated "otitis" in every cat with topical medications apparently successfully in every case. I don't think I ever did either cytology or C&S ever on a cat and, [much more than dogs] they all returned to normal. I never did a lateral wall resection in a cat and I can't remember a failure. Topical human steroid creams and lotions dramatically reduced sebum production. Severe presentations got a shot of Betsolan which gave dramatic rapid relief.

Happy to be contradicted by another vet who just used topicals and got rid of the ear mites, as I did.

It's a pity that more dinovets don't post here because I'm sure their combined experience would be the same.

Chasing cytology, whilst noble, will IMHO only reveal the obvious response to irritation, mainly ear mites which then were almost pandemic in cats and [mainly] puppies for first vaccs.

Steroid containing drops. and acaricides seemed to fix virtually all presentations.

Case volume was, of course, comparatively much larger than today.