| Nächste Überarbeitung | Vorhergehende Überarbeitung |
| psom [2022/07/19 13:14] – angelegt m2 | psom [2022/07/19 17:20] (aktuell) – m2 |
|---|
| ====== Primary Secretory Otitis Media (PSOM) ====== | ====== Primary Secretory Otitis Media (PSOM) ====== |
| |
| glue ear, otitis media with effusion | **glue ear, otitis media with effusion** |
| | ===== Ursache ===== |
| |
| ===== <font 12.0pt/inherit;;inherit;;inherit>Ursache</font> ===== | * Auslöser unbekannt - evtl. Dysfunktion der Eustachischen Röhre |
| | * häufige Diagnose bei Cavalier King Charles Spaniels |
| | * fast ausschließlich bei CKCS - seltener bei Boxer, Dackel und Shih Tzu |
| | * muköser Plug der das Mittelohr anfüllt und das Trommelfell nach aussen drückt |
| |
| <font 12.0pt/inherit;;inherit;;inherit>häufige Diagnose bei Cavalier King Charles Spaniels</font> | ===== Symptome ===== |
| |
| muköser Plug der das Mittelohr anfüllt | * ähnliche Symptome wie bei Syringomyelie |
| | * moderate bis schwere Schmerzen im Kopf und Halsbereich |
| | * Ohrenkratzen, Kopfreiben (überfüllte Bulla Tympanica) |
| | * Taubheit |
| | * Anfälle, Müdigkeit, Nystagmus, Fazialisparese, Ataxie |
| | * Kopfschiefhaltung - vestibulär Syndrom |
| |
| <font 12.0pt/inherit;;inherit;;inherit>It consists of a highly viscous mucus plug which fills the dog’s middle ear and</font> | ===== Diagnose ===== |
| |
| <font 12.0pt/inherit;;inherit;;inherit>may cause the tympanic membrane to bulge. The mucus has also been referred to as</font> | * CT oder MRT |
| | * bei Trommelfellruptur auch otoskopisch diagnostizierbar |
| | * Tympanometry ist eine nicht invasive Metode für die Mittel Ohr Untersuchung. |
| | * BAER (Brain-stem auditory evoked response) |
| | * Ein UK-Studie zeigte bei dem BAER-Test deutliche Gehörverluste bei 23 Cavalliers mit bekannter PSOM (diese Studie wurde in 2011 und 2015 mit gleichen Ergebnissen wiederholt): 74% waren Taub, 15% ataktisch, 7% laterale facial paralise, 56% Juckreiz und Kofpschutteln, 19% lokale Schmerzen. Nach eine Myringotomie wurden alle klinische Symptome zw. 4 wochen und Jahren behoben. |
| |
| <font 12.0pt/inherit;;inherit;;inherit>“hyperintense material “.</font> | ===== Therapie ===== |
| |
| <font 12.0pt/inherit;;inherit;;inherit>PSOM has been reported almost exclusively in cavaliers. Because the pain and other</font> | * Myringotomie mit Spülung |
| | * Tympanostomie (als alternative empfohlen, aber es gibt keine Studie über die langfristige Wirksamkeit als PSOM-Therapie). |
| <font 12.0pt/inherit;;inherit;;inherit>sensations in the head and neck areas, resulting from PSOM, are similar to some symptoms</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>caused by syringomyelia (SM), some examining veterinarians may have mis-diagnosed SM in</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>cavaliers which actually have PSOM and not SM. Other breeds in which PSOM has been</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>diagnosed are boxers, dachshund, and shih tzu.</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>What it is</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>The cause of PSOM is unknown. Dr. Lynette Cole reports that it is speculated to be due</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>to a dysfunction of the middle ear or the Eustachian (auditory) tube: either (a) the increased</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>production of mucus in the middle ear, or (b) decreased drainage of the middle ear through the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>auditory tube, or (c) both.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>The auditory tube connects the middle ear to the back of the nose. The tube serves to</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>maintain equal air pressure both inside and outside of the middle ear, to allow the eardrums</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>(tympanic membranes) to vibrate properly. The tube also allows fluid from mucous membranes</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>in the middle ear to drain through the nose. If the Eustachian tube is not working properly, the air</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>in the middle ear is absorbed, but it cannot be replaced, causing air pressure inside the middle ear</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>to be lower than the air pressure outside, in the ear canal, creating a partial vacuum. This</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>difference in air pressure causes the mucous fluid to collect inside the middle ear. The fluid then</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>begins to become thicker and build up, becoming an ever-enlarging mucus plug.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In a ten year study conducted in Sweden and reported in 2003, 61 cases of primary</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>secretory otitis media were diagnosed in 43 cavaliers. In that study, conducted by Wiwian</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Stern-Bertholtz, Lennart Sjöström, and Nils Wallin-Håkanson, they explain the condition</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>technically as follows:</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>“The Eustachian tube is kept closed by the surface tension caused by contact between air</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>and mucus. A particular agent, identified as a combination of different phospholipids,</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>decreases the surface tension in PSOM mucus plugs removed from cavalier. Downs</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Veterinary Practice, Bristol, UK. http://www.downsvets.co.uk/the Eustachian tube of</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Page 2 of 6</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>dogs, thus reducing the pressure needed to open the tube. When the tube is closed, the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>pressure in the middle ear is reported to become negative in relation to the pressure in the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>tube, which is equivalent to atmospheric pressure. This negative pressure, caused by lack</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>of aeration, draws out the sterile transudate from the glandular tissues in the middle ear to</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>the surface of the mucous membrane. The negative pressure remains and the process of</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>accumulation of mucus carries on as long as the tympanic membrane is intact and the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Eustachian tube is closed. Failure to open the Eustachian tube and thereby release the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>secretory products is believed to be the cause of secretory otitis media. An obstruction of</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>the osseous part of the Eustachian tube is reported to be the most common cause. In</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>PSOM, the overfilling of the middle ear with mucus and the subsequent bulging of the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>tympanic membrane, and the pain and neurological signs that are common, indicate that</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>the pressure within the middle ear is high rather than low, at least in the final part of the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>disease process. “ Photo above shows mucus plugs removed from a cavalier. Courtesy,</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Downs Veterinary Practice, Bristol, UK.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In a 2010 study (and a 2013 report of the same study), UK veterinary researchers</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>examined MRI scans of the skulls of 34 cavalier King Charles spaniels, each of which had been</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>scanned twice over periods from one month to 46 months. They concluded in their report that</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>PSOM is a progressive condition in the CKCS and can progress from none to unilateral or</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>bilateral; or from unilateral to bilateral on sequential scans, and that PSOM is an acquired</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>condition in the CKCS and will not resolve spontaneously once it has developed. However, a</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>few breeders report that second MRI scans of their PSOM-affected cavaliers show that the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>PSOM has disappeared without treatment.</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Relation to Other Disorders</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In a 2010 report, UK researchers found an association between PSOM and</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>brachycephalic conformation in cavaliers. They stated: “in CKCS, greater thickness of the soft</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>palate and reduced nasopharyngeal aperture are significantly associated with OME [otitis media</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>with effusion, meaning PSOM]. “ However, they did not explain why PSOM is so nearly limited</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>to the cavalier, while so many other breeds are brachycephalic. They also concluded that</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>bilateral PSOM was associated with CKCS with more extreme nasopharyngeal conformation,</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>than unaffected CKCS.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In an October 2010 presentation before a meeting of the UK’s Association of Veterinary</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Soft Tissue Surgeons, Robert N. White, a board certified veterinary soft tissue surgeon practicing</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>at Willows Veterinary Centre and Referral Service in Solihull, West Midlands, observed that the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>cavalier does not appear to be a classically brachycephalic breed, despite the extent of BAOS in</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>the breed, and that the extent of both PSOM and SM in the breed suggests that the CKCS may</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>suffer from a combination syndrome of the three disorders, all associated with Chiari-like</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>malformation.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>EDITOR’S NOTE: A uniqueness of the CKCS’s morphology is that the breed was</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>created in the 1920s from a more extreme snub-nosed English toy spaniel -- the King</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Charles spaniel -- by breeding to elongate the muzzle, rather than to shorten it. It is as if</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>the cavalier’s muzzle has been treated like an accordion -- first compressed to create the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Page 3 of 6</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>predecessor King Charles spaniel, and then stretched.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Infection as a cause of PSOM in the cavalier has been discounted by the researchers.</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Symptoms</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>The principal symptoms are moderate to severe pain in the head or neck, holding the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>neck in a guarded position, and tilting the head. Other signs may include scratching at the ears,</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>itchy ears, head tilt, head rubbing, excessive yawning, crying out in pain, ataxia, drooping ear or</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>lip, inability to blink an eye, rapid eyeball movement, facial paralysis or nerve palsy, Vestibular</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>disease, some loss of hearing, seizures, and fatigue. These symptoms, in many cases, are very</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>similar to those of syringomyelia and, to some extent, to those of progressive hereditary</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>deafness. Therefore, the examining veterinarian should take care to consider these other possible</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>causes of the dog’s symptomatic behaviors.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In a 2009 UK study of 23 cavaliers with PSOM, the researchers (who choose to refer to</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>the disorder as middle ear effusion) tested the dogs’ hearing with the Brainstem Auditory</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Evoked Reponses (BAER) test and found that, even though the dogs’ owners considered their</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>dogs’ hearing capabilities to be normal, the BAER tests demonstrated a conductive hearing loss</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>in ears affected by middle ear effusion (PSOM). See same study in 2011 Veterinary Journal.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In an April 2015 report involving 27 cavaliers affected with PSOM, the researcher found</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>that:</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>“In 74% (20/27) of the cases the dogs were deaf, 15% (4/27) of the dogs showed ataxia,</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>7% (2/27) showed a head tilt and 7% (2/27) showed a facial paralysis of the affected side.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In 59% (16/27) of the cases the dogs were scratching, 52% (14/27) of the dogs were</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>rubbing and 56% (15/27) were shaking their heads. In 19% (5/27) of the cases the dogs</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>seemed to experience pain localized to the head or ears according to the owners.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Gradations of these symptoms were divided in mild, moderate, severe and extreme. ...</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>“In the 27 dogs in this study, 14 of the 27 dogs were rubbing their head. Head rubbing</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>(against the floor or other surfaces) has, with the exception of dermatitis and allergies</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>(Bruet, Bourdeau et al. 2012), only been associated with syringomyelia and CM and an</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>unknown syndrome of behavioral signs of discomfort in the CKCS in former literature</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>(Rusbridge 2005, Rusbridge, Carruthers et al. 2007). Only 7 of these 14 dogs were also</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>diagnosed with CM/SM at the moment of the occurring clinical signs. After the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>myringotomy procedure, all clinical signs, including the head rubbing, were resolved in</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>all 14 dogs for a period varying from four weeks to years. It seems that in these cases, the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>head rubbing was caused by the overfilled bulla(e) tympanica(e) and therefore this</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>clinical sign can also be associated with PSOM. “</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Diagnosis</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>The standard means of detecting PSOM by veterinary dermatology (preferably) or</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>neurology specialists is by either computed tomography (CT) or a magnetic resonance imaging</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Page 4 of 6</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>(MRI) scan. Both require that the dog be under general anesthesia. However, if the case is severe</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>enough that the pars flaccida, the top portion of the dog’s tympanic membrane (ear drum), is</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>bulging, the condition may be visible on x-rays and even diagnosed manually with an otoscope.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In extreme cases, the tympanic membrane may have ruptured and the mucus plug clearly seen. It</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>also may be observed by using an operating microscope with good lighting and at a suitable</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>magnification.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Tympanometry (impedance audiometry) is a noninvasive method of examining the</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>function of the Otometermiddle ear while varying the atmospheric pressure in the external ear</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>canal and inferring the amount of sound energy that is transmitted through the tympanum by</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>measuring the reflected sound energy. In a February 2015 study, Dr. George Strain reported that</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>the sensitivity and specificity of tympanometry for the diagnosis of PSOM in cavaliers were 84</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>and 47%, respectively. He recommended that clinical studies of conscious dogs with PSOM need</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>to be performed to validate the clinical usefulness of these recordings. (See tympanometer at</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>right.)</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>However, in an August 2015 report, Dr. Lynette Cole examined 60 cavalier King Charles</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>spaniels which had clinical signs suggesting PSOM. To diagnose the disorder, they used</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>otoscopy, tympanometry, pneumotoscopy and tympanic bulla ultrasonography, in addition to</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>using computed tomography (CT), which they stated was “the gold standard for the diagnosis of</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>PSOM in the CKCS. “</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>All of the methods diagnosed PSOM in ears with large bulging “pars flaccida “ (the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>triangular, flaccid portion of the eardrum). However, cavaliers may have PSOM even though</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>their pars flaccida is flat rather than bulging. She found that tympanometry detected the PSOM</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>in only 47% of ears with a flat pars flaccida. She concluded that, in cavaliers with a flat pars</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>flaccida, only the CT scan can reliably detect PSOM in the CKCS.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Other possible alternative instruments for diagnosis of PSOM include pneumotoscopy,</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>tympanic bulla ultrasonography, and the brain-stem auditory evoked response test (BAER).</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>However, in the August 2015 report described above, the researchers found that pneumotoscopy</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>detected the PSOM in only 79% of ears with a flat pars flaccida, and tympanic bulla</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>ultrasonography detected the PSOM in only 47% of ears with a flat pars flaccida.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Veterinary dermatologists in the United States may be located on the American College</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>of Veterinary Dermatology website.</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Treatment</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>– myringotomy</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Treatment traditionally has consisted of performing a myringotomy, making a small cut</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>in the eardrum (tympanic membrane), followed by flushing the middle ear to force out the mucus</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>plug. The photograph at right is of a myringotomy in progress. The ring in the middle of the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>photo is the eardrum. The tube tip at the top is the device used to flush the inner ear and force out</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>the mucus. You may watch a Cavaliers with Syringomyelia Symptoms on YouTubeclose up</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Page 5 of 6</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>video of a myringotomy actually being performed on a cavalier named Baylee on YouTube.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Following the myringotomy, the specialist typically will repeat the CT scan, to see if all</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>of the mucus has been removed, and then a BAER test to determine if hearing has been restored.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>Topical and/or systemic corticosteroids and antibiotics then are administered. The procedure</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>may have to be repeated, in some cases several times, depending upon how the dog responds.</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In an April 2015 report involving 31 myringotomies and 5 tympanostomies (see below)</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>on 27 cavaliers affected with PSOM, the researcher found that:</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>median of 13 months and a recurrence rate of 61%. After tympanostomy the time to</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>theory which describes that the continual tympanic cavity ventilation by using ventilation</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>tubes may provide a longer symptom-free period. No signs of progression from unilateral</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>to bilateral PSOM were seen. “</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>– tympanostomy</font> | |
| | |
| <font 12.0pt/inherit;;inherit;;inherit>In a March 2008 study conducted by Australian researchers, they inserted tympanostomy</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>tubes (right) within the myringotomy incision in order to provide continual tympanic cavity</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>ventilation and drainage. They found that in the cases of the three CKCSs which they operated</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>on, all three dogs were asymptomatic at the time of follow-up, 8, 6 and 4 months later, and they</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>concluded that the use of tympanostomy tubes may be an acceptable alternative to repeated</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>myringotomy. However, Dr. Cole reports that “no long-term prospective studies have been</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>published on the outcome after extrusion of the tympanostomy tubes as far as the length of time</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>the bulla remains effusion free. In addition, no studies have reported on the efficacy of a more</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>“permanent “ or long-term tympanostomy tube for treatment of PSOM. “ In a February 2013</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>report, a team of UK researchers also have questioned the effectiveness of repeated</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>tympanostomies.</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>In an April 2015 report involving 31 myringotomies (see above) and 5 tympanostomies</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>on 27 cavaliers affected with PSOM, the researcher found that:</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>median of 13 months and a recurrence rate of 61%. After tympanostomy the time to</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>theory which describes that the continual tympanic cavity ventilation by using ventilation</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>tubes may provide a longer symptom-free period. No signs of progression from unilateral</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>to bilateral PSOM were seen. “</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>In an August 2015 study of 12 cavalier King Charles spaniels with PSOM, a team of UK</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>clinicians report on the results of 22 video-otoscopy-guided tympanostomy tube placements from</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>2012 to 2014 at The Royal Veterinary College. The tympanostomy tubes were successfully</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>placed in the tympanic membrane in the cavaliers, under video-otoscopic guidance using a rigid</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>endoscope and grasping forceps. Outcomes were reported by telephonic answers to</font> | |
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| <font 12.0pt/inherit;;inherit;;inherit>Page 6 of 6</font> | |
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