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psom [2022/07/19 13:36] – [Ursache] m2psom [2022/07/19 17:20] (aktuell) – m2
Zeile 1: Zeile 1:
 ====== Primary Secretory Otitis Media (PSOM) ====== ====== Primary Secretory Otitis Media (PSOM) ======
  
-glue ear, otitis media with effusion +**glue ear, otitis media with effusion**
- +
 ===== Ursache ===== ===== Ursache =====
  
-Auslöser unbekannt - evtl. Dysfunktion der Eustachischen Röhre +  * Auslöser unbekannt - evtl. Dysfunktion der Eustachischen Röhre 
- +  * häufige Diagnose bei Cavalier King Charles Spaniels 
-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
-fast ausschließlich bei CKCS - seltener bei Boxer, Dackel und Shih Tzu +
- +
-muköser Plug der das Mittelohr anfüllt und das Trommelfell nach aussen drückt +
  
 ===== Symptome ===== ===== Symptome =====
  
   * ähnliche Symptome wie bei Syringomyelie   * ähnliche Symptome wie bei Syringomyelie
-  * moderate bis schwere Schmerzen im Kopf und Halsbereich, Kopfschiefhaltung +  * moderate bis schwere Schmerzen im Kopf und Halsbereich 
-  * Ohrenkratzen+  * Ohrenkratzen, Kopfreiben (überfüllte Bulla Tympanica)
   * Taubheit   * Taubheit
-  * Anfälle, Müdigkeit +  * Anfälle, Müdigkeit, Nystagmus, Fazialisparese, Ataxie 
-  * Nystagmus +  * Kopfschiefhaltung - vestibulär Syndrom
-  * Paralyse des Gesichts +
-  * vestibulär Syndrom +
-  * Ataxie +
- +
-Symptome ähnlich zu Syringomyelia und progressive kongenitale Taubheit +
- +
-Therefore, the examining veterinarian should take care to consider these other possible +
- +
-causes of the dog’s symptomatic behaviors. +
- +
-In a 2009 UK study of 23 cavaliers with PSOM, the researchers (who choose to refer to +
- +
-the disorder as middle ear effusion) tested the dogs’ hearing with the Brainstem Auditory +
- +
-Evoked Reponses (BAER) test and found that, even though the dogs’ owners considered their +
- +
-dogs’ hearing capabilities to be normal, the BAER tests demonstrated a conductive hearing loss +
- +
-in ears affected by middle ear effusion (PSOM). See same study in 2011 Veterinary Journal. +
- +
-In an April 2015 report involving 27 cavaliers affected with PSOM, the researcher found +
- +
-that: +
- +
-“In 74% (20/27) of the cases the dogs were deaf, 15% (4/27) of the dogs showed ataxia, +
- +
-7% (2/27) showed a head tilt and 7% (2/27) showed a facial paralysis of the affected side. +
- +
-In 59% (16/27) of the cases the dogs were scratching, 52% (14/27) of the dogs were +
- +
-rubbing and 56% (15/27) were shaking their heads. In 19% (5/27) of the cases the dogs +
- +
-seemed to experience pain localized to the head or ears according to the owners. +
- +
-Gradations of these symptoms were divided in mild, moderate, severe and extreme. … +
- +
-“In the 27 dogs in this study, 14 of the 27 dogs were rubbing their head. Head rubbing +
- +
-(against the floor or other surfaces) has, with the exception of dermatitis and allergies +
- +
-(Bruet, Bourdeau et al. 2012), only been associated with syringomyelia and CM and an +
- +
-unknown syndrome of behavioral signs of discomfort in the CKCS in former literature +
- +
-(Rusbridge 2005, Rusbridge, Carruthers et al. 2007). Only 7 of these 14 dogs were also +
- +
-diagnosed with CM/SM at the moment of the occurring clinical signs. After the +
- +
-myringotomy procedure, all clinical signs, including the head rubbing, were resolved in +
- +
-all 14 dogs for a period varying from four weeks to years. It seems that in these cases, the +
- +
-head rubbing was caused by the overfilled bulla(e) tympanica(e) and therefore this +
- +
-clinical sign can also be associated with PSOM. “ +
- +
-Diagnosis +
- +
-The standard means of detecting PSOM by veterinary dermatology (preferably) or +
- +
-neurology specialists is by either computed tomography (CT) or a magnetic resonance imaging +
- +
-Page 4 of 6 +
- +
-(MRI) scan. Both require that the dog be under general anesthesia. However, if the case is severe +
- +
-enough that the pars flaccida, the top portion of the dog’s tympanic membrane (ear drum), is +
- +
-bulging, the condition may be visible on x-rays and even diagnosed manually with an otoscope. +
- +
-In extreme cases, the tympanic membrane may have ruptured and the mucus plug clearly seen. It +
- +
-also may be observed by using an operating microscope with good lighting and at a suitable +
- +
-magnification. +
- +
-Tympanometry (impedance audiometry) is a noninvasive method of examining the +
- +
-function of the Otometermiddle ear while varying the atmospheric pressure in the external ear +
- +
-canal and inferring the amount of sound energy that is transmitted through the tympanum by +
- +
-measuring the reflected sound energy. In a February 2015 study, Dr. George Strain reported that +
- +
-the sensitivity and specificity of tympanometry for the diagnosis of PSOM in cavaliers were 84 +
- +
-and 47%, respectively. He recommended that clinical studies of conscious dogs with PSOM need +
- +
-to be performed to validate the clinical usefulness of these recordings. (See tympanometer at +
- +
-right.) +
- +
-However, in an August 2015 report, Dr. Lynette Cole examined 60 cavalier King Charles +
- +
-spaniels which had clinical signs suggesting PSOM. To diagnose the disorder, they used +
- +
-otoscopy, tympanometry, pneumotoscopy and tympanic bulla ultrasonography, in addition to +
- +
-using computed tomography (CT), which they stated was “the gold standard for the diagnosis of +
- +
-PSOM in the CKCS. “ +
- +
-All of the methods diagnosed PSOM in ears with large bulging “pars flaccida “ (the +
- +
-triangular, flaccid portion of the eardrum). However, cavaliers may have PSOM even though +
- +
-their pars flaccida is flat rather than bulging. She found that tympanometry detected the PSOM +
- +
-in only 47% of ears with a flat pars flaccida. She concluded that, in cavaliers with a flat pars +
- +
-flaccida, only the CT scan can reliably detect PSOM in the CKCS. +
- +
-Other possible alternative instruments for diagnosis of PSOM include pneumotoscopy, +
- +
-tympanic bulla ultrasonography, and the brain-stem auditory evoked response test (BAER). +
- +
-However, in the August 2015 report described above, the researchers found that pneumotoscopy +
- +
-detected the PSOM in only 79% of ears with a flat pars flaccida, and tympanic bulla +
- +
-ultrasonography detected the PSOM in only 47% of ears with a flat pars flaccida. +
- +
-Veterinary dermatologists in the United States may be located on the American College +
- +
-of Veterinary Dermatology website. +
- +
-Treatment +
- +
-– myringotomy +
- +
-Treatment traditionally has consisted of performing a myringotomy, making a small cut +
- +
-in the eardrum (tympanic membrane), followed by flushing the middle ear to force out the mucus +
- +
-plug. The photograph at right is of a myringotomy in progress. The ring in the middle of the +
- +
-photo is the eardrum. The tube tip at the top is the device used to flush the inner ear and force out +
- +
-the mucus. You may watch a Cavaliers with Syringomyelia Symptoms on YouTubeclose up +
- +
-Page 5 of 6 +
- +
-video of a myringotomy actually being performed on a cavalier named Baylee on YouTube. +
- +
-Following the myringotomy, the specialist typically will repeat the CT scan, to see if all +
- +
-of the mucus has been removed, and then a BAER test to determine if hearing has been restored. +
- +
-Topical and/or systemic corticosteroids and antibiotics then are administered. The procedure +
- +
-may have to be repeated, in some cases several times, depending upon how the dog responds. +
- +
-In an April 2015 report involving 31 myringotomies and 5 tympanostomies (see below) +
- +
-on 27 cavaliers affected with PSOM, the researcher found that: +
- +
-“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a +
- +
-median of 13 months and a recurrence rate of 61%. After tympanostomy the time to +
- +
-recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the +
- +
-theory which describes that the continual tympanic cavity ventilation by using ventilation +
- +
-tubes may provide a longer symptom-free period. No signs of progression from unilateral +
- +
-to bilateral PSOM were seen. “ +
- +
-– tympanostomy +
- +
-In a March 2008 study conducted by Australian researchers, they inserted tympanostomy +
- +
-tubes (right) within the myringotomy incision in order to provide continual tympanic cavity +
- +
-ventilation and drainage. They found that in the cases of the three CKCSs which they operated +
- +
-on, all three dogs were asymptomatic at the time of follow-up, 8, 6 and 4 months later, and they +
- +
-concluded that the use of tympanostomy tubes may be an acceptable alternative to repeated +
- +
-myringotomy. However, Dr. Cole reports that “no long-term prospective studies have been +
- +
-published on the outcome after extrusion of the tympanostomy tubes as far as the length of time +
- +
-the bulla remains effusion free. In addition, no studies have reported on the efficacy of a more +
- +
-“permanent “ or long-term tympanostomy tube for treatment of PSOM. “ In a February 2013 +
- +
-report, a team of UK researchers also have questioned the effectiveness of repeated +
- +
-tympanostomies. +
- +
-In an April 2015 report involving 31 myringotomies (see above) and 5 tympanostomies +
- +
-on 27 cavaliers affected with PSOM, the researcher found that: +
- +
-“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a +
- +
-median of 13 months and a recurrence rate of 61%. After tympanostomy the time to +
- +
-recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the +
- +
-theory which describes that the continual tympanic cavity ventilation by using ventilation +
- +
-tubes may provide a longer symptom-free period. No signs of progression from unilateral +
- +
-to bilateral PSOM were seen. “ +
- +
-In an August 2015 study of 12 cavalier King Charles spaniels with PSOM, a team of UK +
- +
-clinicians report on the results of 22 video-otoscopy-guided tympanostomy tube placements from +
- +
-2012 to 2014 at The Royal Veterinary College. The tympanostomy tubes were successfully +
- +
-placed in the tympanic membrane in the cavaliers, under video-otoscopic guidance using a rigid +
- +
-endoscope and grasping forceps. Outcomes were reported by telephonic answers to +
  
 ===== Diagnose ===== ===== Diagnose =====
  
-MRT: Mucus hyperintens+  * 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.
  
 ===== Therapie ===== ===== Therapie =====
  
-itchy ears, head tilt, head rubbing, excessive yawning, crying out in pain, ataxia, drooping ear or +  * Myringotomie mit Spülung 
- +  * Tympanostomie (als alternative empfohlen, aber es gibt keine Studie über die langfristige Wirksamkeit als PSOM-Therapie).
-lip, inability to blink an eye, rapid eyeball movement, facial paralysis or nerve palsy, Vestibular +
- +
-disease, some loss of hearing, seizures, and fatigue. These symptoms, in many cases, are very +
- +
-similar to those of syringomyelia and, to some extent, to those of progressive hereditary +
- +
-deafness. Therefore, the examining veterinarian should take care to consider these other possible +
- +
-causes of the dog’s symptomatic behaviors. +
- +
-In a 2009 UK study of 23 cavaliers with PSOM, the researchers (who choose to refer to +
- +
-the disorder as middle ear effusion) tested the dogs’ hearing with the Brainstem Auditory +
- +
-Evoked Reponses (BAER) test and found that, even though the dogs’ owners considered their +
- +
-dogs’ hearing capabilities to be normal, the BAER tests demonstrated a conductive hearing loss +
- +
-in ears affected by middle ear effusion (PSOM). See same study in 2011 Veterinary Journal. +
- +
-In an April 2015 report involving 27 cavaliers affected with PSOM, the researcher found +
- +
-that: +
- +
-“In 74% (20/27) of the cases the dogs were deaf, 15% (4/27) of the dogs showed ataxia, +
- +
-7% (2/27) showed a head tilt and 7% (2/27) showed a facial paralysis of the affected side. +
- +
-In 59% (16/27) of the cases the dogs were scratching, 52% (14/27) of the dogs were +
- +
-rubbing and 56% (15/27) were shaking their heads. In 19% (5/27) of the cases the dogs +
- +
-seemed to experience pain localized to the head or ears according to the owners. +
- +
-Gradations of these symptoms were divided in mild, moderate, severe and extreme. … +
- +
-“In the 27 dogs in this study, 14 of the 27 dogs were rubbing their head. Head rubbing +
- +
-(against the floor or other surfaces) has, with the exception of dermatitis and allergies +
- +
-(Bruet, Bourdeau et al. 2012), only been associated with syringomyelia and CM and an +
- +
-unknown syndrome of behavioral signs of discomfort in the CKCS in former literature +
- +
-(Rusbridge 2005, Rusbridge, Carruthers et al. 2007). Only 7 of these 14 dogs were also +
- +
-diagnosed with CM/SM at the moment of the occurring clinical signs. After the +
- +
-myringotomy procedure, all clinical signs, including the head rubbing, were resolved in +
- +
-all 14 dogs for a period varying from four weeks to years. It seems that in these cases, the +
- +
-head rubbing was caused by the overfilled bulla(e) tympanica(e) and therefore this +
- +
-clinical sign can also be associated with PSOM. “ +
- +
-Diagnosis +
- +
-The standard means of detecting PSOM by veterinary dermatology (preferably) or +
- +
-neurology specialists is by either computed tomography (CT) or a magnetic resonance imaging +
- +
-Page 4 of 6 +
- +
-(MRI) scan. Both require that the dog be under general anesthesia. However, if the case is severe +
- +
-enough that the pars flaccida, the top portion of the dog’s tympanic membrane (ear drum), is +
- +
-bulging, the condition may be visible on x-rays and even diagnosed manually with an otoscope. +
- +
-In extreme cases, the tympanic membrane may have ruptured and the mucus plug clearly seen. It +
- +
-also may be observed by using an operating microscope with good lighting and at a suitable +
- +
-magnification. +
- +
-Tympanometry (impedance audiometry) is a noninvasive method of examining the +
- +
-function of the Otometermiddle ear while varying the atmospheric pressure in the external ear +
- +
-canal and inferring the amount of sound energy that is transmitted through the tympanum by +
- +
-measuring the reflected sound energy. In a February 2015 study, Dr. George Strain reported that +
- +
-the sensitivity and specificity of tympanometry for the diagnosis of PSOM in cavaliers were 84 +
- +
-and 47%, respectively. He recommended that clinical studies of conscious dogs with PSOM need +
- +
-to be performed to validate the clinical usefulness of these recordings. (See tympanometer at +
- +
-right.) +
- +
-However, in an August 2015 report, Dr. Lynette Cole examined 60 cavalier King Charles +
- +
-spaniels which had clinical signs suggesting PSOM. To diagnose the disorder, they used +
- +
-otoscopy, tympanometry, pneumotoscopy and tympanic bulla ultrasonography, in addition to +
- +
-using computed tomography (CT), which they stated was “the gold standard for the diagnosis of +
- +
-PSOM in the CKCS. “ +
- +
-All of the methods diagnosed PSOM in ears with large bulging “pars flaccida “ (the +
- +
-triangular, flaccid portion of the eardrum). However, cavaliers may have PSOM even though +
- +
-their pars flaccida is flat rather than bulging. She found that tympanometry detected the PSOM +
- +
-in only 47% of ears with a flat pars flaccida. She concluded that, in cavaliers with a flat pars +
- +
-flaccida, only the CT scan can reliably detect PSOM in the CKCS. +
- +
-Other possible alternative instruments for diagnosis of PSOM include pneumotoscopy, +
- +
-tympanic bulla ultrasonography, and the brain-stem auditory evoked response test (BAER). +
- +
-However, in the August 2015 report described above, the researchers found that pneumotoscopy +
- +
-detected the PSOM in only 79% of ears with a flat pars flaccida, and tympanic bulla +
- +
-ultrasonography detected the PSOM in only 47% of ears with a flat pars flaccida. +
- +
-Veterinary dermatologists in the United States may be located on the American College +
- +
-of Veterinary Dermatology website. +
- +
-Treatment +
- +
-– myringotomy +
- +
-Treatment traditionally has consisted of performing a myringotomy, making a small cut +
- +
-in the eardrum (tympanic membrane), followed by flushing the middle ear to force out the mucus +
- +
-plug. The photograph at right is of a myringotomy in progress. The ring in the middle of the +
- +
-photo is the eardrum. The tube tip at the top is the device used to flush the inner ear and force out +
- +
-the mucus. You may watch a Cavaliers with Syringomyelia Symptoms on YouTubeclose up +
- +
-Page 5 of 6 +
- +
-video of a myringotomy actually being performed on a cavalier named Baylee on YouTube. +
- +
-Following the myringotomy, the specialist typically will repeat the CT scan, to see if all +
- +
-of the mucus has been removed, and then a BAER test to determine if hearing has been restored. +
- +
-Topical and/or systemic corticosteroids and antibiotics then are administered. The procedure +
- +
-may have to be repeated, in some cases several times, depending upon how the dog responds. +
- +
-In an April 2015 report involving 31 myringotomies and 5 tympanostomies (see below) +
- +
-on 27 cavaliers affected with PSOM, the researcher found that: +
- +
-“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a +
- +
-median of 13 months and a recurrence rate of 61%. After tympanostomy the time to +
- +
-recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the +
- +
-theory which describes that the continual tympanic cavity ventilation by using ventilation +
- +
-tubes may provide a longer symptom-free period. No signs of progression from unilateral +
- +
-to bilateral PSOM were seen. “ +
- +
-– tympanostomy +
- +
-In a March 2008 study conducted by Australian researchers, they inserted tympanostomy +
- +
-tubes (right) within the myringotomy incision in order to provide continual tympanic cavity +
- +
-ventilation and drainage. They found that in the cases of the three CKCSs which they operated +
- +
-on, all three dogs were asymptomatic at the time of follow-up, 8, 6 and 4 months later, and they +
- +
-concluded that the use of tympanostomy tubes may be an acceptable alternative to repeated +
- +
-myringotomy. However, Dr. Cole reports that “no long-term prospective studies have been +
- +
-published on the outcome after extrusion of the tympanostomy tubes as far as the length of time +
- +
-the bulla remains effusion free. In addition, no studies have reported on the efficacy of a more +
- +
-“permanent “ or long-term tympanostomy tube for treatment of PSOM. “ In a February 2013 +
- +
-report, a team of UK researchers also have questioned the effectiveness of repeated +
- +
-tympanostomies. +
- +
-In an April 2015 report involving 31 myringotomies (see above) and 5 tympanostomies +
- +
-on 27 cavaliers affected with PSOM, the researcher found that: +
- +
-“[A]fter a single myringotomy procedure the mean recurrence time is 19.9 months with a +
- +
-median of 13 months and a recurrence rate of 61%. After tympanostomy the time to +
- +
-recurrence was shorter then after myringotomy (p = 0.022), which is contrary to the +
- +
-theory which describes that the continual tympanic cavity ventilation by using ventilation +
- +
-tubes may provide a longer symptom-free period. No signs of progression from unilateral +
- +
-to bilateral PSOM were seen. “ +
- +
-In an August 2015 study of 12 cavalier King Charles spaniels with PSOM, a team of UK +
- +
-clinicians report on the results of 22 video-otoscopy-guided tympanostomy tube placements from +
- +
-2012 to 2014 at The Royal Veterinary College. The tympanostomy tubes were successfully +
- +
-placed in the tympanic membrane in the cavaliers, under video-otoscopic guidance using a rigid +
- +
-endoscope and grasping forceps. Outcomes were reported by telephonic answers to +
- +
-Page 6 of 6+
  
  
psom.1658230574.txt.gz · Zuletzt geändert: 2022/07/19 13:36 von m2