glue ear, otitis media with effusion

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

• ähnliche Symptome wie bei Syringomyelie
• moderate bis schwere Schmerzen im Kopf und Halsbereich, Kopfschiefhaltung
• Ohrenkratzen
• Taubheit
• Anfälle, Müdigkeit
• Nystagmus
• 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

MRT: Mucus hyperintens

itchy ears, head tilt, head rubbing, excessive yawning, crying out in pain, ataxia, drooping ear or

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