A Pandora's box in feline medicine: presenting signs and surgical outcomes in 58 previously hoarded cats with chronic otitis media-interna.

OBJECTIVES: The aim of the present study was to report clinical findings, surgical complications and outcomes for previously hoarded cats treated surgically for otitis media-interna (OMI) and to investigate the risk factors for complications and poor outcomes. METHODS: A retrospective study was conducted of 58 cats from an institutional hoarding environment that underwent ventral bulla osteotomy (VBO). RESULTS: Inappetence was uncommon at presentation (9/58, 16%) compared with pruritus/alopecia (50%), nasopharyngeal signs (45%), otitis externa (OE) (79%) and otitis interna (OI) (ataxia ± head tilt/head excursions) in 40%. Purulent aural discharge occurred in 36% and polyps in 26%. The tympanic bulla wall was moderately or severely thickened radiographically in 38/108 (35%) ears. Cultures were positive for Streptococcus equi subspecies zooepidemicus in 26/48 (54%) cats. Of the 58 cats, 40 (69%) had complications after the first VBO and 19/30 (63%) after the second. Of 101 complications, 56 (55%), from 27/88 (31%) surgeries, were considered serious, including life-threatening perioperative complications in seven, OI in eight, prolonged anorexia in six and worsening of pruritus/alopecia in nine cases. Three cats developed xerostomia (dry mouth) after the second VBO. Pruritus/alopecia, nasopharyngeal signs, OE and purulent aural discharge resolved in a statistically significant proportion of cats but persisted in some. Full resolution of OI was uncommon. OI preoperatively, and surgery performed by a generalist (vs specialist) surgeon, were risk factors for OE at recheck (OI: odds ratio [OR] 4.35; 95% confidence interval [CI] 1.21-15.70; P = 0.02; surgery: OR 3.64; 95% CI 1.03-12.87; P = 0.045). No other prognostic indicators were identified. No variables tested were significantly associated with risk of serious complications or euthanasia. CONCLUSIONS AND RELEVANCE: Surgical management of chronic OMI was successful in most cases but was not benign and not always beneficial. The analysis was unable to identify clinically helpful outcome predictors. Optimal management of chronic feline OMI remains a challenge, particularly for animal shelters. Less invasive approaches and chronic medical management require further investigation.

DISTRIBUTION AND SHORT- AND LONG-TERM EFFECTS OF INJECTED GELIFIED ETHANOL INTO THE LUMBOSACRAL INTERVERTEBRAL DISC IN HEALTHY DOGS.

Radiopaque gelified ethanol preparation has been described as a useful agent for treatment of humans with intervertebral disc protrusion. The material is injected into the nucleus pulposus under image guidance with intention to cause the protruded disc material to recede. Because treatment options for dogs with chronic protrusions are limited, new and minimally invasive treatments are desirable. The aim of this experimental, descriptive, prospective study was to assess the feasibility and safety of percutaneous injection of gelified ethanol into the lumbosacral intervertebral disc of dogs. Lumbosacral intervertebral discs of normal dogs (n = 9) were imaged with magnetic resonance imaging and then injected with gelified ethanol using image guidance. The accuracy of gelified ethanol placement in the nucleus pulposus and presence of leakage of the injected material were documented. Postinjection computed tomography (CT) findings (n = 9), short-term (n = 9) and long-term (n = 4) follow-up magnetic resonance imaging and CT findings were compared to document the distribution of the injected preparation and identify effects on adjacent tissues. Percutaneous injection of the intervertebral disc was successful in delivering radiopaque gelified ethanol to the nucleus pulposus in all dogs. Leakage of the injected material into the vertebral canal was present in three dogs immediately following injection and in another additional dog at 1 year following injection. All dogs tolerated the injection well and had no clinical adverse reactions within the study period. Findings indicated that injection of the nucleus pulposus of healthy dogs was well tolerated, even in the presence of mild leakage of material from the intervertebral disc.

Comparison between computed tomography, fluoroscopy, and ultrasonography for guiding percutaneous injection of the canine intervertebral disc.

A minimally invasive method for delivering injectable therapeutic agents would be desirable for the treatment of intervertebral disc disease in dogs. The purpose of this study was to compare computed tomography (CT), ultrasonography (US), and fluoroscopy modalities for guiding percutaneous injection into canine intervertebral discs. Intervertebral discs of 14 dog cadavers were injected with a gelified ethanol therapeutic agent. Successful injectate placement and injectate leakage were determined based on necropsy inspection of discs. Injection into the nucleus pulposus was successful in 55 of 78 (71%) of all injected discs. Injections guided using CT and fluoroscopy were significantly more successful than US-guided injections. Odds of successful injection without leakage were greater for CT vs. US (P = 0.0026) but there was no significant difference between CT and fluoroscopy (P = 0.0620). Injection success rates did not differ among vertebral sites or dog cadavers of varying weights. Forty-nine (63%) of injection sites had injectate leakage outside the disc and 10 of these involved structures within the vertebral canal. The highest rate of injection success with the least amount of leakage was achieved with CT guidance. Findings indicated that CT, fluoroscopy, and US are feasible modalities for guiding percutaneous injection of a gelified ethanol therapeutic agent into the canine intervertebral disc, with moderate to high success rates for different regions of the spine. However, a moderately high rate of injectate leakage occurred outside of the disc and this should be taken into consideration for future safety and efficacy studies.

Imaging diagnosis--temporomandibular joint dysplasia in a Basset Hound.

A 5-month-old intact male Basset Hound presented for evaluation of pain and crepitation during manipulation of the temporomandibular joint, worse on the right side. A computed tomography (CT) scan of the head was performed. The CT images demonstrated the osseous features of temporomandibular joint dysplasia and facilitated a 3D reconstruction, which allowed better visualization of the dysplastic features. The patient responded to conservative management with a tape muzzle with no recurrence reported by the owner 6 months after presentation.

Oral thermal injury associated with puncture of a salbutamol metered-dose inhaler in a dog.

OBJECTIVE: To describe the clinical features, diagnostic work-up, treatment, and outcome of a dog with oral thermal injury secondary to chewing on a salbutamol metered-dose inhaler (MDI). CASE SUMMARY: A Boxer dog was presented after chewing on a salbutamol MDI. The dog was anxious, tachycardic and had moderate hypokalemia. The dog was treated with potassium supplementation and discharged after 24-hour hospitalization. Five hours after the discharge, the dog represented for dysphagia, anorexia, cervical pain, and a left-sided head tilt. Oral examination revealed edematous and erythematous swelling of the soft palate causing airway compromise; histopathology demonstrated vascular necrosis and infarction. The dog was treated with supportive care including the placement of a tracheostomy tube. The dog recovered fully and was discharged 8 days after initial presentation. NEW OR UNIQUE INFORMATION PROVIDED: Salbutamol toxicity has been documented previously in dogs but oral thermal injury associated with a salbutamol MDI has not been reported in dogs. Although a rare complication, dogs who have been exposed to MDIs should have a thorough oral exam and be monitored closely for signs of respiratory compromise.