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

Linda S Jacobson, Kyrsten J Janke, Sasha K Kennedy, Gina A Lockwood, Shawn D Mackenzie, Carl D Porter, Patrick B Ringwood

Background: The authors report on the clinical findings, surgical complications and outcomes of 58 cats with chronic otitis media-interna (OMI) that were transferred from a hoarding environment. They also investigate the risk factors for poor outcomes and complications.

Study: The authors conducted a retrospective study of the medical records of the cats that underwent ventral bulla osteotomy (VBO) for OMI at a shelter hospital. They classified the clinical signs, radiographic findings, bacterial cultures, surgical procedures and postoperative complications of the cats. They also performed statistical analysis to test the effects of VBO on clinical signs and to identify potential prognostic indicators.

Methods: The authors included cats that originated from the same hoarding environment, had clinical findings consistent with OMI, and had bulla disease confirmed by imaging or surgery. They excluded cats that were euthanized before confirmation, did not meet the case definition, or had surgical complications unrelated to OMI. They collected data on preoperative and postoperative clinical signs, surgical complications, outcomes and risk factors. They used McNemar’s test to compare the resolution of clinical signs after VBO, and odds ratios to quantify the associations between risk factors and outcomes/complications.

Results: The authors found that 58 cats met the inclusion criteria and underwent VBO. Most of them had moderate/severe otitis externa (OE), nasopharyngeal signs, purulent aural discharge and polyps. Radiographically, most of them had increased opacity and thickening of the tympanic bulla wall. Cultures were positive for Streptococcus equi subspecies zooepidemicus in more than half of the cats. Of the 58 cats, 40 had complications after the first VBO and 19 after the second. Of 101 complications, 56 were considered serious, including life-threatening perioperative complications in seven, otitis interna (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. No other prognostic indicators were identified. No variables tested were significantly associated with risk of serious complications or euthanasia.

Limitations: The authors acknowledged that their study was limited by its retrospective nature and the difficulties of managing complex cases in a shelter setting. They also noted that their case selection may have been biased toward more severe cases, as radiography has lower sensitivity for diagnosis of OM than CT or MRI. They also stated that their assessment of the clinical success of VBO was limited by perpetuating factors for OE and rhinosinusitis in some cats.

Conclusions: The authors concluded that surgical management of chronic OMI was successful in many cases but not benign and not always beneficial. They suggested that conservative medical management could be considered for some cases, with surgery reserved for cases with quality-of-life concerns that might reasonably be expected to be alleviated by VBO. They also recommended further research on less invasive approaches and chronic medical management for chronic feline OMI.

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