Standing surgical procedure for treatment of otitis media in a horse

Abstract

SummaryA 13‐year‐old Appaloosa gelding was referred for evaluation of a left‐sided facial nerve paralysis. On clinical examination, the gelding exhibited muzzle deviation to the right, dropped left ear and blepharospasm of the left eye. A Schirmer tear test revealed 66% reduction in tear production in the left eye and a focal corneal ulcer (0.7 cm by 0.7 cm) was present ventrally in the left eye. Endoscopic examination of the upper airways and guttural pouches showed no abnormalities. Computed tomographic examination revealed an accumulation of soft‐tissue attenuating material within the tympanic bulla, consistent with otitis media. Medical management with 30 mg/kg trimethoprim sulfadiazine and 2.2 mg/kg phenylbutazone orally twice a day for 6 weeks was unsuccessful. The non‐perforated tympanic bulla was fenestrated from the left guttural pouch using diode LASER transendoscopically, under standing sedation, to allow drainage of the inner ear. Mucopurulent fluid drained from the tympanic bulla cavity. Endoscopic examination 6 months post‐surgery showed that the fenestrated site had healed over, with no evidence of inflammation at the site. A very mild muzzle deviation to the right was still present 6 months' post surgery but the horse was able to prehend and masticate without difficulty. The procedure was successful, and the clinical signs improved significantly post‐surgery.