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My cat has been trying to get over an ear infection. I

My cat has been trying...
My cat has been trying to get over an ear infection. I didn't know anything was wrong until I saw her have a seizure. I took her in right away after she had two of them in the morning(August 9). She has built up yeast/bacteria in her ears. She went under anesthesia to have the brown fluid drained with a cleaner, but the vet was unable to remove it all. Her ear drums were ruptured and it was possible that it was in the inner ear. I was given an oral antibiotic and ear drops to give her. It has been at least two weeks now since I started her on the medication (oral antibiotic 1 week). She still isn't her normal self. Her hearing has been affected, and I don't know if she can hear at all. She crouches low to the ground and seems apprehensive, which before this infection was not like her at all. Even when going to pet her head, she kind of ducks, as if to avoid it. She liked to be held but now she jumps down right away. She hasn't though had any more seizures and her eyes aren
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Answered in 6 minutes by:
8/28/2012
Dr Rachel
Dr Rachel, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 178
Experience: 12 years small animal veterinary practice
Verified
Dr Rachel :

Hello - I'd be happy to discuss Princess with you.

Dr Rachel :

It sounds like she has been through quite a bit this month - poor thing!

Customer:

yes she has!


Dr Rachel :

With what you are describing, I agree that it is quite likely that she has at least some hearing loss.

Dr Rachel :

Since she had ruptured ear drums and inner ear infections, it is also likely that this could have affected her balance (damage to her vestibular system). Sometimes this resolves, but often it just is a matter of time as they adjust to it, which they tend to do remarkably well.

Customer:

He also said that he could use a chemical to clean her ears, but that would also cause permanent hearing loss. I don't want to give up hope yet that her hearing may come back.

Customer:

Is there some way to get the rest of the fluid out without damaging everything surrounding it?


Dr Rachel :

Yes - in fact there is some controversy about baytril otic possibly having some ototoxicity - which can cause permanent hearing loss.

Customer:

Should I stop using those drops?


Customer:

I don't know if they are even helping anymore.

Dr Rachel :

Not unless she is covered with something else - did your vet culture or do a swab of the material from Princess' ears?


Customer:

The first vet I went to did, and they told me it showed yeast and bacteria.

Dr Rachel :

So was it the second vet who put her under anesthesia to drain the fluid? Did they say that her ear drums were ruptured at that time? Or were they ruptured when the first vet saw her?

Customer:

The vet just looked in her ears today. He didn't take a swab.


Dr Rachel :

To drain the fluid, we usually have to make small slits in the ear drums if they aren't ruptured.

Dr Rachel :

My other concern is the short course of clavamox - inner ears have next to no blood supply - so generally it is recommended to do at least a 6 weeks course of antibiotics if you suspect an inner ear infection.

Customer:

The first vet couldn't get a good look at her ears, so she wanted to put her under anesthesia. She started talking about cleaning her teeth at the same time. That irritated me because that wasn't the issue and I felt it was all about money. That's why I got a second opinion with this current vet. He put her under anesthesia and used a cleaner to drain a good portion of the brown fluid. He said that both eardrums were pretty much ruptured. The right one was hardly there I think.

Dr Rachel :

Ok, so probably she had an ongoing infection for a while if they were barely there. The swab can identify bact

Dr Rachel :

bacteria and yeast, but won't really identify what antibiotics that bacteria would be sensitive to.

Customer:

I thought clavamox should be longer. I asked him about the clavamox antibiotic today, and he said she didn't need anymore of it. I felt strongly that she should. So now I'm having my doubts about the well-being of my cat at this veterinary.

Dr Rachel :

So if she isn't improving, I would say a culture would be the next step so that the exact right antibiotic would be chosen.

Dr Rachel :

What did he say about how her ears looked today?

Dr Rachel :

Her ducking and avoiding petting worries me - I wonder if that could be a pain response. It could also, as I mentioned be just a response to her having damage to her vestibular system and trying to adjust to that.

Customer:

He said that the outer part looks fine, but it's hard to tell how much is further in. He said there may be inflammation. He took my cat to another room and Princess yelled like I never heard her do before. She is a very calm cat. That really worried me because it sounded like torture.


Dr Rachel :

If there is ear drum damage or compromise, you just have to be extremely careful about what medications are used in the ear because the inner ear is so sensitive.

Dr Rachel :

She is not on any pain medication?

Customer:

No she is not

Customer:

How do I know if my cat is in pain?

Dr Rachel :

Well - if she responded that strongly to him looking in her ears (I'm assuming that's what he did in the other room), and if she is doing this avoidance behavior, I would strongly suspect she has at least some discomfort. Cats can be very hard to tell - they try to hide things like that because in nature that makes them look weak and then makes them susceptible to other animals.

Customer:

I just don't know what to do. I want to help her the best way that I can. I already feel so bad because she gave me no signs of an ear infection until the seizures came. She was so happy all the time.

Dr Rachel :

There is a surgery where they go in and open up the boney vault from below and drain the inner ear that way. This is generally something a specialist would do. If you have access to a specialist, it sounds like that might be a good option at this point anyway.

Dr Rachel :

I totally understand! I know you are doing your best to try to help her! :( Ear infections in cats are relatively rare things - so in my experience when we do see them, they can be very severe.

Dr Rachel :

And that's probably because they are so good at hiding things that bother them as well.

Dr Rachel :

Can you describe the seizures she had?

Customer:

I was in bed and she was with me. I was sleeping on my stomach and felt this moving in the bed. I thought she was just scratching herself. It continued, so I turned over and took a look at her. She appeared to be having a spasm. She wasn't waking up, she was whimpering, and shaking violently. It only lasted 15-20 seconds about. After, she tried to jump off the bed, and her legs gave out. She had problems walking and one side of her was worse. I thought it was a stroke.

Dr Rachel :

How scary for you!

Dr Rachel :

And for Princess too.

Customer:

She had three seizures that lasted between 10-15 seconds and one 2 second seizure on the table at the vet.

Dr Rachel :

Did they do any bloodwork to make sure there was no other cause for the seizures?

Customer:

Yes it was! I took her in right away to get bloodwork done and have her examined.

Dr Rachel :

Oh good.

Customer:

Her bloodwork was fine. Her thyroid was about 4.0. I requested that they test that because it wasn't part of the bloodwork. What bothered me was that they didn't check her ears as part of the physical checkup. I was the one that watched her carefully and saw her scratching at her ears. So I went back in to them and that's when they noticed all the bacteria.

Dr Rachel :

Here's my other concern - the only time I have heard about seizures (true seizures, which it sounds like she was definitely having) should be associated with ear infections would be if the infection was also going to her brain as far as I know. Now that is my experience and what I was taught, but maybe the vets you have seen have seen something different.

Dr Rachel :

Vestibular episodes (being unbalanced, unable to stand up) I have certainly seen - but true seizures with loss of consciousness just doesn't make sense unless that infection is also affecting her brain.

Dr Rachel :

I'm glad her bloodwork was fine.

Customer:

Is it a worse infection then that can't be treated?

Dr Rachel :

No, not necessarily.

Dr Rachel :

There really isn't any way to comment on the severity of the infection or it's ability to be treated without culturing.

Dr Rachel :

That's the point at which we will know what antibiotics can be used.

Customer:

What has to be done to get a culture?

Dr Rachel :

She would probably have to be anesthetized again, or at least heavily sedated in order to get a good sample from her inner ear.

Dr Rachel :

They would then take a sample of that fluid/material and send it to the lab -they grow the bacteria in the sample and then test what antibiotics would work to kill that bacteria.

Customer:

If her eardrum is starting to come back in the right ear, would that hurt it from healing?

Dr Rachel :

If she has an inner ear full of infection, a healing eardrum isn't going to help her.

Dr Rachel :

That infection really needs to be adequately addressed.

Customer:

I don't know why the current vet did not test the brown liquid. That puzzles me.

Dr Rachel :

I hate to say you need a 3rd opinion, but I don't think that would be a bad idea at this point.

Dr Rachel :

I'm not sure why they wouldn't at least suggest it either. Perhaps he didn't expect it to be so bad - he did say the liquid came from her inner ear, right?

Customer:

I agree that I do need a 3rd opinion. That's the feeling I had today. I'm glad that you have been talking with me. It makes me feel better that I'm doing the right thing. He didn't know for sure. He just kept saying that there was so much fluid, and he couldn't get it all drained. I don't know if he ever said inner ear...he said that the fluid was deeper in the ear and that there was probably inflammation.

Customer:

He showed me a picture of the ear canal again...of a dog, but he said it's similar to a cat's. It seemed like he pointed more to the middle part. He also mentioned that if the infection doesn't clear up, then there is surgery to remove the tympanic bulla or whatever it's called.

Dr Rachel :

Yes - that's the surgery I mentioned.

Dr Rachel :

The inner ear is just such a sensitive area. And it could be that Princess just needs something to help decrease that inflammation more - baytril otic has a limited ability to do that. A lot of ear drops contain steroids, but that can be dangerous in the face of infection (let bacteria grow more).

Customer:

I think that would be a last resort though because then there is no chance of the cat hearing if she does heal over time.

Dr Rachel :

My feeling about that has always been that the key is that they are comfortable. Cats are amazingly resilient and can adapt to many things - but chronic pain is not a good thing of course.

Dr Rachel :

But certainly it is worth looking into other options first, I agree.

Dr Rachel :

I'm not sure if I haven't just given you more questions - but I hope you do have better luck with another opinion.

Customer:

So I guess getting a culture from a different vet would be my next step.

Dr Rachel :

I know you are just trying to do the right thing for Princess - it's heartbreaking to see them so uncomfortable.

Dr Rachel :

Definitely that is what I would start with - and maybe another vet can just give you a different perspective on treatment and may have a better idea of how to address this to make her more comfortable.

Customer:

Yes, it is difficult....especially since Princess always liked me to hold her like a baby and she would sleep on my stomach/chest throughout the night. She's a very loving cat.

Dr Rachel :

If you do have a specialist available to you (a dermatologist would probably be your best bet) I would certainly recommend that first.

Dr Rachel :

Please do keep me updated on how she is doing! I'll send you a follow-up message in a few days. You can return to this question in your account even after rating.

Dr Rachel :

Is there anything else I can answer for you?

Customer:

There are dermatologists for cats?


Dr Rachel :

Yes - veterinary dermatology specialists - they receive generally 4-6 extra years of training to be board certified.

Customer:

oh, okay. Thanks! I didn't know that.

Dr Rachel :

Sometimes they require a referral, but most state veterinary laws say that your vet is required to give you a referral if you request it.

Dr Rachel :

You are welcome.

Customer:

Thank you so much for ALL of your help!! I greatly appreciate it!

Dr Rachel :

You are very welcome - I just hope Princess starts feeling better soon! Best of luck!

Customer:

Thanks! :) I've been praying for the little girl. If it's meant to be, then it will. I'm remaining optimistic. Thanks again for everything!

Dr Rachel :

I'll keep her in my prayers too. Have a good night.

Dr Rachel
Dr Rachel, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 178
Experience: 12 years small animal veterinary practice
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