Aug 30, 2017
by Dr. Michael Trapani
This is a story about PeeWee. He’s a cute little dog, not exactly young but certainly not old. You’d never know that something is missing. PeeWee’s problem started with difficulty swallowing. He couldn’t open his mouth and was in great pain when anyone tried to open it for him. Sometimes he would paw at the side of his head, as if he had a headache. That was it.
So they took PeeWee to their veterinarian, who saw the pain, and anesthetized PeeWee to look in his mouth. And what did they find? A giant abscess bulging from one side of PeeWee’s pharynx, which is the space between PeeWee’s mouth and his larynx. Oh, and one little detail: PeeWee’s right ear had no hole. Sure, PeeWee had a pinna, the big flap of the ear that we all think of as the ear, and he had an ear canal, the tube that leads down to the eardrum, but they weren’t connected. PeeWee was missing a hole.
Well, that’s weird, everyone thought. PeeWee’s abscess was lanced and drained, and his infection was cultured, and the right antibiotic therapy was started, and PeeWee improved. But he still had pain and he still wasn’t right, and no matter how long his therapy was extended, the infection just would not go away. Eventually, PeeWee was referred to a specialist for a CAT scan.
You have to love high-tech medicine. The CAT scan report described in amazing detail the infection in PeeWee’s middle ear cavity, and how it had burned through the osseous bulla (the boney wall of the middle ear), and extended along the base of PeeWee’s skull, infecting the bones there as well as his TMJ (jaw joint), and how it had worked its way down through the tissue to the pharynx, where it finally created the abscess, which was drained by surgically creating a hole! The CAT scan report also described how PeeWee’s ear canal did not communicate with his pinna. The detail revealed by this imaging technique is truly astounding.
What to do? Surgeons were consulted, and recommended a ventral ear ablation, in which the middle ear is approached from below the ear canal and then the boney cavity of the middle ear is removed, the area debrided (surgically cleaned), and the lower ear canal detached and removed, effectively ablating all external and middle ear structures. It isn’t cheap, and it certainly isn’t guaranteed.
Somehow, PeeWee found himself in my office for a case review. As I went through the record, it was clear that everyone had done everything right. I agreed that a ventral ear ablation was probably PeeWee’s best hope for a cure. The problem was, I didn’t think it would work.
Why? PeeWee had a nasty chronic bone infection in the base of his skull. No surgery could possibly hope to remove all of the infected bone, so no matter what was done, PeeWee’s infection was going to persist for a long, long time.
And there was that one nagging detail: Why did PeeWee have this problem in the first place? Why didn’t PeeWee’s middle ear infection just burn through his eardrum, like it would in any other dog, and drain through the ear? Middle ear infections aren’t uncommon, but they almost never do what this one did.
It’s the hole! Without an opening in the ear canal, the infectious material had nowhere to go. It accumulated in the middle ear cavity until it burned through, then followed the path of least resistance along the underside of the skull and finally down into the wall of the pharynx.
We recommended a much simpler (and less costly) surgery, a lateral ear resection, the purpose of which is to create a permanent opening for PeeWee’s ear. Once this was done, the infectious material inside his middle ear cavity was vacuumed out (and piles of nasty crud removed) and cultured.
As expected, the infection there was resistant to all of the previously used antibiotics. Why? His earlier treatment had killed all the sensitive bacteria. These were the survivors. It’s evolution in action.
PeeWee has done pretty well. You can barely tell that he has a new hole in the side of his head, and his infection is drying up. We tried taking him off antibiotic after only 30 days, and he started showing soreness again, so his treatment will be extended to 90 days (or more). We are hoping that if we control the infection long enough, PeeWee will remove all of the infected bone himself and sterilize the area. This process takes place on a bone-healing time frame, so it’ll take at least 12 weeks. We’re keeping our fingers crossed.
Not a single hole in the body that can be abnormally closed without creating a problem. Close the hole that you breath through - you’re dead in minutes. Close the hole that you poop through - you’re dead in days. Close the hole that you eat through - you’re dead in weeks. Close the tiniest hole, like the opening of an itty bitty oil gland in the skin - you’ll have a pimple, or a boil in no time. Whoever designed these bodies really knew what they were doing.
Please support our sponsors: