Horner’s Syndrome after Ventral Bulla Osteotomy

GFSOT86

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Hi everyone,

I recently came across this wonderful community while researching about Ventral Bulla Osteotomy surgery and Horner’s Syndrome. I tries to search for these two topics together to find a thread where it was discussed, but I couldn’t really find the answer(s) I was wanting. Please feel free to link me to any of the threads I might have overlooked.

First, some back ground information on my cat, Oliver.
In May 2021 I adopted Oliver who was rescued from Amman Jordan and flown over to the US (VA to be exact). He’s somewhere around 3 to 4 years old, but age is hard to estimate because he’s had a hard start to his life. He has obvious healed injuries and scars from previous cat fights.
When I first got him, he was a very loud and noisy breather. His soft palate was inspected for polyps but none were found.
Over the next year and a half he suffered from multiple rounds of nasal discharge and ear discharge in one or both nostrils/ears. We were constantly trying so many medications and antibiotics - Azithromycin being the main one that would get him feeling better and reduce the discharge.
The vet kept trying to say that the ears and nose were two different issues - but I’ve always known better. We took a culture of the ear crud and based on what grew, we were told to get a CT scan.
Last month, Dec 2022, the discharge stopped draining out of his nose and ears and was going straight down into his stomach. 😫
We had to hospitalize him for a nasal flush (this got the discharge draining out the ears and nose when we got him) and we finally got the CT scan.
Spoiler alert - they found polyps and a massive amount of inflamed tissue from his inner ear to the base of his nose. He had at minimum 4 large polyps. Next step was a Ventral bulla osteotomy.
They suggested to split the VBO into two surgeries - one for the left ear cavity and base of his nose (done a week ago) and another for his right ear. This was in case the swelling was really bad, if both sides were done at once he might not be able to breathe.
The first surgery went well, the incision is healing nicely and I couldn’t be happier. He is quiet when he breathes! He has a slight case of Horner’s Syndrome but the vet said since he can blink and close his eye he doesn’t need drops to treat it.
I will definitely talk to the vet about these questions but I was wondering if anyone else could provide any insight.
Has anyone else done two VBOs before? How long did you wait in between the two surgeries?
I am thinking it’s a good idea to wait a “normal amount of time” aka 2 - 4 weeks?? For the Horner’s Syndrome to hopefully resolve itself before we do the second surgery. How long does the typical case of Horner’s last post VBO?
Even without the Horner’s, I’m not sure how long to wait in between each surgery. I don’t want the clean/fixed side to be contaminated by the dirty other side that still has the polyp. Is that a thing that could happen? Thanks for reading and any advice you can give!
 

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silent meowlook

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Hi. I have worked at a hospital that did VBO on a cat that had reoccurring ear infections that were not treatable with normal routine medications. I don't know all the details of the surgery since it was close to 15 years ago and with a different department than I was working at. I did however take care of the cat in the hospital and at his home for the following couple of days. That cat did not get Horner's syndrome,

It would completely make sense that your cat got Horner's from the surgery. Cats can get Horner's from an ear cleaning or even a bath. There are many reasons they can get it and as far as I know it usually clears up within a month.

These are honestly questions you have to ask your vet that did the surgery, I am assuming it was done at a specialty hospital. I would follow their advice for the best outcome. It is a highly specialized surgery in cats and I think, if your cat is doing as well as you say, they must have done an excellent job. Someone that has a cat that has had the surgery done, really isn't qualified to give advice because each cat is different and what each surgeon has done in their experience of what works for their patients can be very different.

It sounds like your kitty is doing well. I am happy for you both.

I also want to say that you are a super hero for rescuing this kitty. You are the best!!
 

silent meowlook

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I couldn't copy this link for some reason, so I copied the text from it.

J Am Vet Med Assoc
. 2022 Apr 28;260(8):892-898. doi: 10.2460/javma.21.01.0054.
Transoral ventral tympanic bulla osteotomy in cats: 13 cases (2016-2019)
Pierre H M Moissonnier 1 2, Margaux Blondel 1, Maria Manou 2, Eric Viguier 1
Affiliations expand
PMID: 35358062 DOI: 10.2460/javma.21.01.0054
Abstract
Objective: To analyze the results of transoral ventral bulla osteotomy (TOVBO) in cats.

Animals: 13 client-owned cats treated by TOVBO between February 2016 and February 2019.

Procedures: Medical records of cats with a diagnosis of middle ear disease (MED) that underwent TOVBO were reviewed. The procedure was similar to the one described for dogs. Short-term follow-up was obtained via clinical examination before discharge and at day 15 postoperatively. Long-term follow-up was performed via telephone interview.

Results: 13 cats (age range, 8 months to 12 years) underwent unilateral (n = 10) or bilateral (3) TOVBO (16) for the treatment of tympanic bulla (TB) infection (10), nasopharyngeal inflammatory polyps (5), or bullet retrieval from the TB (1). There were no intraoperative complications. One cat with a poor preoperative status died at postoperative day 3 from pneumonia. Eight cats experienced postoperative complications including head tilt (n = 2), Horner syndrome (3), loss of appetite (2), and temporary blindness (1). Collected samples confirmed the presence of nasopharyngeal inflammatory polyps (5), or otitis media (8). Six months after surgical intervention, 9 cats were free of MED signs.

Clinical relevance: This oral approach provided a good access to the TB in all cases. The complications observed after TOVBO were similar to those for VBO. In cats, TOVBO seems to be an acceptable and safe minimally invasive alternative to the other approaches of the TB to address MED.

Similar articles
 
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GFSOT86

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Hi. I have worked at a hospital that did VBO on a cat that had reoccurring ear infections that were not treatable with normal routine medications. I don't know all the details of the surgery since it was close to 15 years ago and with a different department than I was working at. I did however take care of the cat in the hospital and at his home for the following couple of days. That cat did not get Horner's syndrome,

It would completely make sense that your cat got Horner's from the surgery. Cats can get Horner's from an ear cleaning or even a bath. There are many reasons they can get it and as far as I know it usually clears up within a month.

These are honestly questions you have to ask your vet that did the surgery, I am assuming it was done at a specialty hospital. I would follow their advice for the best outcome. It is a highly specialized surgery in cats and I think, if your cat is doing as well as you say, they must have done an excellent job. Someone that has a cat that has had the surgery done, really isn't qualified to give advice because each cat is different and what each surgeon has done in their experience of what works for their patients can be very different.

It sounds like your kitty is doing well. I am happy for you both.

I also want to say that you are a super hero for rescuing this kitty. You are the best!!
Thank you! he is my heart. The sweetest little man. Such a strong and stubborn fighter but also the biggest love.
Ok so hopefully about a month the Horners should clear up but could take a little bit longer and not be permanent still.
He is very active today, acting like his normal self when he feels good 😊. The last Gabapentin dose is in 3 hours and it’s now been a week since the surgery. The eye/eyelid is not getting worse and it’s definitely no where near as bad as some of the cases/photos I’ve seen so I’ve got my 🤞🏻!!
I will absolutely ask my surgeon and/or vet their advice on how long to wait in between the two surgeries, I was just doing research if anyone else has had to go through two of them and what they did. In case my surgeon tells me that it’s up to me to decide how long to wait.
I have no idea how common this surgery is since I seem to chose to own cats with rare medical maladies. I really just wanted to give myself peace of mind of how long Horners can usually last post VBO surgery before clearing up on its own.
My 11 year old cat, Sampson, died from a hemangiosarcoma which required an emergency splenectomy. This I’ve been told is usually only found/performed on large dogs!
My 13 year old cat, Figaro, died almost a year ago from lymphoma that originally presented as white blood cell and fibrous build up inside his eye!
So I’m used to being in the dark and on new territory with cats medical conditions now unfortunately. Just wasn’t sure how common a VBO was and I’ve honestly never heard of Horners syndrome until researching this surgery. They tell me the polyps for Oliver are benign which I tend to agree with because this ordeal has been happening for at least a year and a half now, if not longer, and the other two previously mentioned cats only lasted 2 months after major symptoms developed.
One thing I have noticed that perhaps you might have seen before us that when he yawns, instead of the tongue being straight (normal) it curves like a C shape with the opening of the C facing the side of the VBO. Have you ever seen anything like this before? And yes I promise I will also ask my vet all of this.
thanks!!!
 
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GFSOT86

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I couldn't copy this link for some reason, so I copied the text from it.

J Am Vet Med Assoc
. 2022 Apr 28;260(8):892-898. doi: 10.2460/javma.21.01.0054.
Transoral ventral tympanic bulla osteotomy in cats: 13 cases (2016-2019)
Pierre H M Moissonnier 1 2, Margaux Blondel 1, Maria Manou 2, Eric Viguier 1
Affiliations expand
PMID: 35358062 DOI: 10.2460/javma.21.01.0054
Abstract
Objective: To analyze the results of transoral ventral bulla osteotomy (TOVBO) in cats.

Animals: 13 client-owned cats treated by TOVBO between February 2016 and February 2019.

Procedures: Medical records of cats with a diagnosis of middle ear disease (MED) that underwent TOVBO were reviewed. The procedure was similar to the one described for dogs. Short-term follow-up was obtained via clinical examination before discharge and at day 15 postoperatively. Long-term follow-up was performed via telephone interview.

Results: 13 cats (age range, 8 months to 12 years) underwent unilateral (n = 10) or bilateral (3) TOVBO (16) for the treatment of tympanic bulla (TB) infection (10), nasopharyngeal inflammatory polyps (5), or bullet retrieval from the TB (1). There were no intraoperative complications. One cat with a poor preoperative status died at postoperative day 3 from pneumonia. Eight cats experienced postoperative complications including head tilt (n = 2), Horner syndrome (3), loss of appetite (2), and temporary blindness (1). Collected samples confirmed the presence of nasopharyngeal inflammatory polyps (5), or otitis media (8). Six months after surgical intervention, 9 cats were free of MED signs.

Clinical relevance: This oral approach provided a good access to the TB in all cases. The complications observed after TOVBO were similar to those for VBO. In cats, TOVBO seems to be an acceptable and safe minimally invasive alternative to the other approaches of the TB to address MED.

Similar articles
Thanks!!
 
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GFSOT86

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Okay thanks. Hoping it’s temporary but I guess if it’s not he should adapt to it. I’ll definitely try to show my vet.
 

silent meowlook

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I am so sorry about your other two cats. Hemangiosarcoma is very rare in cats. In 30 years, I have only seen it once, maybe twice.

The lymphoma you described, I have not seen originating from the eye.

I am sorry. They were lucky to be with you.
 
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GFSOT86

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I am so sorry about your other two cats. Hemangiosarcoma is very rare in cats. In 30 years, I have only seen it once, maybe twice.

The lymphoma you described, I have not seen originating from the eye.

I am sorry. They were lucky to be with you.
Thank you. I tried my best for both of them, but sometimes you just can’t beat cancer, darn it!

So far everything seems well with Oliver except for the Horners and Tongue curving and the tongue thing is kinda cute TBH. I think he’d adapt just fine to eating with it eventually.
Hopefully both of them will “repair” themselves - I’m trying not to worry unnecessarily.
I’m hoping Monday to hear back about the cultures from the polyps - the did say they believed them to be benign which makes sense to me given the time he’s had them. Also I definitely think postponing until the first week of Feb for the second surgery if not later should be best.
 
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Update for anyone else following/interested.

Tongue issue and “inability” to chew dry food: the vet did not know why this happened but we both believe it was due to inner swelling from the VBO pressing on nerves or deep tongue muscles. After 2.5 weeks, Oliver has been willing to actually chew dry food again. He still has trouble but the curve to the tongue when he yawns has become straighter. There is no way it’s due to oral issues (calici, tumors etc) because he was fine pre surgery. It’s leftover swelling pressing on nerves - explains both tongue and horners.

Horner’s syndrome - 2.5 weeks in, it has not gotten worse, it’s either the same or better - all in all a mild case.

2nd VBO - the vet said to wait 2 weeks for tongue/eating situation to improve and hopefully Horners syndrome to disappear. As long as I keep seeing improvement (or no change), we can keep waiting on the surgery for up to 6 months before worrying that the “dirty” side could infect the “cleaned” side.

Hope this helps someone else considering VBO or seek no the same symptoms post VBO that I did.
 
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