You are not my cat's vet, but I have a question about ear infections.
March 21, 2023 12:16 PM   Subscribe

We have a cat with a stubborn ear infection and I'm looking for opinions/advice.

First, the cat.

This goblin has a stubborn ear infection in one ear that responded well to packing but came back quickly after the treatment. The vet we're using has told us that she has a polyp, and that it should be removed as it's the likely cause/main contributor to the infection. The packing was done twice at a cost of $185 per treatment.

In the materials we were given (and also in every place I've read online), the chance of the polyp recurring is said to be 'very high,' unless a more involved surgery is performed. This more involved surgery also comes with a substantially higher price tag. The first option is going to be about $1200, all in. They didn't even quote the second option.

I should mention that I have a slightly weird vibe from this particular vet; in the past I've gotten the feeling that there's a bias toward more expensive treatments. I get it, they need to make money, but early in this cat's life, they wanted to amputate one of her legs which had gotten injured prior to our getting her. The leg went on to heal fine on its own, and she has completely normal use of it.

So, my question: is this worth seeking another opinion on? On the one hand, does this sound normal/reasonable? On the other hand 'welp, twice with antibiotics didn't fix this - time to pull that thing out but it's going to come back anyway' seems...I don't know, off. Feedback and experiences welcome.

Bonus cat.
posted by jquinby to Pets & Animals (14 answers total)
Best answer: When my dog had recurrent ear infections, what wound up knocking it out was a round of prednisone—no fun for any of us (although, frankly, not less fun than cleaning out his ears every week) but it did the job for good after several failed courses of antibiotics. I'm not a vet, and a dog is not a cat, but given how effective it was I'm surprised your vet skipped straight to surgery. Based on some admittedly cursory reading I'm also not convinced polyps definitely cause ear infections rather than the other way around. In short: if you're getting a weird vibe, I think there's ample reason to get a second opinion!
posted by babelfish at 12:51 PM on March 21

Best answer: Is this a cat-only vet? You might see if there is a specialist cat vet you could go to for a second opinion. I went to one for my boy cat, and while I probably won't go back for routine things, for the health issues I was curious about, I got good professional advice about procedures and costs and risks and prognoses.

Certainly a second vet opinion is cheaper than $1200.
posted by hippybear at 1:03 PM on March 21 [4 favorites]

Best answer: Absolutely. It will likely be cheaper than re-packing and definitely cheaper than $1,200. Listen to the vibes.
posted by *s at 1:08 PM on March 21

Response by poster: It is not a cat-only vet; they're multi-animal, plus dog grooming, boarding, and the usual specialty food for sale in the front. Not big-box-adjacent, but not really mom-and-pop either.
posted by jquinby at 1:42 PM on March 21

Best answer: Yeah, I'd try another vet just to see what they say. They all vary wildly in how conservative they are to treat things and I think it's worth going with your gut to find one that you trust isn't just trying to make a buck on you.
posted by dawkins_7 at 2:08 PM on March 21 [1 favorite]

Best answer: I've seen "ear drying creme/powder" supposedly safe for cats and dogs. I've also seen an appliance sold on Indiegogo that's an electric dryer but I kinda doubt a cat would sit around for that. :)
posted by kschang at 2:57 PM on March 21

Best answer: Interesting timing. My 17 year old cat was just to the vet this week. Local vet, does all animals. She has an ear infection that we have drops for (I've never heard of packing the ear, intriguing!) It's called "Tresaderm", 15ml, and it must be refrigerated. It's worked very quickly on her ears (and I'm getting very good at bundling a small but feisty senior citizen cat).

As an aside: another cat I have I took to a different vet, which turned out to be affiliated with some sort of veterinary chain. They told me that cat needed her teeth out, and quoted me over $3,000. Second opinion said her teeth were fine (she was at the vet for an allergic skin condition). I worry that some of these chain type vets are all about the money, not necessarily the animals true needs.

So yeah, I'd go for a second opinion.
posted by annieb at 4:41 PM on March 21

Best answer: I got to ValuVet where I live, and there may be one near you. They don't do big things but their vets are great and have had good solutions! Going to a specialist may help but maybe also going to a place that's less invasive/fancy/expensive might be another thing to consider!
posted by smorgasbord at 6:30 PM on March 21

Best answer: Turns out it's on Kickstarter, and so far, very few backers.
posted by kschang at 12:59 AM on March 22

Best answer: Even if you end up doing the surgery, you should do it at a different vet after a second opinion. The only reason not to would be if you’re in a remote area that does not have other veterinary services within range, but it sounds like you’re in a place that supports more than the one vet, or can get to such a place. If a vet gives you iffy vibes, ditch them. It’s also extremely normal to get second opinions and ask around about prices for surgery and other specialty procedures. I don’t think that you need a cat specific vet, unless you know of one and want an excuse to check it out.

I also had not heard of ear packing before. Upon looking it up it seems to be a semisolid goop full of a combo of medications that they push into the ear, so you don’t have to give regular ear drops at home. Seems smart but also kind of one size fits all. Is your (very cute!) cat particularly uncooperative, or would she handle getting ear drops? Did your vet take any kind of sample and analyze it? Cuz it sounds like ear packing has an antibiotic, and antifungal, and a steroid in it, but if you actually knew if it was bacterial or fungal or something else you could be more specific in your treatment, as well as know better what to expect if it gets worse, thus justifying (or not) the cost and risk of surgery, or of pursuing other treatment options.
posted by Mizu at 3:20 AM on March 22

Response by poster: She would (probably) tolerate daily ear drops; she's already tolerating regular ear cleaning but is getting wary when she hears me pulling kleenex from the box or sees the bottle of ear wash in my hand.

The packing was a new one for me. It was lanolin, IIRC, mixed with other off-label antibiotics and other things. It was definitely bacterial - the cytology confirmed it. There are many veterinary options locally, including a cat-only specialist a bit further away. I'll make an appointment with someone today.

Thank you, all. Appreciate the feedback and gut-checks.
posted by jquinby at 8:27 AM on March 22 [2 favorites]

Best answer: It sounds reasonable to me, unfortunately. It's difficult to treat an infection when the polyp occludes the ear canal.

One of my cats had ventral bulla osteotomy surgery to treat a chronic ear infection and permanently remove the underlying polyp. The surgery involves removing the middle ear contents via an incision in the ventral neck.

My kitty was older at the time of his surgery, and he was feline leukemia positive, but he came through the surgery with flying colors. He did develop Horner syndrome, which is a result of sympathetic nervous system dysfunction. It caused transient anisocoria (unequal pupil size) and a droopy eyelid. Horner syndrome is not an unexpected complication of this surgery, >80% of cats get it.

My cat lived several more years with great quality of life until the very end. He never had issues with infection in that ear again. The surgery was very expensive but I'd do it again.

If you want to hear more about the ventral bulla osteotomy procedure, you can message me. I don't think you are ever wrong for seeking a second opinion, though.
posted by easy, lucky, free at 2:41 PM on March 22 [2 favorites]

Response by poster: Postscript: The second opinion confirmed the first diagnosis - the polyp should come out. However, the cost for the procedure was in the neighborhood of $400, which will include packing after-the-fact and steroids for inflammation. Kitty's on the schedule for tomorrow morning.
posted by jquinby at 10:24 AM on March 29 [1 favorite]

Response by poster: Post-postscript: the removal went well - holy cow that thing was huge! She recuperated in a day or two and the vet gave her a clean bill of health today. We'll watch and see, but so far there's no grodiness or smell - just a look of suspicion when I reach for the cat carrier.
posted by jquinby at 4:18 PM on April 10 [2 favorites]

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