Unexpected upper airway obstruction after ear flushing in two cats

This case report outlines complications associated with ear flush procedures in two cats. The first case, a female Domestic Short Hair cat, aged 8 years and weighing 3.9 kg, presented with signs of Horner's syndrome and right-sided facial paralysis. Magnetic resonance imaging revealed bilateral otitis media and right-sided bulla osteolysis. Under general anaesthesia with sevoflurane, a bilateral myringotomy and ear flush was performed. After flushing of the right ear, there was significant swelling on the right side of the head, extending to the left side and with oropharyngeal oedema, which made visualization of the trachea impossible. It was decided not to attempt tracheal extubation. Intravenous (IV) clemastine and topical mannitol were administered to treat a possible drug reaction and decrease oedema, respectively. The cat was transferred to intensive care unit and maintained under general anaesthesia. The lungs were mechanically ventilated, and antimicrobials and steroids were administered IV. The subsequent day, as the swelling and oedema had resolved, successful extubation was performed, and the patient was discharged from the clinic. The second case was a spayed female Domestic Short Hair cat, aged 9 years, weighing 2.4 kg and with a history of ear disease. It had recently developed symptoms of right-sided peripheral vestibular syndrome. Under anaesthesia with sevoflurane, magnetic resonance imaging revealed bilateral otitis media with bulla osteitis. The cat's trachea was extubated after ear flush and myringotomy, followed shortly after by emergency orotracheal reintubation owing to oropharyngeal soft tissue swelling causing upper airway obstruction. The cat was administered glucose and phenylephrine topically and dexamethasone IV. The airway was nebulized with diluted epinephrine. Anaesthesia recovery and extubation were possible a few hours later. The cat recovered in an oxygen cage in the intensive care unit and was administered antimicrobials, maropitant and butorphanol IV and closely monitored overnight. The cat was discharged from the clinic the next day.