Meet Tom, a beautiful 18 month-old Maine Coon who had been struggling with chronic otitis externa since adoption. Despite months of topical treatments, his condition failed to improve, and he was eventually referred to our team at Hong Kong Veterinary Specialty Services.
In cases like Tom’s, where patients do not respond to initial medical therapy, it is essential to consider deeper underlying causes—particularly middle ear infection. Tom was diagnosed at an early stage of the disease but could have easily been missed for a few more months. Signs are typically quite discrete until they markedly worsen.
Advanced imaging with a CT scan of the skull revealed severe bilateral disease affecting both tympanic bullae (middle ears).
Under the same anaesthesia, surgical debridement was performed to address the infection directly.
Middle ear infections are unfortunately common in young cats, often associated with upper respiratory conditions such as feline viral infections (“cat flu”). If left untreated, they can progress to serious complications, including severe neurological signs such as:

• Head tilt (the head is persistently tilted to one side)
• Vestibular ataxia (loss of balance or a wobbly, uncoordinated walk)
• Nystagmus (rapid, involuntary eye movements)
• Facial nerve paralysis (drooping of the face, inability to blink, or changes in ear/lip position)
• Altered mentation (changes in behavior, confusion, or reduced awareness)
• Difficulty breathing (abnormal or labored breathing patterns)

Early diagnosis and timely surgical intervention—most commonly via ventral bulla osteotomy—offer the best outcomes for these patients and can significantly improve their quality of life.
Tom is now on the road to recovery, and his case highlights the importance of looking beyond surface symptoms when treatments aren’t working.