He's got a middle ear infection w/likely ruptured eardrum that just doesn't seem to be getting better. Have been treating in accordance with vet recommendations, but my guy seems to be doing worse at this point - lethargy, anti-social behavior, and low appetite for even his fav foods. It scares me to see him doing so poorly - he was better than this before treatment and I'm not sure what to do from here :-(
For those who want the short version
Sam is acting lethargic, anti-social and won't eat much...all out of the blue after 4 weeks of conventional treatment with oral and topical antibiotics. What should I do?
Has your cat gotten over a bad middle ear infection that didn't resolve quickly with standard treatments?
How did you achieve a good outcome?
What procedures, meds, alternative therapies helped?
For those who like details: the full history:
6 months ago - Had him treated for an ear infection in right ear (w/ Animax ointment), which seemed to resolve the issue.
1 month ago - His right eye was not blinking! Took him into a different vet, and who told us it was facial nerve paralysis from a big ear infection. Both ears were infected, with the right one being more severe. Our vet gave us Baytril Otic drops and oral clindamycin after testing a swab for bacteria and yeast (yes to both), and told me to continue with the artificial tears in the eye that doesn't blink.
Recent negative turn - Took him in to the new vet for two recheck appointments so far. At first, was told he was looking better and he seemed to have more movement in the eyelid area. Came back again, and vet was concerned that it wasn't looking better than the previous recheck. Vet suggested I finish the last dose of the clindamycin and then switch to Zithromax (25mg daily), as it was effective against another possible bacterial culprit. After taking him home from the vet that day, he didn't seem to be doing well. I figured he was probably just tired. He received the last dose of the clindamycin, and continued to seem increasingly lethargic and less hungry. Next day I switched him to Zithromax. Tendency toward lethargy and loss of appetite continued.
What I've done to try to stop his decline - Saw that his ear was red/inflamed deeper inside and causing him to scratch. Stopped the Baytril Otic, as the doc suggested it might be causing sensitivity in the ear canal because of the silver (though vet didn't say to do this explicitly). The ears looked substantially better. I put a couple of drops of jojoba oil in the ear canal, to soften wax and allow him to shake it out - this seemed to help get nasty stuff out and decreased redness. But the problems continued - only low level appetite, hiding behavior, sleeping lots and only getting up occasionally go to the cat box. I stopped the Zithromax today (it has a long half-life), because he looks so terrible and wouldn't eat anything. Am worried that it was causing nausea, stomach pain, or taste distortion that made him reject his favorite foods. It's been 36 hours since his last dose and symptoms all remain. The Baytril was last given 2.5 days ago.
Remaining conventional ideas, which all seem bad:
1. Ear cleaning under sedation - vet was not excited about this, said there could be vestibular problems even from simply cleaning with saline
2. Try Animax again, since it seemed to (at least for a while) work before, especially in clearing any pus/wax out of the ear canal - but what if this caused the problem in the first place, either by spreading the infection to the middle ear or because it was administered to a ruptured eardrum? This doesn't seem likely to entirely fix the middle ear problem.
3. Prednisolone orally at a small dose to reduce inflammation - don't want to do this because he seems sickly and I don't want to decrease immune response if he's fighting infection...also the risk of diabetes scares me.
What would you do if you were me? I'm planning on talking to the vet soon, but, as I said, I don't know what to do because all options the vet has given me look bad...and I just want to see Sam move around and act normal again as soon as possible. I'm worried sick myself!
Any shared ideas, experiences, etc. would be greatly appreciated!!!