Bonnie's owners had suspected for some time that she was not quite right! It appeared that she was in some degree of discomfort but didn't or couldn't indicate where the problem lay.

This type of presentation is both challenging and frustrating to owners and veterinary surgeons alike. "If only they could talk" became a well used phrase in my consulting room.

It soon became clear after a very positive response to pain relief that "Bonnie" was indeed experiencing some discomfort, but where?

It then transpired, after repeated examinations, that we came across our first clue. Despite showing no symptoms of head shaking or scratching "Bonnie" had an ear infection which seemed initially to respond to medication.

The entire puzzle was not fully apparent until further investigation had been carried out. Ear swabs taken for culture demonstrated a particularly resistant organism (Pseudomonas) which failed to improve despite more intensive medication.

Radiography of her head finally highlighted the fact that she was suffering from a middle ear infection deep within her skull. Treatment of this type of condition is extremely difficult. Since the organism is able to thrive in this environment where it is warm, moist and there is no air, medical therapy can be very limited.

Since poor "Bonnie's" headaches were unremitting it was decided to opt for a more radical surgical option. The environment of Bonnie's ear canal and middle ear favours further growth of the organism therefore the logic is to remove the ear canal and clean out the middle ear (bulla osteotomy). If the organism has nowhere to flourish "Bonnie's" defences will then overcome it and the pain will cease.

Needless to say surgery of this kind is complex and not without complications. Fortunately, early indications are that "Bonnie" has finally taken a large step in the right direction for that longstanding headache!

Terry Dunne BVMS, Cert SAO, MRCVS

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