What is your diagnosis? Middle ear material from a dog Nicole M. Weinstein 1 , Katie M. Boes 1 , Elizabeth Mauldin 2 , John Rossmeisl 3 1 Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA; 2 Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA; and 3 Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA Correspondence N. Weinstein, Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA E-mail: nweinste@vet.upenn.edu DOI:10.1111/vcp.12319 Case Presentation A 13-year-old, male castrated Cavalier King Charles Spaniel (CKCS) was referred to the Veterinary Teaching Hospital of the Virginia-Maryland Regional College of Veterinary Medi- cine for suspected vestibular disease of 2 days duration. The clinical history included a left head tilt and circling to the left, which progressed to left lateral recumbency within approxi- mately 12 hours. Upon admission, respiratory distress was also noted. Relevant physical and neurologic examination findings included moderate bilateral otic discharge, positional strabismus (OS), rotary nystagmus (OU) with a fast phase to the right, absence of postural reactions in all limbs, and exag- gerated spinal reflexes in all limbs. The clinical examination findings supported a multifocal neurologic condition that included dysfunction of both peripheral and central vestibu- lar systems. Magnetic resonance imaging (MRI) and an otoscopic examination were performed. MRI revealed material in both the left and right ear bullae as well as caudal occipital malfor- mation syndrome–syringohydromyelia (COMS-SM). During the otoscopic exam, the left tympanic membrane was bul- ging, but intact, while the right was ruptured. Slides of mate- rial obtained during myringotomy on the left ear were submitted for cytologic evaluation (Figures 1 and 2). Figure 1. Specimen from the middle ear of a Cavalier King Charles Spa- niel with vestibular disease. A B Figure 2. (A and B). Direct smear preparation of the middle ear material of a Cavalier King Charles Spaniel with vestibular disease. Wright–Giemsa 9 20 objective. 195 Vet Clin Pathol 45/1 (2016) 195–196 ©2016 American Society for Veterinary Clinical Pathology Veterinary Clinical Pathology ISSN 0275-6382