Cat with glue ear

Question
Bear with this long background. Question at bottom :) Over 2 years ago, cat had significant dizzy spells. Was zoomed up to UC Davis. MRI showed right middle ear full of goop, small amount in left. Had bulla osteotomy. Goop culture did not grow anything. She had another spell a week after surgery, perhaps caused by surgery.

Was fine after that for one year. Had one spell. Then about nine months later had one a month, 3 months in row. I finally realized kitty needed a new regular vet. Also went back to UC Davis. MRI showed full LEFT middle ear, right looks clear. Had myringotomy in left ear(was not offered bulla, to my later regret). Goop did not grow anything.

About 90 days go by: another day of dizzy spells Feb 2. UC Davis vet thinks goop accumulated again or wasn't fully cleaned out. Kitty is scheduled for MRI and possible bulla osteotomy in mid-March. The thinking is she did well after right bulla and one for the left may also have excellent results.

Kitty has been fine since Feb 2. It's hard to take a well cat to surgery, but if we wait and see...she's bound to have more spells that make her miserable and wreak havoc in her humans' lives.

I'm worried there won't be enough goop in there and the vet won't want to do a bulla osteotomy. (I'm also worried about more cost down the road, of course.) I guess I have two questions:

In your experience with glue ear, is it likely there IS a bunch of goop in that left middle ear soon after a myringotomy?

Given kitty's history, would it make sense for me to push for a bulla as prevention if there isn't much in there?

Thank you so much for your input.

Answer
Middle ear disease in cats results in an overproduction of mucus. This is usually from an infection.  The normal cultures that we do do not grow some of the organisms reaponsible for middle ear diseases in cats, like chlamydophylla, mycoplasmas, and bordetella.  Ask UC Davis if they cultured or treated for these organisms.  Sometimes in a truly sterile middle ear with effusion, we can place steroids into the bulla to cause the lining to regress and decrease the amount of mucus production.  If the eardrum is intact, when periodic myringotomy an dbulla flushing may be all tha tis needed to maintain your kitty. A bulla osteotomy removes the mucus producing lining of the middle ear, so it will decrease mucus accumulation.