follow up to feline vestibular disease Q

Question
2 months ago you answered my question about my elderly cat Magic's dizzy spells and said:

"This is called vestibular disease and it is from either the inner ear or from something in the brain.  Usually, if the eyes wiggle side to side (horizontal nystagmus) then it is from the inner ear.  If these eye movements are vertical, then it is most likely in the brain.  Bonine (meclizine) usually helps relieve some of the dizziness, but high dose steroids are often used to decrease any inflammation around the nerves.  I have even done myringotomy (putting a hole in the eardrum) in some of these cases because the vestibular problem can arise from a change in the air pressure within the middle ear cavity."

We gave him 2 shots of Cerenia and his symptoms went away for 2 months but returned last night. We are trying Cerenia again and hoping for another good response, but regarding your answer, what steroid and dosage would you typically try in ideopathic geriatric vestibular disease? Do you recommend myringotomy based on a specific diagnosis or test results, or as a last resort if the condition doesn't respond to steroids?

There is an Animal Dermatology Clinic here in San Diego, would you recommend I take him there if symptoms persist?

http://www.animaldermatology.com/location/21/Animal-Dermatology-Clinic

Thanks for your help!
Theo

Answer
I know Dr. Griffin and Dr. Boord at that clinic.  They will do a good job for you.  To answer your question, I usually give an intravenous injection of dexamethasone sodium phosphate at 0.1 mg per pound of body weight.  I may repeat that dose in 3-4 days if it seems to help.  Myringotomy is done if I suspect anything in the middle ear that changes the air pressure.  They will have a video otoscope there and they can evaluate the eardrum under very high magnification to see if there is a problem within the middle ear cavity.