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Primary Secretory Otitis Media in the Cavalier King Charles Spaniel is a rare and complex disorder. However, using a well established protocol, including well established procedures, modern day imaging tech-nology, precise treatment and adequate post-treatment care can lead to a high rate of successfully dissipated symptoms and long-term well-being our the patients. The suggested protocol is based on 14 examined patients in a 1 year time period. It includes otoscopic examination, cytology, culture and sensitivity testing, magnetic resonance imaging, viodeootoscopy, deep ear cleaning, myringotomy, educating the owners, owners’ feedback, subsequent therapy and long-term follow up. The study concludes that MRI and educating the owners are two extremely important tools that should not be overlooked. Additionally, further research with the addition of DNA analysis is needed.