1) diseases of the nasal cavity and larynx Flashcards
Describe the functional anatomy of the nasal cavity
Nostrils, nasal plane, bony case, nasal septum, right and left halves of the nasal cavity, nasal conchae, choanae
- Respiratory and olfactory region
- Regulation of airflow (pulmonary oedema, mouth breathing!)
- Heating and humidification
- Mucosal cleaning
- Olfaction (cribriform plate, brain!)
Describe the history and clinical signs of the nasal cavity
Discharge, sneezing, bleeding, pain, stridor, dyspnoea, reverse sneezing
- Systemic diseases!
• Discharge (distemper, viral rhinotracheitis)
• Epistaxis (bleeding disorder)
- Physical examination
• Shape, nasal stridor, closing the mouth, discharge uni- / bilateral, inspection of the mouth (teeth!), depigmentation
What are some special diagnostic procedures?
Radiography • Sedation, positioning, limited value - Rhinoscopy • Anaesthesia, tracheal intubation, sphinx-like posture, visualization and biopsy! Treatment? - CT, MRI - Olfactory tests
Describe the general overview of diseases of the nasal cavity and frontal sinus
Congenital diseases
• Malformation of the nasal plane
• Oronasal, oropharyngeal clefts
• Primary ciliary dyskinesia / Kartagener’s syndrome
- Rhinitis
• Viral, bacterial, mycotic, specific (neurogenic) - Tumours
• Nasal plane / nasal cavity / frontal sinus - Epistaxis
- Trauma
Viral rhinitis of cats?
FHV-1, FCV 80-90% (URT)
➢ Paroxysmal sneezing, serous ocular and nasal discharge in 5 days mucopurulent
➢ Can be concurrently infected with both and cause similar clinical signs, and contribute towards chronic infection
o FHV can also have severe conjunctivitis and corneal ulceration
o FCV can have mild ocular signs, oral ulcers and gingivitis, lameness (self-limiting)
Chronic carriers: no signs or sneezing, mild nasal discharge, gingival ulceration
➢ Chronic viral disease can also lead to mucosal destruction and secondary bacterial infection leading to a syndrome called “chronic snufflers”
o Unilateral/bilateral mucopurulent nasal discharge
o +/- chronic sneezing
➢ Diagnosis
o PCR on conjunctival swab
o “chronic snufflers”
▪ Rule out other causes of mucopurulent nasal discharge
▪ Radiographs
▪ Scoping
▪ +/- culture of nasal discharge
➢ Treatment? Prevention!
o Supportive therapy: nebulization and humidification, lysine
o Antibiotics: doxycycline to prevent secondary bacterial infections
o “Chronic snufflers”
▪ 8 weeks of doxycycline or clindamycin (good bone penetration)
▪ +/- short courses of relapse
▪ +/- saline nebulization
▪ Anti-viral medication
Viral rhinitis of dogs?
Canine distemper - profuse mucopurulent discharge
- PCR !
Canine Herpes Virus - profuse mucupurulent discharge
diagnosis by autopsy
Bacterial rhinitis aetiology
usually secondary to:
viral infections
foregin body
tumour, disruption of mucosal integrity
Causes of conjunctivitis in cats
Mycoplasma and Chlamydophila felis
Causes of primary respiratory tract infections
Mycoplasma, Bordetella bronchiseptica, Clamydophila felis (cats)
Diagnosis of bacterial rhinitis
Culture of nasal swab
conjunctivits swab and PCR
Treatment of BActerial rhinitis
Treatment of underlying disease
supportive therapy with nebulizaiton and humidification, nutritional support
AB: DOxycycline for up to 3 weeks
Antibiotics in bacterial rhinitits?
Doxycycline for up to 3 weeks
Mycotic rhinitis in Dogs aetiology
Aspergillus spp. > cryptococcus
typically canine disease, especially young dogs with long nose
purulent to sanguineous discharge, pain on palpation, ulceration of nasal planum and signs of systemic illness
can have neurological signs
Mycotic rhinitis in cats aetiology
Cryptococcus - typically feline disease - cryptococcus neoformans
can have neurological signs with cryptococcus var gatti
LCAAT is used for monitoring titre levels as an indication of response therapy
Diagnosis of mycotic rhinitis
Rhinoscopy: Scoping (fungal plaques), bone resorption, atrophy of the conchae
• Serology – fungal antibody titres
• Biopsy, cytological demonstration of organisms
• culture
Treatment of mycotic rhinitis
topical 1% clotrimazole gel 1-3x endoscopy + oral itraconazole
topical enilconazole via tubes through trephine holes 10ml 16% BID for 14 days
systemic: ketoconazole, itraconazole or fluconazole for 8 weeks
cryptococcus: systemic antifungals
nasal polyps
especially in the cat - uni-/bilateral, nasal cavity, nasopharynx, clinical signs, rhinoscopy, radiographs, biopsy, surgery
cats may extend their necks and pant very anxious
recurence of the polyp is very unusual
prognosis for recovery is excellent
tumours of the nasal cavity
Any age, but > 5 years
- Commonly squamous cell carcinoma, adenocarcinoma, sarcoma, lymphoma (cats)
- Clinical signs
• Systemically well
• Unilateral to bilateral discharge, advanced cases see facial deformity
Internal Medicine Final Small Animals 2018
4
- Diagnosis
• Radiography, rhinoscopy, CT
• Scoping and biopsy
- Treatment: radiation therapy, chemotherapy, surgery
- Euthanasia (bleeding, dyspnoea, stop eating)
epistaxis
Nasal bleeding (recurrent / profuse)
- Caused by local and systemic disease processes
• Aspergillosis, tumour, trauma, DIC, coagulopathy, thrombocytopathy / thrombocytopenia, hypertension
- Radiography and rhinoscopy should be delayed for 48 hours!
- Nasal tamponade (sedation: threatening hypovolemic shock!), 1-3 drops of 0,1% adrenaline (brain arteries!)
general information about the pharynx diseases
General anatomy: Oro-/ naso-/ laryngopharynx
- History: dysphagia, coughing, gagging, regurgitation, salivation
- Physical examination: sedation +/-, intubation?
- Diagnostic procedures: pharyngoscopy, video fluoroscopy, retrograde rhinoscopy, CT (middle ear), ultrasonography (masses)
Name some diseases of the pharynx
Foreign body
- Common in dogs! Sudden salivation after eating bones (wood sticks), pain, dysphagia, dyspnoea; intubation?
Retropharyngeal abscess
- Migrating foreign body, salivation, fever, dysphagia, diagnosis difficult, painful neck, WBC ↑
Nasopharyngeal polyps
- See above
Nasopharyngeal stenosis
- Young cats, rare, open-mouth breathing, endoscopy, surgery, balloon dilatation
Soft palate abnormabilities?
Elongated soft palate
- Brachycephalic dogs, stertorous breathing, exercise intolerance, collapse, gagging
Cleft palate
- Neonate patients! Milk in the nares, aspiration! Surgery
Soft palate hypoplasia
- Brachycephalic dogs, chronic rhinitis, gagging, reverse sneezing
Functional anatomy of the larynx
Functions: air flow, protection of the lower airway (from
aspiration), vocalization
• 3 unpaired cart. (epiglottis, cricoid, thyroid) and 1 pair of
arytenoid cart.
• Glottis=cranial opening of the larynx (corniculate and
cuneiform process and epiglottis)
• Fe: interarytenoid cart. Ø, laryngeal ventricles Ø
• Cricoarytenoid muscles, caudal laryngeal nerves
history and diagnostic procedures in laryngeal disease
Changes in vocalisation, stridor (air turbulance through the
narrowed laryngeal opening), coughing, gagging
• Systemic disease? (neuropathy, myopathy?), secondary
complication? (aspiration)
• Palpation (pain? fremitus?), auscultation (stridor?),
exercising the patient
• Laryngoscopy (sedation?)
overview of diseases of the larybx
Laryngitis / obstructive inflammatory dis.
• Laryngeal paralysis
• Laryngeal collapse / brachycephalic airway
syndrome
• Neoplasia
laryngitis causes
• Common! Infectious agents Dog: CAV-2, CPIV, Bordetella
br., (kennel cough); Cat: FHV-1, FCV, vaccination?
• Loud cough, fever+/-, pneumonia+/-, lethargy+/-
• Antibiotics (doxycycline, amox+clav.)
• Antitussives (butorphanol, hydrocodone but pneumonia!)
• Other causes: local irritation (endotr. intubation, foreign
body, hot food, insect bites) Glucocorticosteroids!
Tracheostomy?
obstructive laryngitis
• Rare, dog and cats • Histopathology is imperative to distinguish between neoplasia and obstructive inflammatory disease • Severe respiratory distress, dysphonia, stridor, dyspnea • Glucocorticoids, tracheostomy tube placement
Laryngeal paralysis
Arytenoid cart. fails to abduct during inspiration! Recurrent
laryngeal nerve
Older, large breed dogs, idiopathic»(fe)
• Congenital: Bouvier des Flandres, Siberian Husky, Bull Terrier
Acquired (idiopathic, trauma, systemic neuromuscular disease):
Labrador Retrivers, Saint Bernards, Irish Setters
• Partial/complete; unilateral/bilateral
• Stridor, exercise intolerance, voice change, coughing,
respiratory distress, hyperthermia
• Inspection, paradoxic movement (laryngoscopy), complete
neurologic examination, X-ray (aspiration., metastatic dis.)
management of laryngeal paralysis
• Obstruction→ marked negaLve pressure
→ mucosal and pulmonary oedema
→ hyperthermia, inflammaLon
• Supplemental oxygen: endotracheal tube, mask, tracheal
catheter/tube (propofol 4-7mg/kg iv.)
• Sedation: anxiolytic tranquilizer acepromazine (0,02-0,05 mg/kg
iv.,im.,sc.)
• Hyperthermia: cool iv. fluid, wet towels over the animal
• Glucocorticoids, furosemide (oedema and inflammation)
• Examination and treatment any underlying disorder
• Surgical repair of the area to open the airway
(partial laryngectomy, arytenoid lateralisation, removal of
the vocal folds)
• Aspiration pneumonitis (common consequence)
laryngeal collapse/ brachycephalic airway syndrome
• Secondary to congenital airway malformations in
brachycephalic dogs (stenotic nares, elongated soft palate,
hypoplastic trachea, laryngeal saccular edema and
eversion)
• Chronic increased negative pressure during inspiration →
laryngeal cartilages will weaken and collapse (stage I-III.)
• Medially displaced cuneiform and corniculate processes
• Stridor, respiratory distress, syncope (exercise,
temp.)
• Sedation, oxygen, cooling, glucocorticoids,
furosemide
• Surgical treatment of congenital malfomations,
excision of everted laryngeal saccules
laryngeal neoplasia
• Rare
– Cats: squamous cell carcinoma, lymphoma but polyps
and obstuctive laryngitis!
– Dogs: malignant epithelial tumors and rhabdomyoma
• Dysphonia, stridor, respiratory distress, gagging,
coughing
• Laryngoscopy and biopsy, metastasis?
• Surgery (partial laryngectomy, permanent tracheostomy
