Nasal disease Flashcards
Name some of the main clinical signs of nasal disease
- Sneezing
- Snoring or increased respiratory noise
- Nasal discharge
- Epistaxis
- Facial pain
What are the DDx for acute nasal disease?
- Nasal foreign body
- Viral URT infection (cats)
- Allergic / irritant rhinitis
- Tooth root abscess: can present as nasal disease if they rupture internally into the nasal cavity
What are the DDx for chronic nasal disease?
- Unresolved acute disease
- Feline Rhinotracheitis
- Neoplasia
- Fungal rhinitis
- Lymphocytic/plasmacytic rhinitis
How should investigation of nasal disease be carried out on the clinical exam?
- Inspection of the head
- Palpation of the head
- Retropulsion of the globe
- Assessment of nasal airflow
- Oral examination
- Mandibular lymph node palpation
Inability to retropulse the globe indicates?
A space-occupying lesion in the retrobulbar space
Describe the use of blood tests when investigating nasal disease
- Routine haematology and biochemistry screens to look for evidence of systemic disease.
- Clotting profile if epistaxis is the only clinical sign, has been severe or there is evidence of haemorrhage elsewhere e.g. petichiae or ecchymoses.
- Serological testing for Aspergillus fumigatus or Cryptococcus neoformans
What other investigations can you do for nasal disease?
- Radiography
- Rhinoscopy
- Nasal biopsy
- Forced nasal flush
- FNA of lymph nodes
- Nasal swabs for bacteriology / cytology
Where other than the head should be radiographed if nasal neoplasia is suspected?
Thorax - to look for metastasis
What is the causative agent of fungal rhinosinusitis in the dog?
Aspergillus fumigatus
Which animals are most likely to be affected by fungal rhinosinusitis?
Young to middle aged medium or large breed dogs
Where in anatomically damaged by fungal rhinitis?
Causes extensive damage and destruction of the turbinates
What are the clinical signs of fungal rhinitis?
- Nasal discharge: usually mucopurulent. Epistaxis is a frequent finding
- Facial pain
- Ulceration and depigmentation of the nasal planum/nares
- Dullness and depression
What are the diagnostic methods for fungal rhinitis, which is gold standard?
- History and clinical signs.
- Serology: false negatives are relatively frequent, rarely false positives will occur
- Radiography
- Rhinoscopy
- Histopathy = GS!
What will be seen on radiographs of patients with fungal rhinitis?
Shows destruction of the turbinate bones with increased radiolucency and increased fluid density in the nasal cavity due to discharge
What will be seen on rhinoscopy of patients with fungal rhinitis?
Reveals turbinate destruction and possibly visible fungal plaques and allows collection of nasal biopsies
What is seen on the histopathy of patients with fungal rhinitis?
Identification of fungal hyphae in nasal biopsies is the gold standard for diagnosis of fungal rhinitis.
How can fungal rhinitis be treated?
Oral antifungal drugs are largely ineffective
Topical treatment with antifungal drugs is the most successful. 2 techniques are commonly used:
• Trephination of the frontal sinuses followed by packing with clotrimazole cream
• Non-invasive clotrimazole soaking via catheters placed in the nasal cavity
Which neoplasia’s can affect the nasal cavity?
A variety of mostly malignant tumours may affect the nasal cavity, including adenocarcinoma, osteosarcoma, chondrosarcoma, squamous cell carcinoma, fibrosarcoma and lymphoma
What are the clinical signs of a nasal neoplasia?
- Reduced nasal airflow.
- Nasal discharge (frequently epistaxis).
- Facial swelling or distortion
- Palate swelling or distortion
- Exopthalmos due to invasion into the retrobulbar space.
- Neurological signs due to extension through the cribriform plate
How is neoplasia of the nasal cavity diagnosed?
History and clinical signs Diagnostic imaging Rhinoscopy and biopsy
How is neoplasia of the nasal cavity treated?
- Radiation therapy: palliative rather than curative
- Chemotherapy for nasal lymphoma
Non-infectious inflammatory rhinitis is also known as?
Lymphocytic/plasmacytic rhinitis
What are the clinical signs of non-infectious inflammatory rhinitis?
- Serous or mucopurulent nasal discharge, usually bilateral.
- Sneezing / snorting.
How is non-infectious inflammatory rhinitis diagnosed?
History and clinical signs Diagnostic imaging
Rhinoscopy and biopsy
What will be seen on diagnostic images for non-infectious inflammatory rhinitis?
Mild loss of turbinate detail and increased soft tissue density due to discharge in the nasal cavity
What are the treatment approaches for non-infectious inflammatory rhinitis?
- Environmental modification: cleaning and ventilation, humidification
- Saline instillation / intermittent nasal flushes
- Anti-inflammatories (NSAIDs or corticosteroids)
- Antibacterials
- Mucolytics
- Allergen testing / elimination
Name some examples of common nasal foreign bodies
Grass seeds, pieces of wood, grass blades (especially in cats)
What are the clinical signs of a nasal foreign body?
- Sudden onset.
- Sneezing (often paroxysmal at first, later intermittent).
- Distress / pawing at face.
- Eventually may cause purulent nasal discharge (usually unilateral).
How is a nasal foreign body diagnosed?
- History and clinical signs
- Rhinoscopy
- Diagnostic imaging
- Exploratory rhinotomy
How is a nasal foreign body treated?
- Nasal flushing to dislodge the foreign body. Pack the common pharynx with swabs and examine them for the foreign body post-flushing.
- Endoscopic removal.
- Rostral retraction of the soft palate and retrieval with forceps for grass blades in cats.
- Rhinotomy if none of the above is successful.
How can dental disease cause nasal disease?
- If apical abscesses rupture into nasal cavity
- Usually in older patients
- Extract affected teeth and treat with appropriate Antibacterials
What are some other causes of nasal discharge?
- Cleft palate
- Ciliary dyskinesia
- Parasites
- Dysphagia and nasopharyngeal reflux
