Nasal disease

Question 1

What clinical signs do you associate with nasal disease?

Answer 1

• Nasal discharge – serous, mucoid, mucopurulent, sanguinous/epistaxis, mixed
• Sneezing
• Pawing or rubbing at muzzle
• Facial deformity, asymmetry (more likely with neoplasia)
• Loss of pigment on the nasal planum
• Ulceration
• Epiphora
• Open-mouth breathing
• Halitosis
• Stertor
• Coughing
• Seizure (rare)

Question 2

What history questions do you want to ask the owner?

Answer 2

• When last normal
• Vaccination – cats
• Previous episodes
• One/both nares – did it start unilaterally
• Nature of discharge/presence of blood
• Reverse sneezing?
• Pain/difficulty eating
• Halitosis

Question 3

What pathologies might result in nasal disease?

Answer 3

• Primary, eg viral rhinitis, FB, neoplasia, fungal rhinitis
• Secondary, eg dental disease causing inflammation and nasal damage, or nasal-related signs; bacterial rhinitis secondary to viral disease; stenotic nares

Nasal signs may be due to non-nasal disease:
- Systemic disease, eg respiratory disease, coagulopathy, severe hypertension
- Disease close by, eg dental disease, nasopharyngeal abnormalities

Question 4

What are examples of diseases that may look like nasal disease but are not primarily a nasal pathology?

Answer 4

• Systemic Infectious disease eg distemper
• Reverse sneezing
• Dental disease
• Coagulopathy
• Severe hypertension
• Vomiting/ regurgitation

Question 5

What elements of the clinical examination will be important in a patient with suspected nasal disease?

Answer 5

• Facial symmetry
• Sub-m LN
• TEETH
• Eye position
• Facial pain
• Air flow

Question 6

How will we investigate a case of nasal disease?

Answer 6

• History and CE
• Blood tests;
  
  • Coags
  • Serology
• Imaging
  
  • Radiographs
  • CT
  • Rhinoscopy
• Sampling:
  
  • Cytology
  • Biopsy
  • C&S

Question 7

What are the clinical signs of nasal neoplasia? How is it diagnosed? How is it treated? What is the prognosis?

Answer 7

Signs: nasal discharge, epistaxis, sneezing, snuffling

Diagnosis: radiography, CT rhinoscopy and biopsy.

Treatment: radiotherapy +/- chemotherapy/surgery.

Prognosis: depends on nature and location of tumour.

Question 8

What are the clinical signs of nasal fungal disease? How is it diagnosed? How is it treated?

Answer 8

Common clinical signs:
Cream or greenish nasal discharge (mucoid; mucopurulent or muco-haemorrhagic)
Nasal planum ulceration
Sneezing;
Nasal pain.
Depigmentation;
Epistaxis;
Destruction of turbinates.

Diagnosis:
CT; rhinoscopy; sampling

Treatment
Topical treatment is most effective
Remove as much infection as possible
Treat topically
Clotrimazole
Enilconazole

Question 9

What are possible diseases of the nasal planum?

Answer 9

• Depigmentation
• Hyperkeratosis
• Ulceration
• Autoimmune eg pemphigus, lupus
• Neoplasia
  
  • Squamous cell carcinoma
  • Cutaneous epitheliotropic lymphoma
  • Others ++