nasal disease of cats and dogs

Question 1

Nasopharyngeal polyp: tx

Answer 1

Removal through mouth or external ear canal with avulsion/traction

Question 2

Nasopharyngeal polyp: px

Answer 2

Good
Can recur in up to 1/3 of cases
Higher rate with bulla involvement
Ventral bulla osteotomy is more invasive
Contra lateral polyp occurs

Question 3

nasal FB

Answer 3

Uncommon
Plant awns, grass, small sticks, etc

Question 4

Nasal FB: Clin sxs

Answer 4

Acute onset of sneezing, after rooting in soil or playing in field
Sneezing is persistent and paroxysmal
Pawing at nose, possible epistaxis
Symptoms lessen as FB object migrates caudally
Chronicity leads to nasal d/c and sneezing

Question 5

nasal fb: dx & tx

Answer 5

Immediate rhinoscopy, small biopsy instruments can grasp and remove the material
Aggressive nasal flush may remove object that cannot be visualized
Advanced imaging- do at a later date if rhinoscopy comes up negative but symptoms persist
Surgical rhinotomy is rare

Question 6

lymphoplasmacytic rhinitis: causes

Answer 6

Idiopathic, possibly immune mediated
inhaled allergens or irritant
chronic in nature

Question 7

Lymphoplasmacytic rhinitis: clin sxs

Answer 7

Chronic nasal discharge, either unilateral or bilateral- typically mucoid or mucopurulent
Coughing
less common: reverse sneezing, stertor, ocular dc

Question 8

lymphoplasmacytic rhinitis: dx

Answer 8

Exclude other causes of inflammation
Advanced imaging is recommended: fluid accumulation, soft tissue opacification, turbinate destruction, less commonly frontal sinus involvement, changes bilateral despite unilateral symptoms
rhinoscopy: nasal d/c, red/inflamed/edematous mucosa, turbinate atrophy/destruction
biopsy: lymphoplasmacytic infl

Question 9

Lymphoplasmacytic rhinitis: tx

Answer 9

Glucocorticoids-systemic or topical
Other immune modulating medications
Antihistamines
Abx- doxy
NSAIDs

Question 10

allergic rhinitis

Answer 10

Uncommonly dx
Type 1 hypersensitivity
clinical signs may be seasonal

Question 11

Allergic rhinitis dx

Answer 11

bx will show eos

Question 12

allergic rhinitis: tx

Answer 12

Avoid environmental allergens, antihistamines, steroids initially
Good response to tx

Question 13

nasal aspergillosis

Answer 13

Ubiquitous soil saprophyte
Endogenous flora in nasal cavity?
Inf may occur following inhalation of a large number of fungal spores
Toxins and metabolites decreased mucociliary and phagocytic function
Dz spreads throughout the nasal cavity and often into frontal sinuses
Rarely disseminates-except German shepherds

Question 14

aspergillosis: signalment, hx and sxs

Answer 14

Young to middle age dogs
Rare in cats
Unilateral nasal dc-progress to bilateral, starts as mucopurulent to hemorrhagic
Sneezing, epistaxis
Pawing at noses
Ulceration and depigmention of nasal planum
Facial deformity in advanced cases
Lethargy and anorexia

Question 15

aspergillosis: dx

Answer 15

Suspect based on signalment, hx, clinical signs
ID of fungal plaques or fungal organisms
Advanced imaging (high sens & spec)-Frontal sinus involvement?
rhinoscopy: turbinate atrophy, fungal plaques

Question 16

aspergillosis: tx oral antifungals

Answer 16

Req prolonged administration
Oral fungicide not good success rate
Newer antifungals (voriconazole, posoconazole)-very expensive
Used for patients with cribiform plate destruction
Adjunctive therapy

Question 17

nasopharyngeal polyp definition

Answer 17

benign tumor composed of granulation tissue
covered with respiratory epithelial layer
surface may be ulcerated

Question 18

nasopharyngeal polyp: signalment

Answer 18

kitten and young adult cats
very rare in dogs
median onset: 3 mo to 6.1 years
range: 3 mo to 18 years

Question 19

nasopharyngeal polyp: cause

Answer 19

not known
may be congenital defect of 1st pharygneal pouch
may be due to chronic inflammation of middle ear

Question 20

nasopharyngeal polyp: location

Answer 20

usually originates in the middle ear and extends down a stalk to eustachian tube to reach the nasopharynx
extension through tympanic membrane into external ear canal may occur

Question 21

nasopharyngeal polyp: clin sxs

Answer 21

loud, stertorous breathing
sneezing
serous to mucopurulent nasal d/c
otitis externa or otitis media may develop-Horner’s syndrome, facial nerve paralysis

Question 22

nasopharyngeal polyp: dx

Answer 22

ID to tumor: oral or otoscopic exam
rads
CT scan or MRI-preferred (bulla involvement?)
caudal rhinoscopy

Question 23

lymphoplasmacytic rhinitis: signalment

Answer 23

middle age to older dogs (mean 8)
german shepherds and dachshund

Question 24

aspergillosis: cyto/histopath

Answer 24

direct endoscopic guidance is best
mucosal brush or impression smears
bx of plaque and adjacent mucosa
surrounding infl

Question 25

aspergillosis: culture

Answer 25

fungal culture of plaque
results takes 1-2 weeks
high spec
not always performed

Question 26

aspergillosis: serology

Answer 26

AGID
poor sens, good spec
rule in if pos, cannot rule out if neg

Question 27

aspergillosis: debridement of plaques

Answer 27

destroy all plaques! Destroy all plaques!
frontal sinus: trephination and curettage or open surgical debridement

Question 28

aspergillosis: tx

Answer 28

topical treatment
clotrimazole-infused slowly as 1% solution
destroy fungal plaques-then treatment with med