Nasal diseases Flashcards
Serous – watery, clear Nasal discharge can indicate (2)
Inflammatory disease, feline viral upper respiratory tract infection
Mucopurulent – viscous, opaque (white, yellow, green) nasal discharge can indicate
Any nasal disease with inflammation and secondary bacterial infection.
Bloody nasal discharge can indicate (3)
Aspergillosis, neoplasia, other inflammatory or infectious diseases damaging nasal vascular structures.
Epistaxis – pure blood
Remember also hemostatic disorders, systemic diseases, high blood pressure, hyperviscosity!
NB: Check coagulation!
Infectious Differential diagnoses for nasal discharge (4)
Canine infectious respiratory disease
complex (dogs)
Feline upper respiratory tract disease
(cats)
Aspergillosis
Canine distemper virus
Inflammatory Differential diagnoses for nasal discharge (3)
Lymphoplasmacytic rhinitis (dogs)
Feline chronic rhinosinusitis (cats)
Nasopharyngeal polyps
Dental Differential diagnoses for nasal discharge (2)
Tooth root abscess
Oronasal fistula
Neoplastic Differential diagnoses for nasal discharge (3)
Adenocarcinoma
Lymphoma
Sarcomas
Pulmonary disease Differential diagnoses for nasal discharge (2)
Bacterial pneumonia
Eosinophilic bronchopneumopathy
(dogs)
Describe Canine sinonasal aspergillosis
Common cause of chronic nasal
discharge in dogs.
Rare in cats
Caused by Aspergillus fumigatus
Restricted to nose and/or frontal sinuses
Unclear why only some of the exposed
dogs get disease
Characterized by severe nasal turbinate destruction:
Dermonecrolytic fungal toxins and inflammation
Disease may extend into surrounding soft tissues and even brain
Typical signalment in Canine sinonasal aspergillosis
Young to middle aged, large mesaticephalic or dolichochephalic male dogs
Clinical signs of Canine sinonasal aspergillosis
Chronic mucopurulet or bloody nasal discharge (unilateral -> bilateral),
facial pain, sneezing, reverse sneezing, depigmentation and ulceration of
nasal planum,
normal to increased airflow through nostrils,
decreased appetite, lethargy, seizures if inflammation extended to forebrain.
Diagnosis of Canine sinonasal aspergillosis.
No single test is diagnostic!
Combination of diagnostic procedures
necessary.
Destructive, cavitating changes
of nasal cavity can be seen with CT, radiographs, rhinoscopy.
Presence of fungus:
Rhinoscopic visualization of plaques, cytology, histology, serology or culture.
Treatment of Canine sinonasal aspergillosis.
Debridement of fungal plaques during rhinoscopy, also from frontal sinus if needed.
Topical treatment with enilconazole or clotrimazole soak under general anesthesia.
Control scoping and re-treatment in 2-5 weeks.
- Prognosis
Fair to good
Describe Canine lymphoplasmacytic rhinitis.
+ signalment
+ clin. signs
Also called idiopathic chronic rhinitis.
- Important, common chronic nasal disease in dogs.
Etiology unclear
Infectious, allergic, immune-mediated, odontogenic background?
Typical Signalment:
Young to middle-aged dog
Clinical signs
Usually bilateral, chronic mucoid, mucopurulent nasal discharge (rarely bloody).
Diagnosis of Canine lymphoplasmacytic
rhinitis.
Radiographic and CT findings
Increased soft tissue opacity in nasal cavity.
Usually no severe bony destruction.
Rhinoscopy
Turbinate erosion, inflammation, mucus
Diagnosis
Exclusion of other nasal diseases!
Lymphoplasmacytic infiltrates within
nasal mucosa in histopathology
Treatment of Canine lymphoplasmacytic rhinitis.
No specific treatment.
Humidification of nasal secretions
Saline drops into nasal cavity or saline nebulization.
Treatment of secondary bacterial infection
Corticosteroid treatment trial
Inhaled fluticasone, prednisolone
(Do not always help!)
Treatment trial with antifungals?
Trial with piroxicam, other NSAIDs?
Trial with antihistamine?
- Prognosis generally good, but some signs
may persist.
Most nasal tumors in dogs and cats are…?
+ clin. signs
+ physical exam
malignant.
Locally invasive, and In Older animals.
Dogs: adenocarcinoma, squamous cell carcinoma, undifferentiated carcinoma, sarcomas
Cats: lymphoma, adenocarcinoma, sarcomas
Clinical signs
Nasal discharge (serous, mucoid, mucopurulent, bloody), unilateral -> bilateral.
Physical examination
Absent air flow, deformation of facial bones, exophthalmos
Diagnosis of nasal neoplasia.
Diagnostic imaging
Soft tissue opacity, turbinate and facial bone destruction, asymmetric lesions, soft tissue mass external to facial bones.
Rhinoscopy
Soft tissue mass, also diffuse lesions
Histopathology required for diagnosis!
May not be representative: tumors cause a marked inflammatory response to nasal mucosa, secondary bacterial or fungal infections possible.
Fine needle aspirates from lymph nodes, mass or through lytic bone.
Treatment of nasal neoplasia.
Treatment depends on tumor type.
Radiation is the treatment of choice
for most tumors.
(+/- Surgery)
Or, Chemotherapy
+/- Surgery
Prognosis poor without proper treatment.
Describe Feline nasopharyngeal polyps.
+ clin. signs
Benign growths affecting young cats
Polypoid, pink mass with a stalk
Inflammatory tissue, connective tissue, epithelium.
Often attached to the base of eustachian tube
Can extend to ear canal, middle ear, pharynx, nasal cavity
Clinical signs
Serous or mucopurulent nasal discharge,
upper airway obstruction, stertorous breathing, signs indicating otitis externa or media/interna.
Diagnosis and treatment of feline nasopharyngeal polyps.
Diagnosis
Visualization in rhinoscopy, otoscopy, laryngoscopy. Remember to check ear canals!
If possible, radiographs or CT of the bullae to see involvement.
Histopathology after removal
Treatment
Removal by traction
Regrowth possible
Bulla osteotomy
Describe Feline chronic rhinosinusitis.
+ signalment
+ clin. signs
Etiology unknown -> idiopathic disease
Usually young adult cats
Clinical signs
Chronic bilateral mucoid or mucopurulent nasal discharge,
sometimes bloody, sneezing.
Diagnosis of Feline chronic rhinosinusitis.
Exclusion of other disease processes
Remember otoscopy and dental probing!
Secondary bacterial infection is common
Culturing nasal discharge is of no benefit
(Diagnostic nasal flush for culture?)
Oropharyngeal swabbing for PCR?
Calici, herpes, Mycoplasma, Bordetella
Result can be problematic to interpret!
Diagnostic imaging and rhinoscopy
Turbinate erosion, inflammatory changes, edema, mucus
Histology of nasal biopsies
Neutrophilic and/or lymphoplasmacytic inflammation, occasionally eosinophils
Treatment of Feline chronic rhinosinusitis.
Treatment is rarely curative, emphasis on palliation and management.
Decrease environmental irritants
Facilitate drainage of discharge (Topical saline, nasal flush under anesthesia)
Long-term periodic courses of antibiotics with anaerobe coverage and good penetrance to bone (Amoxicillin-clavulanate, clindamycin, doxycycline)
Reduce inflammation and pain (Prednisolone, inhaled steroids, antihistamine? NSAIDs?)
Nasal mites are caused by what spp.?
Describe nasal mite infestation.
Pneumonyssoides caninum
Small, whitish-yellowish mite, 1mm in size
Caudal nasopharynx and frontal sinuses of dogs
Signs: Reverse sneezing, sneezing, pawing of the nose, chronic nasal discharge, epistaxis, loss of smelling ability
NB Many infestations are subliclinical!
Treatment of nasal mites.
Pneumonyssoides caninum: Usually empirical treatment trial, mites may be seen in rhinoscopy.
Topical selamectin (Stronghold®) 3 times every 2 weeks
Milbemycin oxime (Interceptor®, Milbemax®) 1mg/kg po 3 times every
10 days
Ivermectin 0.2mg/kg sc, repeated once after 3 weeks
Imidaclopride/moxidectin (Advocate®), at least twice?
Isoxazolines(Bravecto®, Nexgard®, Simparica®, Credelio®), maybe?
Describe Bacterial rhinitis
Primary bacterial rhinitis uncommon in dogs.
Bordetella bronchiseptica rhintis occasionally seen in cats.
Usually secondary complication to another disease process.
Difficult to diagnose: Neutrophilic inflammation not specific. Bacterial cultures may grow normal flora.
