Nasal diseases

Question 1

Serous – watery, clear Nasal discharge can indicate (2)

Answer 1

 Inflammatory disease, feline viral upper respiratory tract infection

Question 2

Mucopurulent – viscous, opaque (white, yellow, green) nasal discharge can indicate

Answer 2

Any nasal disease with inflammation and secondary bacterial infection.

Question 3

Bloody nasal discharge can indicate (3)

Answer 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!

Question 4

Infectious Differential diagnoses for nasal discharge (4)

Answer 4

 Canine infectious respiratory disease
complex (dogs)

 Feline upper respiratory tract disease
(cats)

 Aspergillosis

 Canine distemper virus

Question 5

Inflammatory Differential diagnoses for nasal discharge (3)

Answer 5

 Lymphoplasmacytic rhinitis (dogs)
 Feline chronic rhinosinusitis (cats)
 Nasopharyngeal polyps

Question 6

Dental Differential diagnoses for nasal discharge (2)

Answer 6

 Tooth root abscess
 Oronasal fistula

Question 7

Neoplastic Differential diagnoses for nasal discharge (3)

Answer 7

 Adenocarcinoma
 Lymphoma
 Sarcomas

Question 8

Pulmonary disease Differential diagnoses for nasal discharge (2)

Answer 8

 Bacterial pneumonia
 Eosinophilic bronchopneumopathy
(dogs)

Question 9

Describe Canine sinonasal aspergillosis

Answer 9

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

Question 10

Typical signalment in Canine sinonasal aspergillosis

Answer 10

Young to middle aged, large mesaticephalic or dolichochephalic male dogs

Question 11

Clinical signs of Canine sinonasal aspergillosis

Answer 11

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.

Question 12

Diagnosis of Canine sinonasal aspergillosis.

Answer 12

 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.

Question 13

Treatment of Canine sinonasal aspergillosis.

Answer 13

 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

Question 14

Describe Canine lymphoplasmacytic rhinitis.
+ signalment
+ clin. signs

Answer 14

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).

Question 15

Diagnosis of Canine lymphoplasmacytic
rhinitis.

Answer 15

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

Question 16

Treatment of Canine lymphoplasmacytic rhinitis.

Answer 16

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.

Question 17

Most nasal tumors in dogs and cats are…?

+ clin. signs
+ physical exam

Answer 17

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

Question 18

Diagnosis of nasal neoplasia.

Answer 18

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.

Question 19

Treatment of nasal neoplasia.

Answer 19

Treatment depends on tumor type.

Radiation is the treatment of choice
for most tumors.
 (+/- Surgery)

Or, Chemotherapy
 +/- Surgery

Prognosis poor without proper treatment.

Question 20

Describe Feline nasopharyngeal polyps.
+ clin. signs

Answer 20

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.

Question 21

Diagnosis and treatment of feline nasopharyngeal polyps.

Answer 21

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

Question 22

Describe Feline chronic rhinosinusitis.
+ signalment
+ clin. signs

Answer 22

Etiology unknown -> idiopathic disease

Usually young adult cats

Clinical signs
 Chronic bilateral mucoid or mucopurulent nasal discharge,
sometimes bloody, sneezing.

Question 23

Diagnosis of Feline chronic rhinosinusitis.

Answer 23

 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

Question 24

Treatment of Feline chronic rhinosinusitis.

Answer 24

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?)

Question 25

Nasal mites are caused by what spp.?
Describe nasal mite infestation.

Answer 25

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!

Question 26

Treatment of nasal mites.

Answer 26

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?

Question 27

Describe Bacterial rhinitis

Answer 27

 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.