Nasal Disorders

Question 1

How do dogs get nasal aspergillosis?

Answer 1

• it’s found on NORMAL nasal mucosa
• ubiquitous in the environment
• NOT associated with immunosuppression
• tendency for Dolicocephalic (long snout) dogs

Question 2

Is canine aspergillosis associated with immunosuppression?

Answer 2

NOPE it is not

Question 3

What are the clinical signs of nasal aspergillosis in dogs?

Answer 3

• Initially UNILATERAL and can progress to bilateral
• some will have EPISTAXIS
• Nasofacial deformity
• ULCERATION and DEPIGMENTATION

Question 4

How do you DX canine aspergillosis?

Answer 4

Clinical signs PLUS:
- Rads can show ∆ in symmetry and and density
- CT may show turbinate lysis
- Rhinoscopy can show atrophied turbinates and plaques
- Cytology shows HYPHAE
Histologic fungal invasion is gold standard
Can fungal culture but not necessary. Don’t culture exudate.

Question 5

Describe TX of Aspergillosis

Answer 5

• Topical clotrimazole, one hour infusion, through nasal tubes*
• 80-90% will resolve with single treatment, some require more than one treatment.

Question 6

How do cats get cryptococcus?

Answer 6

Roman Nose
most have signs of nasal disease:
- bilateral mucopurulent nasal discharge
- sneezing
and also: submandibular lymphadenopathy, anterior uveitis, chorioretinitis, and rarely neurologic disease

Question 7

How do you DX cryptococcus in a cat?

Answer 7

cytologic evaluation of nasal discharge

antigen titer works very well – positive titer = Clinical Disease

Question 8

TX of cryptococcus in felines

Answer 8

1. Fluconazole is the best
2. Itraconazole
3. ketoconazole

Question 9

Signalment of dog with nasal tumor

Answer 9

middle aged or geriatric dolicocephalic dog

Question 10

clinical signs of nasal tumor in dog

Answer 10

unilateral mucopurulent nasal discharge
intermittent epistaxis
Inspiratory stertor
swelling of facial bones
exophthalmos
deviation of hard palate

Question 11

DX nasal tumor in dog

Answer 11

Skull radiographs or CT or MRI:

• bony lysis
• increased soft tissue opacity

retroflexed rhinoscopy:
- direct visualization pink to tan nodular mass

Question 12

TX of dog or cat with nasal tumor

Answer 12

Radiotherapy**
Chemo for Lymphoma and TVT
Piroxicam (COX2 selective) for carcinomas

Surgical debulking can be palliative but not increase survival time

Question 13

What are the typical historical and physical examination findings of nasopharyngeal polyps in cats?

Answer 13

Sneezing
Nasal discharge
Respiratory stridor
Rarely dysphagia and vestibular signs

Question 14

How are feline nasopharyngeal polyps diagnosed?

Answer 14

see mass on oral exam or notice mass effect under anesthesia
may see mass otoscopic exam
Rads may show inc. soft tissue opacity in bulla

Question 15

How are feline nasopharyngeal polyps treated?

Answer 15

traction/avulsion with 30-40% recurrence

after traction/avulsion a ventral bulla osteotomy has rare reccurence

Question 16

Is a fungal culture or detection of antibodies of aspergillus definitive dx?

Answer 16

NOPE

Question 17

When is systemic therapy warranted for aspergillus?

Answer 17

when it has extended out of the nasal cavity

• Ketoconazole
• itraconazole

Question 18

Are cats found with cryptococcus usually immunosuppressed?

Answer 18

NOPE

Question 19

Treatment guidelines for cyrptococcus

Answer 19

treat for 2 months and at least 1 month beyond resolution of symptoms (up to a year)

Question 20

Most common type of nasal tumor

Answer 20

adenocarcinoma

lymphoma is more common in cats

Question 21

Do you need a biopsy for nasal tumors?

Answer 21

YES you must discern what type it is for treatment, whether radiation or chemo will be helpful, and progonosis

Question 22

Canine nasal tumor prognosis

Answer 22

1. no treatment – 3-6 months
2. SX alone – 3-6 months
3. Radiotherapy and treatment – 12-16 months

No difference if just surgery or just treatment. Radiotherapy is the way to go

Adenocarcinomas and sarcomas may have longer MST
SCC and aplastic have shorter MST

Cats have better Px than dogs

Question 23

How can you differentiate what side a nasopharyngeal polyp is on if rads are unhelpful?

Answer 23

traction/avulsion and the side that Horner’s develops on is the side for bulla osteotomy