Nasal & Nasopharyngeal Disorders in SA Flashcards by Rebecca Hancorne

Clinical signs of nasal/nasopharyngeal disorders

Sneezing (nasal dz/foreign material)
Reverse sneeze (caudal nasal cavity or nasopharynx)
Nasal discharge - req’s characterisation
Swallowing motion (retronasal d/c & swallowing)
Resp sound (stertor)
Resp pattern (normal, open mouth, inspiratory effort)
Duration of clinical signs & onset

How well did you know this?

Not at all

Perfectly

What are some differentials for nasal or paranasal disorders?

congenital
inflammatory
infectious - fungal
neoplastic
nasal polyps
trauma
foreign body
extension of oral or dental dz

How well did you know this?

Not at all

Perfectly

What are some differentials for systemic dz?

V/regurg –> reflux content in the nasal cavity
Infection
if epistaxis –> hypertension, coagulopathy, hyperviscosity, vasculitis

How well did you know this?

Not at all

Perfectly

Are nasal & nasopharyngeal disorders an emergency?

Not often

How well did you know this?

Not at all

Perfectly

When is further evaluation required if there is a nasal/ nasopharyngeal disorder suspected?

*systemic cause
*chronic signs
*severe hemorrhage, pain, malformation
*suspicion of a FB

How well did you know this?

Not at all

Perfectly

How would you approach further eval of nasal/nasopharyngeal disorders?

Bloods
Imaging
Direct observations
Sampling

How well did you know this?

Not at all

Perfectly

What would you be looking for on a CBC as a sign of a disorder?

Neutrophilia (toxic changes) –> inflammation
Epistaxis –> thrombocytopenia, erythrocytosis, Signs of anemia

How well did you know this?

Not at all

Perfectly

What would you be looking for on biochemistry +/- protein electrophoresis?

Concomitant Dz
Systemic Dz
if epistaxis –> protein electrophoresis, hyperglobulinemia

How well did you know this?

Not at all

Perfectly

What clotting tests would you use if you saw epistaxis and what are you looking for with each?

PT/PTT: coagulopathy
TEG: thrombopathy, fibrinolysis disorder

How well did you know this?

Not at all

Perfectly

What tests might you do when looking for infectious dz in the nasal/nasopharyngeal areas?

Cryptococcal Antigen Test
Aspergillus Serology
Angiostrongylus Antigen Test
Faecal flotation
Leishmania/Ehrlichia if recent travel

How well did you know this?

Not at all

Perfectly

Why are radiographs difficult of the nasal/nasopharyngeal areas?

*difficult to take/time consuming
*heavy sedation/GA often req’d
*less detail than CT
*little/no info on cribriform plate
*bony structure only
*poor qlty

How well did you know this?

Not at all

Perfectly

Why is CT better than rads?

high sensitivity
allows for eval of bone/soft tissue incl. cribriform plate

How well did you know this?

Not at all

Perfectly

Why would you use rhinoscopy?

*visualization of nasal mucosa & turbinates
*ID of foreign material, fungal plaques
*Tissue Sampling

How well did you know this?

Not at all

Perfectly

What tests would you do on bx samples taken?

Histopath: neoplasia, inflammatory, fungal
Bacterial culture
Fungal culture: aspergillus, cryptococcus

How well did you know this?

Not at all

Perfectly

What are some common nasal/ nasopharyngeal conditions?

FB
infectious dz
inflammatory conditions
neoplasia

How well did you know this?

Not at all

Perfectly

What are clinical signs of a nasal FB?

acute onset of S
usually out in nature
+/- unilateral serous nasal d/c or epistaxis
later may develop mucopurulent d/c

How well did you know this?

Not at all

Perfectly

How would you treat nasal FB?

Deep sedation/GA
Direct visualization
Otoscopic exam
Rhinoscopy
Flushing of nasal cavity

How well did you know this?

Not at all

Perfectly

What are some common nasal/ nasopharyngeal infectious dz?

*Sinonasal aspergillosis
*cryptococcus (esp cats)
*pediatric feline URT dz
* bacterial rhinitis - rarely primary
*parasitic rhinitis –> Pneumonyssoides caninum (canine nasal mite)

How well did you know this?

Not at all

Perfectly

What is the common fungi that causes sinonasal aspergillosis?

Aspergillus fumigatus

How well did you know this?

Not at all

Perfectly

What are clinical signs that may cause you to suspect Sinonasal aspergillosis?

*mucopurulent, blood-tinged d/c
*unilateral than bilateral
*facial pain
*potential for CNS invasion
*depigmentation of nares

How well did you know this?

Not at all

Perfectly

How would you diagnose sinonasal aspergillosis?

nasal CT
rhinoscopy
Bx
culture

How well did you know this?

Not at all

Perfectly

What are some treatments that can be done for sinonasal aspergillosis?

local/topical
frontal sinus trepanation

What medications can be used for sinonasal aspergillosis?

Clotrimazole
Enilconazole
Usually both infused

What is the prognosis of an animal with Sinonasal aspergillosis?

Long-term generally good
Worse if CNS involved

What are some environmental factors that can lead to pediatric feline upper respiratory tract dz?

poor hygiene stress

What organisms contribute to primary infection in pediatric feline URT dz?

Feline herpesvirus-1 Feline Calicivirus Bordetella bronchiseptica Chlamydophila felis mycoplasma streptococcus

what organisms may contribute to a secondary infection in pediatric feline URT dz?

pasteurella spp e. coli

What clinical signs are common in pediatric feline URT dz?

lethargy & anorexia sneezing conjunctival hyperemia serous & mucopurulent nasal & ocular d/c resp distress - bronchopneumonia death

What testing could be done to help diagnose feline pediatric URT dz?

Bacterial culture Virus isolation or PCR PM

if feline pediatric URT dz is mild to moderate, how would you treat?

Resolves on its own with time (2-3 wks)

if feline pediatric URT dz is moderate to severe (mucopurulent d/c), what txt might you use?

fluid therapy antimicrobials enteral nutrition nebulization and oxygen if bronchopneumonia is present

If a relapse occurs, what txt might you use in feline pediatric URT dz?

Antivirals (Famciclovir) Topical ophthalmic preparations Other: interferon-mu, lysine

How can one manage feline pediatric URT dz?

environmental mgmt (stress mgmt, overcrowding, disinfection) Vx programs

What are some inflammatory conditions common to the nasal & nasopharyngeal area?

Lymphoplasmacytic rhinitis (dogs) feline chronic rhinosinusitis nasopharyngeal polyp (cat) nasopharyngeal stenosis

Idiopathic lymphoplasmacytic rhinitis, aka chronic rhinitis, has what chronic clinical signs?

Sneezing unilateral or bilateral nasal d/c (serous, mucopurulent, bloody)

Idiopathic lymphoplasmacytic rhinitis is more common in which animals?

young to middle age more common more common in large breeds/Dachshunds (?)

How do you diagnose idiopathic lymphoplasmacytic rhinitis?

Exclusion (CT & rhinoscopy & Bx) ID infiltrating plasmacytes & lymphocytes in nasal mucosa

How might you treat idiopathic lymphoplasmacytic rhinitis?

Glucocorticoids - oral, topical Cyclosporine - immune suppressors Doxycycline - immunomodulating antibiotics NSAIDs Avoid irritants

Feline chronic rhinosinusitis is suspected to be caused by...

Allergens FHV-1 Mycoplasma, Bordetella

How do you treat feline chronic rhinosinusitis?

* Supportive care * antibiotics for secondary bacterial infection (culture & sensitivity, Doxycycline or Amoxi-clav) * Anti-inflammatories (Meloxicam, Glucocorticoids) * Repeated nasal flush with saline * Antivirals

Feline nasopharyngeal polyps tend to originate from...

nasopharynx middle/outer ear

What are clinical signs of feline nasopharyngeal polyps?

* mucopurulent d/c * sneezing &/or reverse sneezing * stertorous breathing * gagging or dysphagia * otitis * +/- Horner's syndrome, head tilt

How would you diagnose feline nasopharyngeal polyps?

* CT * Direct visualisation (oral exam, otoscopy)

What txt can be used for feline nasopharyngeal polyps?

* Traction * Glucocorticoids * Ventral bulla osteotomy if recurrent

Nasopharyngeal stenosis can be either...

congenital or acquired

Nasopharyngeal stenosis is caused by

narrowing of nasal passages or nasopharynx causing an obstruction

What clinical signs are present in nasopharyngeal stenosis?

* mucopurulent nasal d/c * sneezing +/- reverse sneezing * stertorous breathing * gagging or dysphagia

How would you diagnose nasopharyngeal stenosis?

* Visualize stenosis (imaging & retroflex rhinoscopy) * balloon dilation * stent placement

Neoplasia in the nasal & nasopharyngeal areas are often...

malignant & locally invasive, but rarely metastasize

What are the most common neoplasias?

* Nasal adenocarcinoma * nasal lymphoma * undifferentiated carcinoma

How would you diagnose nasal/nasopharyngeal neoplasia?

CT Bx

Physical exam of neoplasia causes...

* asymmetry of the face & muzzle * facial deformity or ulceration * nasal d/c, epistaxis, sneezing

How would you locally treat nasal & nasopharyngeal disorders?

Radiotherapy

How would you systemically treat nasal/nasopharyngeal neoplasia?

Chemotherapy palliative care (analgesia, NSAIDs, Antibiotics as needed, etc)