Nasal & Nasopharyngeal Disorders in SA

Question 1

Clinical signs of nasal/nasopharyngeal disorders

Answer 1

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

Question 2

What are some differentials for nasal or paranasal disorders?

Answer 2

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

Question 3

What are some differentials for systemic dz?

Answer 3

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

Question 4

Are nasal & nasopharyngeal disorders an emergency?

Answer 4

Not often

Question 5

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

Answer 5

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

Question 6

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

Answer 6

1. Bloods
2. Imaging
3. Direct observations
4. Sampling

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

PT/PTT: coagulopathy
TEG: thrombopathy, fibrinolysis disorder

Question 10

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

Answer 10

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

Question 11

Why are radiographs difficult of the nasal/nasopharyngeal areas?

Answer 11

*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

Question 12

Why is CT better than rads?

Answer 12

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

Question 13

Why would you use rhinoscopy?

Answer 13

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

Question 14

What tests would you do on bx samples taken?

Answer 14

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

Question 15

What are some common nasal/ nasopharyngeal conditions?

Answer 15

FB
infectious dz
inflammatory conditions
neoplasia

Question 16

What are clinical signs of a nasal FB?

Answer 16

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

Question 17

How would you treat nasal FB?

Answer 17

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

Question 18

What are some common nasal/ nasopharyngeal infectious dz?

Answer 18

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

Question 19

What is the common fungi that causes sinonasal aspergillosis?

Answer 19

Aspergillus fumigatus

Question 20

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

Answer 20

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

Question 21

How would you diagnose sinonasal aspergillosis?

Answer 21

nasal CT
rhinoscopy
Bx
culture

Question 22

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

Answer 22

local/topical
frontal sinus trepanation

Question 23

What medications can be used for sinonasal aspergillosis?

Answer 23

Clotrimazole
Enilconazole
Usually both infused

Question 24

What is the prognosis of an animal with Sinonasal aspergillosis?

Answer 24

Long-term generally good
Worse if CNS involved

Question 25

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

Answer 25

poor hygiene stress

Question 26

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

Answer 26

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

Question 27

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

Answer 27

pasteurella spp e. coli

Question 28

What clinical signs are common in pediatric feline URT dz?

Answer 28

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

Question 29

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

Answer 29

Bacterial culture Virus isolation or PCR PM

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

How can one manage feline pediatric URT dz?

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

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

Question 36

Idiopathic lymphoplasmacytic rhinitis is more common in which animals?

Answer 36

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

Question 37

How do you diagnose idiopathic lymphoplasmacytic rhinitis?

Answer 37

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

Question 38

How might you treat idiopathic lymphoplasmacytic rhinitis?

Answer 38

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

Question 39

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

Answer 39

Allergens FHV-1 Mycoplasma, Bordetella

Question 40

How do you treat feline chronic rhinosinusitis?

Answer 40

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

Question 41

Feline nasopharyngeal polyps tend to originate from...

Answer 41

nasopharynx middle/outer ear

Question 42

What are clinical signs of feline nasopharyngeal polyps?

Answer 42

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

Question 43

How would you diagnose feline nasopharyngeal polyps?

Answer 43

* CT * Direct visualisation (oral exam, otoscopy)

Question 44

What txt can be used for feline nasopharyngeal polyps?

Answer 44

* Traction * Glucocorticoids * Ventral bulla osteotomy if recurrent

Question 45

Nasopharyngeal stenosis can be either...

Answer 45

congenital or acquired

Question 46

Nasopharyngeal stenosis is caused by

Answer 46

narrowing of nasal passages or nasopharynx causing an obstruction

Question 47

What clinical signs are present in nasopharyngeal stenosis?

Answer 47

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

Question 48

How would you diagnose nasopharyngeal stenosis?

Answer 48

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

Question 49

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

Answer 49

malignant & locally invasive, but rarely metastasize

Question 50

What are the most common neoplasias?

Answer 50

* Nasal adenocarcinoma * nasal lymphoma * undifferentiated carcinoma

Question 50

How would you diagnose nasal/nasopharyngeal neoplasia?

Answer 50

CT Bx

Question 51

Physical exam of neoplasia causes...

Answer 51

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

Question 52

How would you locally treat nasal & nasopharyngeal disorders?

Answer 52

Radiotherapy

Question 53

How would you systemically treat nasal/nasopharyngeal neoplasia?

Answer 53

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