Nasal & Nasopharyngeal Disorders in SA Flashcards
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
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
What are some differentials for systemic dz?
V/regurg –> reflux content in the nasal cavity
Infection
if epistaxis –> hypertension, coagulopathy, hyperviscosity, vasculitis
Are nasal & nasopharyngeal disorders an emergency?
Not often
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 would you approach further eval of nasal/nasopharyngeal disorders?
- Bloods
- Imaging
- Direct observations
- Sampling
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
What would you be looking for on biochemistry +/- protein electrophoresis?
Concomitant Dz
Systemic Dz
if epistaxis –> protein electrophoresis, hyperglobulinemia
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
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
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
Why is CT better than rads?
high sensitivity
allows for eval of bone/soft tissue incl. cribriform plate
Why would you use rhinoscopy?
*visualization of nasal mucosa & turbinates
*ID of foreign material, fungal plaques
*Tissue Sampling
What tests would you do on bx samples taken?
Histopath: neoplasia, inflammatory, fungal
Bacterial culture
Fungal culture: aspergillus, cryptococcus
What are some common nasal/ nasopharyngeal conditions?
FB
infectious dz
inflammatory conditions
neoplasia
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 would you treat nasal FB?
Deep sedation/GA
Direct visualization
Otoscopic exam
Rhinoscopy
Flushing of nasal cavity
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)
What is the common fungi that causes sinonasal aspergillosis?
Aspergillus fumigatus
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 would you diagnose sinonasal aspergillosis?
nasal CT
rhinoscopy
Bx
culture
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)
