Nasopharyngeal and Nasal Diseases Flashcards
Sneezing vs reverse sneezing?
Sneezing:
- Expiratory
- Usually associated with nasal or sinus disease
Reverse Sneezing:
- Inspiratory
- Usually associated with nasopharyngeal, caudal nasal, or sinus disease
Which of the following is true about nasopharyngeal polyps?
A. More common in young dogs
B. More common in young cats
C. More common in old dogs
D. More common in old cats
B. More common in young cats
What are causes of nasopharyngeal and middle ear polyps in cats?
- Congenital
- Chronic inflammation
- Viral infection
What are causes of nasopharyngeal and middle ear polyps in dogs?
- Usually secondary to chronic inflammation/rhinitis
What clinical signs can be present in patients with nasopharyngeal polyps?
- Chronic respiratory and/or otic signs
- Stertor
- Upper airway obstruction (may be in respiratory distress)
- Nasal discharge
- Voice change
- Reverse sneezing
- Gagging, coughing, excessive swallowing
What abnormal respiratory sounds can be heard in a patient with polyps?
A. Stertor
B. Stridor
C. Wheezes
D. Crackles
A. Stertor (nasopharyngeal region)
How are polyps causing respiratory distress treated?
Surgical intervention:
1. Traction-avulsion and corticosteroids
or
2. Ventral bulla osteotomy (VBO) if bulla involvement
What is required for definitive diagnosis of a polyp to R/O neoplasia?
Histopath
What is the prognosis after surgical resection of a polyp?
Good but recurrence is possible (VBO prevents recurrence)
What are the causes of nasopharyngeal stenosis?
- Regurg or vomiting (esp. under anesthesia)
- Chronic inflammation
- Post sx scarring
- Trauma
- Mass
What is the treatment protocol for patients with nasopharyngeal stenosis?
Balloon dilation most effective
What clinical signs can be seen in patients with nasopharyngeal stenosis?
-Stertor
- Gagging
- Open mouth breathing
- Nasal discharge
- Inspiratory and Expiratory dyspnea
A patient with suspect nasopharyngeal stenosis. How to diagnose?
- Endoscopy
- CT
What is the most common cause of fungal rhinitis in cats?
Cryptococcus
What are the clinical signs of fungal rhinitis in cats?
- Sneezing
- Nasal discharge (mucoid or purulent, often unilateral)
Which of the following is true about fungal rhinitis in cats?
A. More common in younger cats
B. More common in older cats
A. More common in younger cats
What mass effects result from fungal rhinitis in cats with cryptococcus?
- Decreased/absent nasal airflow
- Exopthalmos
- Facial asymmetry
- Stertor
- Mass in pterygopalantine fossa
What diagnostics need to be ran in a cat with external ulcers around the face, exopthalmos, absent airflow, and unilateral mucopurulent nasal discharge?
All clinical signs of fungal rhinitis (crypto)
- MDB, FELV, FIV
- Thoracic rads (R/O metastatic neoplasia)
- Cytology + culture of nasal d/c
- CT (Fungal rhinitis won’t cause bone lysis)
- Rhinoscopy with biopsy (after CT- more invasive, can skew results if done before)
What is the drug of choice for treatment of cryptococcus in cats?
Fluconazole PO - continue until Ag agglut test is 0
What is the drug of choice for treatment of aspergillus in cats?
Posaconazole or Itraconazole pO
What is the prognosis for a cat with an aspergillus infection?
Good if no CNS involvement, for for sino-orbital aspergillosis
Which of the following usually does not cause bony destruction and turbinate lysis?
A. Nasal neoplasia
B. Chronic rhinosinusitis
C. Cryptococcus
D. Sino-orbital aspergillosis
C. Cryptococcus
Common CS seen in cats and dogs with nasal neoplasia?
- Upper airway obstruction, decreased nasal airflow, epistaxis, sneezing
- Ocular and CNS signs can be present
In cats, __________ usually causes unilateral mucopurulent nasal discharge, while _________ usually causes bilateral mucopurulent nasal discharge
cryptococcus, chronic rhinosinusitis
Nasal airflow is usually preserved in which of the following nasal diseases in cats?
A. Nasal neoplasia
B. Chronic rhinosinusitis
C. Cryptococcus
D. Sino-orbital aspergillosis
B. Chronic rhinosinusitis
What clinical signs can be seen in cats with chronic rhinosinusitis?
- Sneezing
- Mucopurulent bilateral nasal discharge
- Usually nasal airflow is preserved
What age of cats are more susceptible to chronic rhinosinusitis?
Any and all ages
What diagnostics should be ran in a cat with suspect chronic rhinosinusitis?
- MDB, FELV, FIV
- Thoracic rads
- CT (can see bone lysis and inc. fluid density)
- Rhinoscopy and biopsy
- Dental exam
What is the drug treatment protocol for a cat with chronic rhinosinusitis?
- Antibiotics (Doxy, Azithromycin, Amoxi/Clav)
- NSAID (Meloxicam or Piroxicam) or Glucocorticoid (Pred)
What is the most common cause fungal rhinitis in dogs?
Aspergillus
What age and breed signalment in dogs are usually more susceptible to fungal rhinitis?
- Young to mild age
- Dolichocephalics , long nose breeds! (GSD,etc)
What clinical signs can be seen in dogs with fungal rhinitis?
- Copious mucopurulent nasal discharge, can be uni or bilateral
- Sneezing
- Epistaxis
- Facial pain, depigmentation, ulceration
What can be visualized on CT from a dog with fungal rhinitis?
- Destruction of turbinates and cavitations
- Assess the integrity of the cribiform plate
True or False: Dogs and cats with fungal rhinitis must be monitored throughout life as relapse is not uncommon
True
What is the treatment protocol for dogs with fungal rhinitis?
- Topical infusion of Clotrimazole or Enilconazole (catheter placed and soak with solution for 1 hr under GA)
- OR depot cream
- Antifungal PO if cribiform plate is not intact (Intraconazole, Terbinafine for 3-6 months)
What is the prognosis for a dog with fungal rhinitis?
Fair to good, relapse in common (50%)
What age and breed signalment in dogs are usually more susceptible to idiopathic lymphocytic rhinitis (ILPR)?
- Young to middle age
- Dolichocephalics , long nose breeds!
- Mesaticephalic large breeds
- Dachshunds
What clinical signs can be present in a dog with idiopathic lymphocytic rhinitis (ILPR)?
- Uni or bilateral mucopurulent nasal discharge
- Epistaxis
- Excessive mucus/mucosal edema may obstruct airflow
What diagnostics should be ran in a dog with suspect idiopathic lymphocytic rhinitis (ILPR)?
- MDB
- Thoracic rads
- Blood pressure and coag panel if discharge is hemorrhagic
What can be visualized on CT from a dog with idiopathic lymphocytic rhinitis (ILPR)?
May be normal or may show turbinate lysis and mucus accumulation
- Bony destruction and mass lesions are rare with ILPR
What is the treatment protocol for dogs with idiopathic lymphocytic rhinitis (ILPR)?
- Avoid smoke and other allergens
- Long term (6+ month) antibiotic with immunomodulatory effects + NSAID
- ^^ Doxycycline and Piroxicam
What is the prognosis for a dog with idiopathic lymphocytic rhinitis (ILPR)?
Fair, cure rarely achieved, frustrating if d/c can’t be controlled
If nasal discharge is hemorrhagic, which additional diagnostics should be ran?
- Blood pressure and coag panel if discharge is hemorrhagic
Have to R/O: Systemi hypertension, coagulopathy, hyperviscosity, vasculitis, etc
Which of the following is least likely to cause epistaxis?
A. Nasal neoplasia
B. Fungal rhinitis
C. Chronic rhinosinusitis
D. idiopathic lymphocytic rhinitis (ILPR)
C. Chronic rhinosinusitis
