Week 1 - Nasal disease and sneezing Flashcards
What are some clinical signs of nasal disease?
Clinical signs can be similar irrespective of the cause:
Nasal discharge – serous, mucoid, mucopurulent, sanguinous/epistaxis, mixed Sneezing
Pawing or rubbing at muzzle
Facial deformity, asymmetry (more likely with neoplasia)
Loss of pigment on the nasal planum
Ulceration
Epiphora -> excessive tears/watery
Open-mouth breathing
Halitosis (bad breath)
Stertor
Coughing
Seizure (rare)
What questions should you ask owners when concerned with nasal disease?
When last normal
Vaccination – cats
Previous episodes
One/both nares – did it start unilaterally
Nature of discharge/presence of blood
Reverse sneezing?
Pain/difficulty eating
Halitosis
Nasal disease can be primary or secondary. List some examples
Primary
- Viral/bacterial/fungal rhinitis
- FB
- Neoplasia
Secondary
- Dental disease (inflammation and nasal damage)
- Bacterial rhinitis secondary to viral rhinitis
Nasal signs can be caused by non-nasal disease. List some examples
Systemic disease
- respiratory disease
- coagulapathy
- severe hypertension
- infectious disease (e.g distemper)
Disease close by:
- Dental disease
- Nasopharyngeal abnormalities
- Reverse sneezing
- Vomitting/regurgitation
What is reverse sneezing and what are the clinical signs?
Reverse sneezing is the act of forceful convulsant inhalation. It is generally harmless and self-limiting (but owners are worried).
Triggered by nasopharyngeal iteration.
Loud inspiratory noise
Laboured respiratory effort
What are common causes of nasal disease?
Nasal neoplasia
Inflammatory or infectious rhinitis * Fungal rhinitis
Structural/ periodontal disease
Foreign body
Stenotic nares
Other, or no definitive diagnosis
What elements of the clinical exam are important with nasal disease?
Facial symmetry
Submandibular and reteropharyngeal lymph nodes
Teeth
Eye position/displacement
Facial pain
Air flow (glass slide to see condensation or tiny strand of cotton wool to ensure equal air flow).
What diagnostic methods are available for nasal disease?
Use image, look, sample
Image
- CT (preferred)
- Radiography
Look
- Rhinoscopy
Sample
- Blind nasal flush/biopsy (cytology)
- Blood tests (coagulation, serology)
What should you be worried about when an animal presents with acute onset epistasis (nose bleed).
Thrombocytopenia = a low blood platelet count = decreases ability to clot.
Before doing any investigation ensure that the patient is able to clot their blood!
In nasal disease - list the advantages and disadvantages of radiography
Advantages
- Non invasive
- Quick
- Available in most practises
Disadvantages
- Sedation/GA
- Poor visualisation of nasal cavities as there is an overlay of teeth and bone
In nasal disease - list the advantages and disadvantages of CT
Advantages
- Non invasive
- Good visualisation of anatomy
- Shows soft tissue
Disadvantages
- Sedation/GA
- Referral and expensive
- Not readily available
In nasal disease - list the advantages and disadvantages of Rhinoscopy
Advantages
- Visualise anatomy
- Dynamic real-time image
- Can treat/sample (remove FB or flush and sample)
Disadvantages
- Traumatic = can cause nose bleed that impacts image
In nasal disease - list the advantages and disadvantages of a blind nasal flush
Advantages
- Can take sample
- Cheap and quick
- Relatively non-invasive
- Immediate relief for patient
- Sometimes gain tissue sample of histopath
Disadvantages
- Unreliable sample as sampled the whole cavity
- GA required
Output = cytology, C & S and relief of symptoms
What structure has been affected in this radiograph?
Loss of turbinates/bone destruction
Increased opacity in nasal cavity
Why is CT the imaging modality of choice for nasal disease?
Increased detail and often easier to interpret areas like the sinuses and
nasopharynx as there’s no superimposition.
Allows distinction of soft tissue vs fluid(contrast)
What problems are evident in this CT and what would your differential be?
- Loss of turbinated on L hand side
- Bone loss on edges
Soft tissue neoplasm in the caudal left nasal cavity. Resulted in osteolysis and obstructive frontal sinus effusion
What nasal neoplasia is common in dogs and cats?
Dogs = carcinoma, sarcoma, (polyps rare)
Cats = Polyps (young cats), lymphoma, nasal carcinomas
For nasal neoplasia, what are the signs, diagnostic tests, treatment and prognosis?
Signs
- Nasal discharge
- Epistaxis
- Sneezing
- Snuffling
Diagnosis
- CT, radiography
- Rhinoscopy, biopsy
Treatment
- Radiotherapy +/- chemotherapy or surgery
Prognosis: depends on nature and location
What are some clinical signs that can point towards neoplasia?
Unilateral disease
Lytic lesions (bone has been destroyed, leaving a hole in the bone)
Which animals are prone to fungal disease?
Most common in young, mesocephalic (intermediate length and width) and doliocephalic (extremely long skulls) dogs
e.g Rotties, golden retrievers, German shepherd
What are common fungi that cause nasal disease, where do they come from?
Spores are environmental, breathed in and plaques form in some dogs
- rhinitis, FB or trauma can predispose
Dogs = Aspergillus fumigatus
Cats: Aspergillus or Cryptococcus spp
What are common clinical signs of fungal disease and how is it diagnosed?
Common
Cream or greenish nasal discharge (mucoid; mucopurulent or muco-haemorrhagic)
Nasal planum ulceration
Sneezing;
Nasal pain
Sometimes
Depigmentation
Epistaxis
Destruction of terbinates
Diagnosis: CT, rhinos copy, sampling
How do you treat nasal fungal disease and what is the prognosis?
Topical treatment is most effective
Remove as much infection as possible (debride)
Treat topically = Clotrimazole, Enilconazole
Prognosis: Good
What is feline rhinitis/sinusitis and what are some common clinical signs?
Inflammation of the nose and/ or sinuses
sneezing, snuffling, nasal discharge; anorexia; other URT signs
What foreign bodies are common in nasal disease?
Inhalation of grass/grass seeds
In cats -> common to vomit up grass which get stuck above the soft palate -> can use an endoscope to look through the mouth and upwards to the back of the nose
What causes feline rhinitis/sinusitis and what is the treatment?
Follows after viral upper respiratory tract infection: FHV, FCV
Fungal (Cryptococcus, Aspergillosis)
Inhaled allergens
Mass lesion: neoplasia; foreign body (grass blade!); NP polyp
Anatomical defects: cleft palate; trauma; NP stenosis
Dental disease
Primary bacterial rhinitis is RARE (Chlamydophila felis; Mycoplasma spp; Bordatella bronchiseptica)
Treatment: treat underlying cause and symptomatic management.
What are clinical signs of non-destructive (inflammatory) rhinitis, sinusitis?
Increased soft tissue density conforming to the turbinates
(mucopurulent exudate, haemorrhage).
No evidence of a well-defined mass or bony lysis.
Uni or bilateral.
Linked to viral dx in cats – FCV, FHV
How does FIV and FeLV results affect prognosis?
FIV = does not mean prognosis is worse
FeLV = more concerned and can affect prognosis
What is a polyp?
A polyp is a growth = most polyps are benign, but some can lead to cancer.
Han a polyp be visualised and can it be removed?
Spay hook may be used to draw the soft palate rostrally,
allowing visualization of the nasopharynx with a dental mirror.
A flexible endoscope may be retroflexed around the soft palate to enable visualization.
Yes can be removed -> clamp, twist and pull -> they can grow back
What is the nasal planum and what diseases are common?
The nasal planum is the pigmented, hairless, rostralmost surface of the external nose.
Depigmentation
Hyperkeratosis
Ulceration
Autoimmune eg pemphigus, lupus
Neoplasia
- Squamous cell carcinoma
- Cutaneous epitheliotropic lymphoma
- Others ++
Which animal is prone to squamous cell carcinoma?
White cats with solar exposure, rare in dogs
How do squamous cell carcinomas grow, how are they treated and what is the prognosis?
Stage 1: Carcinoma in situ (not invaded basal membrane)
Stage 2 : superficial SCC
Stage 3P infiltrative SCC, locally invasive, mets rare.
Photodynamic therapy (PDT), planectomy (biopsy may cure!), immunomodulators (imiquimod)
Good prognosis with nose off (look like Voldemort!!), may need repeat PDT
What are stenotic nares, what are the clinical signs and how are they treated?
Congenital - component of BOAS (dogs and cats!)
Dorsolateral nasal cartilages are medially displaced, impinging on
the external nasal opening and dramatically decreasing the
available lumen.
Clinical signs:
- Stertorous and stridorous inspiratory noise,
- Coughing,
- Reduced exercise tolerance, sleep disturbances
Treated: Surgery – wedge resection, laser ablation
