SAM2.27: Destructive Rhinitis and Nasopharyngeal dz.

Destructive Rhinitis Ddx (3)

Feline chronic rhinosinusitis.

Fungal rhinosinusitis.

Neoplasia.

Feline Chronic Rhinosinusitis is a common problem in cats where they have

chronic bouts of upper resp dz w/ nasal discharge, increased mucous, and sneezing.

Feline Chronic Rhinosinusitis etiology

Probably multifactorial - FHV-1, secondary bacterial infection, failure of the local immune response.

Feline Chronic Rhinosinusitis - CS (2)

Bilateral nasal discharge.

Can be very mild w/ a majority of cats being systemically well (some get febrile and appear very ill).

Feline Chronic Rhinosinusitis Dx (2)

Exclusion.

R/O cryptococcosis via Ag test.

(No facial deformities)

Dx of Feline Chronic Rhinosinusitis: Tests that can help r/o other dzs (2)

Rhinoscopy and biopsy - Nasal cavity and retropharynx.

Histopath.

Histopath findings of Feline Chronic Rhinosinusitis (2)

Lymphoplasmacytic inflammation - implies chronicity.

Eosinophilic infiltrates - more likely dz associated w/ FHV-1.

Feline Chronic Rhinosinusitis: ABX for secondary infection (4)

Doxy - good spectrum for most common bacteria like Chlamydia, Pasteurella, Bord, and Mycoplasma.

Azithromycin - not effective against pseudomonas (some people use chronically, don't reco).

Amoxicillin - used for mycoplasma, but not effective against pseudomonas.

Clinda - use when there is bone involvement.

Feline Chronic Rhinosinusitis: Anti-inflammatory agents

Piroxicam.

Glucocorticoids - generally not indicated b/c already immunocompromised.

Feline Chronic Rhinosinusitis: Antiviral

Famciclovir - used if dz-associated w/ FHV-1 and eosinophilic inflammation.

Nasal Aspergillosis: Trend (2)

Worldwide.

Dogs >>> cats.

Most common Aspergillus spp.

A. fumigatus

Systemic form of Aspergillus spp

A. tereus.

Nasal Aspergillosis - Nasal form (2)

Primary infection in healthy dogs.

Secondary - penetrating trauma or FB.

Nasal Aspergillosis signalment

Young to middle-aged dolicocephalic dogs

Disseminated Invasive Aspergillosis is

Systemic dz - rare and mostly in GSD

Nasal Aspergillosis CS (3)

Chronic nasal discharged - Purulent or hemorrhagic.

Sneezing.

Neuro signs if invasion through cribriform plate.

Nasal Aspergillosis Dx options (4)

AGID or ELISA (Abs) - 30% FN for sinonasal dz.

Galactomannan Ag test - very sensitive if systemic form (Disseminated invasive).

Cytology.

Fungal Culture (77% sensitivity).

Definitive dx of Nasal Aspergillosis (2)

Changes in CT (destructive rhinitis).

Fungal plaques in rhinoscopy - tend to be in frontal sinus (tx while under anesthesia).

Cytology options for Nasal aspergillosis (2)

Nasal Discharge - low sensitivity (<20%).

Endoscopic - higher sensitivity (>90%).

Therapy for Nasal Aspergillosis - Best Tx

Local instillation w/ Cltrimazole 1% or Enilconazole 1-5%.

Local instillation of antifungal for Nasal aspergillosis

Foley is placed to prevent topical from getting into the throat, to ensure contact w/ mucosa.

Other Tx options for Nasal Aspergillosis (3)

Topical infusion (resolve w/ 1 (65%) or 2+ (87%) txs) - recheck in 1m and re-tx if plaques or nasal discharge.

Clotrimazole cream.

Trephination of the frontal sinus.

Clotrimazole cream (2)

Longer contact time, but potentially better results.

Can be done by O' at home.

Tx for Nasal Aspergillosis w/ cribriform plate compromise (4)

Ketoconazole (40% efficacy).

Fluconazole (60% efficacy).

Voriconazole or posaconazole (80% efficacy).

Tx for 2-6m.

Cryptococcus neoformans is associated w/

pigeon droppings

Cryptococcus gatti is associated w/

bark and leaf litter from eucalyptus trees.

Cryptococcus gatti is rarely

infective to dogs, but does in some endemic areas

Ddx for facial asymmetry in cats

Tumor or cryptococcus.

(NOT rhinosinusitis)

Dx of Cryptococcus

Serology

Dx of Nasal tumor

FNA of the lnn.

Stertorous breathing is indicative of a problem

w/ or extending to nasopharynx.

Nasopharynx is the

cavity Ca. to the choana and dorsal to the soft palate.

Ddx for Nasopharyngeal Dzs (3)

Tumors - older cats.

Polyps - young cats <2y.

Stenosis (more likely in older animals).

Nasopharyngeal Neoplasia

Retropharyngeal lymphoma.

Retropharyngeal lymphoma is seen as

Follicular hyperplasia on rhinoscopy

Signalment of retropharyngeal lymphoma

Adult to old cats w/ stertorous breathing.

Nasopharyngeal Neoplasia Dx and Tx (2)

Dx - Biopsy and Histo.

Tx - similar to nasal tumor.

Nasopharyngeal polyps signalment (3)

Young cats.

Average of 1.5yrs.

Maine coons.

Nasopharyngeal Polyps are

pedunculated neoplastic growths.

Originate in the epithelium of the Tympanic bulla or auditory tube.

CS of Nasopharyngeal Polyps - onset

Progressive and chronic.

CS of Nasopharyngeal Polyps (4)

Nasal discharge.

Stertorous breathing.

Sneezes.

Reverse sneeze.

Additional CS seen w/ Aural Polyps

Otitis.

Tx for Nasopharyngeal Polyps

Sx.

Pull it w/ a spay hooks

Prognosis for Nasopharyngeal Polyps

Facorable w/ mechanical removal.

Recurrence of Nasopharyngeal Polyps (3)

Traction only: 30-50%.

More common when middle ear is involved.

Can be up to 4y post-removal.

Feline Hamartoma Slides

check

Nasopharyngeal stenosis

Pathologic narrowing inside the nasopharynx

Etiology of Nasopharyngeal Stenosis

Congenital or Acquired.

Acquired Nasopharyngeal Stenosis - Etiologies (5)

Chronic rhinitis.

Aspiration rhinitis.

Sx.

Trauma.

Tumors and polyps.

Nasopharyngeal Stenosis Most common causes

Dogs - aspiration rhinitis after an anesthetic event.

Cats - chronic rhinitis.

Nasopharyngeal stenosis in dogs (2)

mean age of 2.4yrs.

~50/50 patent v. nonpatent.

Nasopharyngeal stenosis in cats (2)

mean age of 2.4 yrs.

90% patents, 10% nonpatent.

Nasopharyngeal Stenosis CS (5)

Stertorous breathing (not a requirement).

Dyspnea.

PO breathing.

Nasal discharge.

Gagging and repeated swallowing attempts.

Dx of Nasopharyngeal stensosis

CT or rhinoscopty

Management of Thin lesion (>5mm) for Nasopharyngeal stenosis

Balloon dilation - success after 1 dilation was 30% in dogs and 50% in cats.

Management of Thin lesion (<5mm) for Nasopharyngeal stenosis

Balloon dilation - success w/ a single attempt is 50%

Management of thicker lesions or unsuccessful balloon dilation for Nasopharyngeal stenosis can include what type of stents

Balloon-expandable metallic stent.

Self-expanding metallic stent.

Covered metallic stents.

Removable metallic stents.

If there is no opening in a nasopharyngeal stenosis then

a needle is used, then expanded until you can get balloon in

Prognosis for Nasopharyngeal stenosis

Good.

Complications of Nasopharyngeal stenosis (3)

Tissue-in growth.

Chronic infections.

Oronasal fistula.