31 Disorders of the Nasal Cavity

UPPER

Are FHV and FCV *upper or lower* respiratory infections?

a. Feline Herpes Virus aka Feline Rhinotracheitis Virus

This feline upper respiratory infection causes *corneal ulceration*, dermatitis, abortion, and neonatal death

a. FHV (feline herpes virus, rhinotracheitis)

b. FCV (feline calicivirus)

c. Chlamydophila felis

d. Bordetella bronchiseptica

b. Feline Calici virus

This feline upper respiratory infection causes oral ulceration, interstitial pneumonia, and polyarthritis (the cat will sit on their back paws like a dog not wanting to put weight on their front)

a. FHV (feline herpes virus, rhinotracheitis)

b. FCV (feline calicivirus)

c. Chlamydophila felis

d. Bordetella bronchiseptica

Upper = ulcerations

Is this more typical of *upper or lower* feline respiratory infection?

Acute

Which is more common, *acute or chronic* feline upper respiratory infections?

Upper

Is Chlamydophila felis an *upper or lower* respiratory infection of cats?

Upper respiratory infection

Is Bordetella bronchiseptica an *upper or lower* respiratory infection of cats?

c. Chlamydophila felis

This upper respiratory infection of cats commonly causes conjunctivitis-conjunctival inclusion body

a. FHV (feline herpes virus, rhinotracheitis)

b. FCV (feline calicivirus)

c. Chlamydophila felis

d. Bordetella bronchiseptica

d. Bordetella bronchiseptica

This upper respiratory infection of cats commonly causes coughing and pneumonia in young kittens

a. FHV (feline herpes virus, rhinotracheitis)

b. FCV (feline calicivirus)

c. Chlamydophila felis

d. Bordetella bronchiseptica

*signalment and clinical presentation*, though commercial PCR respiratory panels can be useful

How do you primarily diagnose feline upper respiratory infection?

Steroids because they will prolong clinical signs and inc. shedding of virus

What treatment should you absolutely NOT GIVE feline upper respiratory infection patients? Why?

Supportive for clear nasal discharge (vaporizer), antibiotics for secondary infection (*doxycycline*)

What treatments SHOULD you give feline upper respiratory infection patients?

SECONDARY = from inflamed and compromised mucosa

Majority of bacterial rhinitis is *primary or secondary*? Why?

7-10 days

A typical bacterial rhinitis infection is resolved in how many days?

Fungal nasal disease: Cryptococcus neoformans

What is this a typical presentation of (nasal swelling in younger cats)?

Fungal nasal disease: Aspergillus fumigatus

What is this a typical presentation of (depigmentation and ulceration in a dog)?

Feline Cryptococcus (cryptococcus neoformans)

This saprophytic yeast-like organism is found in avian excrement, has *large polysaccharide capsules* and typically presents as a nose issue in cats that may or may not have immunosuppression (immunosuppression does not predispose)

a. facial swelling/deformity

b. sneezing

e. mucopurulent discharge

f. ulcerative lesion on nasal planum

Select which of the following signs are CLASSIC for feline cryptococcus:

a. facial swelling/deformity

b. sneezing

c. systemic lameness

d. anisophoria

e. mucopurulent discharge

f. ulcerative lesion on nasal planum

Fungal

Seeing things like this on a fundic exam is more typical of *bacterial or viral or fungal* disease.

CYTOLOGY (FNA of facial lesion, nasal discharge) AND SEROLOGY (cryptococcal latex agglutination capsular antigen titer)

What diagnosis can you do for Feline Cryptococcus?

Feline Cryptococcus

Which problem can be diagnosed thru *cytology* FNA of facial lesion or nasal discharge and *serology* cryptococcal agglutination capsular antigen titer (positive is DIAGNOSTIC)?

Feline Cryptococcus cytology

What is this?

Fluconazole

Which is the best antifungal used to treat feline cryptococcus?

MINIMUM of 2 months

How long do you need to treat feline cryptococcus with fluconazole?

FALSE

TRUE OR FALSE: magnitude of positive antigen titer of feline cryptococcus is prognostic

Cryptococcus

What is this unilateral presentation typical of?

Dogs

Aspergillosis is a more common fungal disease of *cats or dogs*

Aspergillosis

This fungal disease in dogs causes destruction of the nasal turbinates, but luckily is often specific to the nasal cavity (not systemic)

Ulceration of nasal planum: think fungal nasal disease like Blastomycosis and Aspergillosis

What is happening here and name a few things it could be

Mesocephalic to dolichocephalic

What type/shape of dog is Aspergillosis commonly seen in?

NO

Is immunosuppression a predisposing factor in Aspergillosis?

Ulceration/depigmentation of the nares: Aspergillosis top differential

A dog is shy or painful when touching the bridge of the nose and it looks like this. What is this presentation? What are you thinking?

a. radiographs

b. CT

c. rhinoscopy

d. serology

e. cytology and histopath

Select the diagnostic methods you can use for Aspergillosis:

a. radiographs

b. CT

c. rhinoscopy

d. serology

e. cytology and histopath

f. pharyngeal wash

Aspergillosis (x-ray)

What is this being used to diagnose, where there is loss of nasal turbinates, increase in soft tissue density, but NO lysis or deviation of the vomer or frontal bones (typically)

Aspergillosis (CT)

note: but remember neoplasia would also be a top

What is this being used to diagnose, showing you destruction of the turbinates and overall integrity of turbinates and cribriform plate?

Aspergillosis (rhinoscopy)

What is this being used to diagnose, showing you white mats, plaques, or granulomas which need to be debulked prior to treatment?

Aspergillosis

What is this being used to diagnose, showing braching hyphae?

Aspergillosis: serology CANNOT be used to assess response to treatment

Cryptococcus: serology used to monitor response to therapy (Cryptococcal latex agglutination capsular antigen titer)

What is the difference between using serology for diagnosis of Aspergillosis versus Cryptococcus?

Topical treatment: Clotrimazole and Enilconazole

What is the BEST treatment for Aspergillosis?

c. clotrimazole

e. enilconazole

Select the best topical treatments used for Aspergillosis:

a. dexamethazone

b. banamine

c. clotrimazole

d. oseltamivir

e. enilconazole

f. apomorphine

Trephination

What is this alternative treatment for Aspergillosis, placing tubes into the sinuses and nasal cavities?

If cribriform plate is disrupted or other systemic involvement

When is systemic therapy indicated for alternative Aspergillosis treatment?

80-90% cure rate with topical clotrimazole under anesthesia

*What is the prognosis like for Aspergillosis?*

Nasal mites: paroxysmal and violent sneezing

What is this, treated with milbemycin or selemectin? What would the dog most likely present with clinically?

CATS

Are nasopharyngeal polyps more common in *cats or dogs*?

Feline nasopharyngeal polyps

These are inflammatory polyps or benign growths that occur in young cats and kittens that attach to the base of the eustachian tube and extend into the external ear canal or middle ear most commonly

a. Obstructive breathing pattern

c. stertor

e. mucopurulent discharge

f. head tilt, nystagmus and Horner's if in ear canal

Select some of the *most common clinical signs* of feline nasopharyngeal poylps:

a. Obstructive breathing pattern

b. epistaxis

c. stertor

d. anatomical anomaly of the nasal bridge

e. mucopurulent discharge

f. head tilt, nystagmus and Horner's if in ear canal

Feline

Which animal's tympanic membrane has a septum in health?

You have to go behind and pull up the soft palate

Normally you cannot see feline nasopharyngeal polyps if you just look orally. So how do you get go them?

Normal feline skull

Is this normal or abnormal?

Feline nasopharyngeal polyp

What is this?

Surgical excision by traction via oral cavity + prednisolone

What is the best way to treat feline nasopharyngeal polyps?

Feline aural/otic inflammatory polyps

What is this?

Abnormal =soft tissue opacity in pharyngeal area is nasopharyngeal polyp

Is this feline skull normal or abnormal?

Tumor (nasal adenocarcinoma = common tumor at caudal aspect of nasal cavity)

What is this?

MALIGNANT (80-90%)

Most nasal neoplasia are *benign or malignant*

Adenocarcinoma

What is the most common nasal neoplasia in dogs?

Nasal neoplasia (first thought should be adenocarcinoma)

A dog presents with nasal discharge, sneezing, nasofacial deformity that looks like this, stertor, and open mouth breathing. Thoughts?

Nasal neoplasia (lymphoma in cat)

Though it doesn't say it a good differential would probably also be cryptococcus if history matches

A cat presents with enopthalamia, nasofacial deformity that looks like this, open mouth breathing, sneezing, and nasal discharge. Thoughts?

Nasal neoplasia (probably adenocarcinoma)

A dog presents with nasal turbinate destruction, soft tissue opacity, and some bony lysis. Thoughts?

Erosion of vomer bone and turbinates = nasal neoplasia (adenocarcinoma)

What is happening in this dog and differential?

Nasal neoplasia = lysis bone into orbit

What are you seeing on this CT?

Lymphoma

What is the most common nasal neoplasia in cats?

Squamous cell carcinoma

What is the most common neoplasia on the nasal planum, especially in WHITE cats?

Histopath

note: remember histopath is the study of entire tissues collected thru means like biopsy, whereas cytology is the study of cells collected thru means like swabs or washes

Though CT, rhinoscopy, and x ray may be great for seeing nasal neoplasia, what is the ONLY definitive diagnostic tool?

Radiation therapy

What is the treatment of choice for carcinomas and sarcomas?

12-16 months = longest prognosis of other treatments

What is the survival time like after using radiotherapy on nasal neoplasias like carcinoma and sarcoma?

Allergic rhinitis

This is hypersensitivity to airborne allergens in cats and dogs, treated by controlling allergens and giving antihistamines/corticosteroids

4 weeks

When we say something is "chronic", how long has it been going on for at least?

Idiopathic chronic feline rhinosinusitis

This *chronic mucoid or mucopurulent discharge for months to years* is typically a diagnosis of exclusion, showing sneezing and nasal discharge most consistently in cats

Idiopathic rhinitis

The number 1 cause of chronic mucoid or mucopuruelnt discharge in the nose is neoplasia. What is the second most common cause?

Chronic inflammation leads to turbinate destruction

What is the problem of the chronic inflammation associated with feline chronic rhinosinusitis?

Cetirizine

What antihistamine is commonly used for feline chronic rhinosinusitis management?

Canine lymphoplastic rhinitis

This is a diagnosis of exclusion in dogs, not related to CAV2, Parainfluenza, Chlamydophila or Bartonella, with bilateral nasodischarge, damage to turbinates, and sneezing

Dogs

You will likely need higher immunosuppressive doses of prednisone for management of *dogs or cats* with idiopathic rhinitis

Into the Eustachian tube

Where does the long stock on the feline nasopharyngeal polyp normally extend?