Lesson 92 - Small Animal Nasal Disease

What typically causes a fever with nasal disease?

muscles working hard to breathe creating more heat

What clinical signs are common with nasal disease?

1. stertor

2. cyanosis

3. nasal discharge

4. sneezing

5. open mouth breathing

6. gagging

When a patient presents to you with signs of nasal disease and respiratory distress, what do you want to do?

keep it calm; exercise, excitement, temperature exacerbate distress

What does negative pressure due to nasal disease cause in the tissue?

inflammation and edema

What main things are you going to evaluate when a nasal disease patient in respiratory distress presents to you?

1. use of accessory muscles

2. discoloration of mucous membranes

3. poor refill time

What diseases localize to the nasal and paranasal areas in dogs?

1. adenocarcinoma

2. aspergillosis

3. foreign bodies

What diseases localize to the nasal and paranasal areas in cats?

1. lymphoma

2. cryptococcosis

3. nasopharyngeal polyps

Why are bacterial infections not a top differential with primary nasal disease?

the mucosa does a great job of protecting against bacteria and its usually only a secondary issue

What is something that all nasal diseases have in common?

1. inflammation

2. mucosal edema

3. +/- secondary bacterial infections

What is important for getting a history for nasal disease?

1. travel

2. accurate description of signs like sneezing vs reverse sneezing

What type of discharge is normal?

serous

If you have a mucopurulent discharge and then it becomes hemorrhagic, what differentials should be at the top of your list?

1. tumor

2. fungus

What discharges can be seen with viral infections?

1. serous

2. mucopurulent +/- blood

What discharges can be seen with fungal infections?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What viral infections can cause nasal disease?

1. feline herpesvirus

2. calicivirus

3. canine influenze

What fungal infections can cause nasal disease?

1. aspergillus

2. cryptococcus

3. penicillium

4. rhinosporidium

What type of discharge is seen with clotting disorders?

epistaxis

What type of discharge is seen with vasculitis?

epistaxis

What type of discharge is seen with hyperviscosity syndrome?

epistaxis

What type of discharge is seen with polycythemia systemic?

epistaxis

What type of discharge is seen with hypertension?

epistaxis

What parasites are common for nasal disease?

1. Pneumonyssoides

2. Capillaria

3. Cuterebra

4. Eucoleus boehmi

5. Linguatula serrata

What type of discharge is seen with parasites?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with neoplasia?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with a nasopharyngeal polyp?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with extension of oral disease?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with allergic rhinitis?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with feline chronic rhinosinusitis?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What type of discharge is seen with canine chronic rhinitis?

1. serous

2. mucopurulent +/- blood

3. epistaxis

What oral diseases can extend into the nasal cavity?

1. tooth root abscess

2. oronasal fistula

3. deformed palate

What are common initial diagnostics that all nasal diseases need?

1. history

2. physical exam

3. funduscopic exam

4. thoracic radiographs

5. blood pressure

What is a dog specific diagnostic for nasal disease?

aspergillosis titer

What is a feline specific diagnostic for nasal disease?

1. nasal swab cytology

2. cryptococcal antigen titer

3. viral testing

4. FeLV/FIV

5. +/- herpesvirus and calicivirus

What initial diagnostics should be included for any nasal disease causing hemorrhage?

1. CBC

2. platelet count

3. coagulation panel

4. +/- BMBT

5. tick borne disease panel in dogs

6. von Willebrand factor assay in dogs

What are advanced diagnostics we can do for nasal disease?

1. anesthesia and complete oral exam

2. nasal radiography/CT/MRI

3. rhinoscopy with biopsy or deep nasal culture

What do you need to do before rhinoscopy?

imaging

When would you want to culture for bacteria with a deep nasal culture?

if patient has been through multiple rounds of antimicrobials

What can we do if a patient cannot afford a referral for nasal imaging?

otoscope

How far do you put your otoscope into the nose?

don't go past the medial canthus

You suspect an infectious cause for a feline nasal disease. What infections can cause upper respiratory infection in cats?

1. Feline herpesvirus

2. Feline calicivirus

3. Bordetella bronchiseptica

4. Chlamydophila felis

5. Mycoplasmas

What are the signs of a feline upper respiratory infection?

1. fever

2. sneezing

3. nasal discharge

4. conjunctivitis

5. ocular discharge

What does feline herpesvirus mainly affect?

eyes and nose

What does feline calicivirus mainly affect?

nose and mouth

What is important about the treatment of feline upper respiratory infections?

usually self limiting but can have secondary bacterial infections

Where are feline URI's common?

shelters

What specific testing can be done for a cat with an upper respiratory infection?

immunofluorescence and virus isolation/PCR on conjunctival, pharyngeal, or tonsillar scrapings/biopsy for herpes and calicivirus

When do we use specific testing for viruses with feline URI?

cattery outbreaks mostly

What is a common clinical sign of calicivirus?

ulcers and vesicles in the oral cavity and nose

What is a clinical sign of FCV viral pneumonia?

orthopnea

What is a clinical sign of Chlamydophila felis?

chronic conjunctivitis

What is the treatment for feline URIs?

1. hydration and nutrition

2. nebulization

3. antimicrobials for secondary infection

4. ophthalmologic care if ulcers

What is the usual antibioticc used for secondary bacterial infections in cats?

penicillin +/-clavulanic acid

What antibiotic is used for a cat with a secondary bordetella, Chlamydophila, or Mycoplasma infection?

doxycycline

What do we have to be careful of with doxycycline in cats?

esophageal stricture

What drugs can we use if a cat has corneal ulcers and you suspect herpes virus?

1. Trifluridin

2. idoxuridine

3. adenine arabinoside

What vaccination options do we have for cats?

1. FHV and FCV advised for all cats

2. Chlamydophila optional

3. Bordetella not routinely needed

What does the FHV and FCV vaccine help with?

severity of disease not prevent infection

What testing is used for Cryptococcus neoformans?

antigen test and cytology

What do we use to monitor therapy of Cryptococcus neoformans?

antigen test

What is the treatment for Cryptococcus neoformans?

1. itraconazole and fluconazole

2. 5-flucytosine

3. amphotericin B-lipid complex

What is the treatment for canine aspergillosis?

topical clotrimazole

How do we treat Aspergillosis if the animal is immunocompromised?

1. azoles

2. +/- Amphotericin B lipid complex

3. surgical removal of granulomas

What is Pneumonyssoides caninum?

nasal mite

What are the clinical signs of Pneumonyssoides caninum?

1. violent sneezing

2. head shaking and pawing at nose

3. reverse sneezing

4. chronic nasal discharge

5. epistaxis

What is the treatment for Pneumonyssoides caninum?

Milbemycin oxime or ivermectin

Why are nasal mites not commonly seen?

heartworm prevention kills them

Where are nasopharyngeal polyps found typically?

1. eustachian tube

2. external/middle ear

3. pharynx and nasal cavity

What clinical signs are seen with nasopharyngeal polyps?

1. stertor

2. serous/mucopurulent discharge

3. neurologic signs

4. ear infections

How do we diagnose nasopharyngeal polyps?

1. radiographs

2. CT

3. otoscopy

4. gross visualization

5. histopathology for definitive diagnosis

What would be seen on radiographs for nasopharyngeal polyp?

soft tissue opacity above soft palate and maybe osseous bulla involvement

What is the treatment for nasopharyngeal polyps?

1. surgical traction

2. bulla osteotomy +/- rhinotomy

What is the prognosis for nasopharyngeal polyps?

1. excellent

2. may regrow with traction surgery

3. transient Horner syndrome

What signalment is more common for dog nasal tumors?

usually older dolichocephalic breeds

How do we diagnose nasal tumors in dogs?

1. radiographs

2. nasal CT

3. rhinoscopy with biopsy and histopathology gives definitive diagnosis

What imaging will we use to make our surgical plan for a nasal tumor?

CT

What radiographs do we want to take for a nasal tumor?

thoracic met check

What is the treatment of choice for most malignant nasal tumors?

radiation

What are the types of benign nasal neoplasias?

1. adenomas

2. fibromas

3. papillomas

4. transmissible venereal tumors

What are the types of malignant nasal neoplasias?

1. adenocarcinoma

2. squamous cell carcinoma

3. lymphoma

What is the treatment for benign nasal neoplasia?

1. surgical removal

2. chemo

3. NSAIDs

4. analgesics

What is the prognosis for nasal tumors in dogs?

1. untreated = poor

2. radiation = MST 13 months and excellent quality of life

What foreign bodies are common for the nose?

1. plant awns like foxtails

2. pine needles

3. mulch

4. grass/straw

5. twigs

6. bone fragments

What is allergic rhinitis associated with?

airway irritants

How do we diagnose allergic rhinitis?

historical relationship between clinical signs and exposure and improvement after removal of irritant

What drugs could we give to help with allergic rhinitis?

1. chlorpheniramine

2. cetirizine/Zertec

What animal is idiopathic rhinitis more common in?

cats

How do we treat idiopathic rhinitis?

1. facilitating drainage with nebulization, flushes, and topical decongestants

2. decrease irritants in the environment

3. control secondary bacterial infections

4. +/- antihistamines

5. +/- corticosteroids

6. salvage turbinectomy

What is important about canine chronic/lymphoplasmacytic rhinitis?

similar to feline and piroxicam is an additional treatment option

What can cause nasopharyngeal stenosis?

1. post anesthesia from trauma and inflammation to tissue

2. post foreign body

What is the treatment for nasopharyngeal stenosis?

place a stent

A 6-year-old dog presents with chronic unilateral nosebleeds and sneezing. There is a mild mucopurulent discharge, sometimes tinged with blood. On physical exam, the nasal cavity appears slightly swollen. What is the most likely cause?

Nasal neoplasia

A 3-year-old cat has bilateral mucopurulent nasal discharge and sneezing for several months. No blood is noted. There is mild nasal congestion. What is the most likely cause?

Viral infection (FHV-1) with secondary bacterial rhinitis

A 5-year-old dog presents with unilateral bloody nasal discharge, nasal pain, and occasional sneezing. What is the most likely cause?

Aspergillosis

A 1-year-old cat presents with chronic stertor, gagging, and mucoid nasal discharge. On oral exam, a mass is visible in the nasopharynx. What is the most likely cause?

Nasopharyngeal polyp

A 2-year-old dog presents with bilateral clear, watery nasal discharge that worsens in spring. Sneezing and face rubbing are noted, but no blood. What is the most likely cause?

Allergic rhinitis

A 7-year-old German Shepherd presents with chronic unilateral epistaxis and sneezing. Physical exam reveals mild facial deformity over the affected nasal passage. CT scan shows turbinate destruction and a soft tissue mass. Cytology is inconclusive. What is the most appropriate next step for diagnosis?

Perform rhinoscopy with biopsy of the mass

A 5-year-old German Shepherd is diagnosed with nasal aspergillosis after rhinoscopy and fungal culture. CT shows turbinate lysis, but no cribriform plate involvement. Which is the preferred treatment?

Topical antifungal therapy via catheters into the frontal sinus

A 1-year-old cat presents with stertor, gagging, and mucoid nasal discharge. Rhinoscopy reveals a pedunculated mass extending from the middle ear into the nasopharynx. What is the treatment of choice?

Endoscopic or traction removal of the polyp

A breeder asks how to prevent nasal aspergillosis in her dogs. Which advice is most accurate?

Avoid exposure to moldy environments and decaying organic matter

A 2-year-old dog presents with sneezing, reverse sneezing, and occasional nasal discharge. Examination reveals mucopurulent, sometimes blood-tinged discharge. A saline flush of the nasal cavity shows small, motile parasites. What is the most likely cause?

Pneumonyssoides caninum