Nasal disease

Cards (23)

  • You are presented with a 1 year old Mn GSD with a progressive 3 month history of mucopurulent nasal discharge. In the last 3 weeks there have been occasional flecks of blood and today he presented after an episode of epistaxis. On clinical examination he is BAR, lively and you have no concerns except for the nasal discharge and a small area of depigmentation on the nasal planum.  What is the most likely cause of the nasal discharge in this case?
    Aspergillosis spp infection
  • You are presented with a 4 year old Fn DSH cat that has a history of chronic nasal discharge. Clinically you have no concerns, though the owner reports that she has always had an intermittently snotty nose with sneezing since she was rehomed 3 years ago. You perform general anaesthesia, pharyngeal examination and a CT scan. The findings are consistent with chronic rhinitis and suspected secondary bacterial infection. What is the most likely factor to have predisposed to this condition?
    A previous feline herpesvirus infection
  • You are presented with a 2yo Me Pointer who has an acute onset (1 week) of unilateral nasal pain, and muco-sanguineous nasal discharge. He is sneezing and is also inappetant. Which condition do you suspect?
    Nasal foreign body
  • Fungal disease is most common in young, mesocephalic and doliocephalicdogs (Rotties, GRets, GSD) and the most common causative agent in dogs is Aspergillus fumigatus but in cats Aspergillus or Cryptococcus species are likely.
    Fungal spores are environmental, breathed in and then plaques form. This can be more likely in animals that have rhinitis, a foreign body or trauma.
  • Common clinical signs of fungal disease include…
    • Cream or greenish nasal discharge (mucoid; mucopurulent or muco-haemorrhagic)
    • Nasal planum ulceration
    • Sneezing
    • Nasal pain.
    And sometimes depigmentation, epistaxis, destruction of turbinates.
  • fungal disease has a variable progression, some are fast (weeks) while some are over months. Diagnosis involves CT, rhinoscopy and sampling. Topical treatment (clotrimazole, enilconazole) is most effective and it is important to remove as much of the infection as possible. The prognosis is good with treatment
  • stenotic nares is an increasingly common congenital issue which is a component of BOAS in both dogs and cats. The dorsolateral nasal cartilages are medially displaced, impinging on the external nasal opening and dramatically decreasing the available lumen. This can lead to…
    • Stertorous and stridorous inspiratory noise
    • Coughing
    • Reduced exercise tolerance
    • Sleep disturbances
  • The only treatment for stenotic nares is surgical and includes wedge resections and laser ablation. The more stenotic the nares the more likely there will be negative pressure which leads to everted laryngeal saccules, hence try to surgically repair these nares earlier in life before there are many signs to prevent the need for tieback surgery.
  • diseases of the nasal planum include…
    • Depigmentation
    • Hyperkeratosis
    • Ulceration
    • Autoimmune e.g. pemphigus, lupus
    • Neoplasia
    • Squamous cell carcinoma
    • Cutaneous epitheliotropic lymphoma and others can also occur
  • neoplasia of the nasal planum is often the cause in animals with chronic nasal signs (15-54% of cases in dogs and 29-70% of cats). The clinical signs often include: nasal discharge, epistaxis, sneezing, and snuffling and can be diagnosed via radiography, CT, rhinoscopy and biopsy. The treatment includes radiotherapy +/-
    chemotherapy/surgery but the prognosis depends on the nature and location of the tumour.
  • Squamous cell carcinomas are most common in white cats (or those with white areas) with solar exposure but is rare in dogs. It is commonly found on the tips of the ears or nose
    • Therapies include
    • Photodynamic therapy (PDT requires referral)
    • Planectomy (biopsy may cure! They might look weird but are curative with good margins)
    • Immunomodulators (imiquimod)
    • Good prognosis if the nose is taken off but may need repeat PDT
  • a nasopharyngeal polyp present with a rattling sound (loss or alteration of voice) but polyps can also form in the ear canal (so check with chronic ear cases) or be oral in location.
  • Disease that crosses the cribriform plate means the disease is getting close to the brain and hence is worrisome.
  • rhinitis / sinusitis = Inflammation of the nose and/ or sinuses which often leads to sneezing, snuffling, nasal discharge, anorexia (especially in cats) and other URT signs
  • causes of rhinitis / sinusisits include…
    • Secondary to a viral upper respiratory tract infection: FHV, FCV
    • Fungal (Cryptococcus, Aspergillosis)
    • Due to inhaled allergens.
    • Primary bacterial rhinitis is RARE
    • Chlamydophila felis; Mycoplasma species; Bordatella bronchiseptica
    • A mass lesion: neoplasia; foreign body (grass blade!) and polyp
    • An anatomical defect e.g. cleft palate; trauma and stenosis
    • Due to dental disease: O-N fistula; apical abscessation; periodontal disease
  • Non- destructive (inflammatory) rhinitis causes an increased soft tissue density conforming to the turbinates (mucopurulent exudate, haemorrhage) with no evidence of a well-defined mass or bony lysis on CT. It may be unilateral or bilateral and is linked to viral disease in cats – FCV, FHV
  • The most common clinical signs associated with nasal disease are…
    • Nasal discharge
    • Serous, mucoid, mucopurulent, sanguinous/ epistaxis, mixed
    • Sneezing
    • Pawing or rubbing at muzzle
    • Facial deformity, asymmetry
    • Loss of pigment on the nasal planum
    • Ulceration
    • Epiphora (tear staining)
    • Open-mouth breathing
    • Halitosis
    • Stertor
    • Coughing
    • Seizure (rare means disease crossed the cribiform plate and is affecting the brain)
  • Common causes of nasal disease include…
    • Nasal neoplasia
    • Inflammatory or infectious rhinitis
    • Fungal rhinitis
    • Structural/ periodontal disease
    • Foreign body
    • Stenotic nares
    • Other, or no definitive diagnosis
  • Diseases that often look like nasal disease (as they often cause nasal signs) but do not have a primary nasal pathology include…
    • Systemic Infectious disease e.g. distemper (respiratory not nasal)
    • Reverse sneezing
    • Dental disease (abscesses or fx causing epistaxis)
    • Coagulopathy (presents with epistaxis but is due to the inability to clot not nasal disease)
    • Severe hypertension (epistaxis)
    • Vomiting/ regurgitation
  • The first step will be to take a history and perform a clinical investigation you can then take blood tests (such as coags and serology to look for systemic disease). If necessary you can then progress onto…
    • Imaging
    • Radiography (often first line but not as helpful as CT)
    • CT
    • Rhinoscopy
    • Sampling (for Cytology, biopsy and/or culture and sensitivity)
    • Nasal flush
    • Nasal swab (Which can be sent for cytology or C&S)
    • Biopsy which can then be sent for histopathology +/- cytology
  • with rhinoscopy, there are two ways to scope a nose you can either enter via the mouth and over the soft palate or in via the nostrils.
    • Fungal plaques are white and irregular while purulent discharge would be more gloopy
  • A Nasal flush is a vigorous irrigation of nasal chambers that should dislodge cells and debris which can be examined cytologically. It requires a cuffed ET tube and a block at the back of the pharynx to prevent aspiration of fluid or debris. This must be done under GA
    • A nasal flush can then be sent off for cytology or culture and sensitivity but can also provide a temporary relief of symptoms
  • Label the image
    A) frontal sinus
    B) cribriform plate
    C) ethmoid
    D) dorsal nasal
    E) middle meatus
    F) alar fold