Canine and Feline Nasal Disease

• Lateral nasal anatomy

  
• What is the cribiform plate?

  The barrier between the nasal sinuses and the brain. Focus on this when looking at scans to make sure that nasal disease has not crossed this barrier into the brain.
• Clinical sings of nasal disease

  • Nasal discharge - serous, mucoid, mucopurulent, sanginous, epistaxis, mixed.
  • Sneezing
  • Pawing or rubbing at muzzle
  • Facial deformity, asymmetry (more likely neoplasia)
  • Loss f pigment on the nasal planum.
  • Ulceration
  • Epiphora (tear staining)
  • Open-mouth breathing
  • Halitosis (bad breath)
  • Stertor
  • Coughing
  • Seizure (rare - only if gone through the cribiform plate).
• reverse sneezing

  Triggered by irritation in the upper airway. self-resolving in almost all cases. Is a soft pate wobble, can be seen more in the BOAS breeds. New irritation in nasopharynx can cause reverse sneezing
• Common causes of nasal disease

  • Nasal neoplasia
  • Inflammatory or infectious rhinitis
  • Fungal rhinitis
  • Strucutral/ periodontal disease
  • Foreign body
  • Stenotic nares
• How to investigate a case of nasal disease?

  • History and CE
  • Blood tests;
  • Coags
  • Serology
  • Imaging
  • Radiographs
  • CT
  • Rhinoscopy - nasal scope, easier to go through the mouth then up and over the soft palate.
  • Sampling
  • Cytology - baseline bloods looking for systemic disease, inflammatory indicators.
  • Biopsy
  • C&S
• CT of nasal disease

  Often the modality of choice. Increased detail and often easier to interpret areas like the sinuses and nasopharynx as there’s no superimposition. Can distinguish soft tissue vs fluid via contrast as fluid does not have a blood supply.
• Shows asymmetry. Shows complete obliteration of the turbinates on the left hand side. Loss of nasal planar down the middle, showing something very invasive, affecting the external structure as well as internal structure.

  
• Sampling - Nasal flush

  Vigorous irrigation of the nasal chambers should dislodge cells and debris which can be examined cytologically.

  • Advantages
  • non-invasive
  • quick procedures
  • occasionally helps to clear discharge and debris from nasal passages and reduce stertor.
  • occasionally produces tissue sample for histopathological examination if nasal mass very friable.
  • disadvantages
  • requires general anaesthesia
  • may not provide material suitable for examination
  • messy.
• Non-destructive (inflammatory) rhinitis

  • Increased soft tissue density conforming to the turbinates (mucoprurulent exudate, haemorrhage)
  • No evidence of a well defined mass or bony lysis
  • Uni or bilateral (typically bilateral if seen secondary to respiratory disease).
  • Linked to viral dx in cats - FCV, FHV
• Nasalpharyngeal polyp

  Visualisation of polyp - spay hook may be used to draw the soft palate rostrally, allowing visualisation of the nasopharynx with the dental mirror. Hear a rattle sound when they have a polyp.

  A flexible endoscope may be retroflexed around the soft palate ti enable visualisation.
• Disease of the nasal planum


  Depigmentation

  Hyperkeratosis

  Ulceration

  Autoimmune e.g. pemphigus, lupus

  Neoplasia

  Squamous cell carcinoma

  cutaneous epitheliotropic lymphoma
• Squamous cell carcinoma

  White cats with solace exposure, rare in dogs.

  Carcinoma in situ - superficial SCC - infiltrative SCC, locally invasive, mets rare.

  therapies: photodynamic therapy, planectomy (biopsy may cure!), immunomodulators.

  Good prognosis if remove where the tumour is e.g. nose, ears.

  
• Stenotic nares

  Common congenital problem, component of BOAS.

  Dorsolateral nasal cartilages are medically displace, impinging on the external opening and dramatically decreasing the available lumen.

  Stertorous and stridorous inspiratory noises, coughing

  Reduced exercise tolerance, sleep disturbances.

  Surgery - wedge resection, laser ablation.

  
• Nasal Neoplasia

  1-2% of all canine tumours.

  15-54% of cases in dogs and 29-70% of cats with chronic nasal symptoms;

  Aetiology;

  Dogs: carcinomas, sarcomas, rarely polyps - primarily older dolichocephalic dogs.

  Cats: polyps (young cats), lymphoma, nasal carcinomas.
• Clinical signs of nasal neoplasia

  Nasal discharge

  Epistaxis

  Sneezing

  Snuffling
• Diagnosis and treatment of nasal neoplasia

  Radiography, CT, rhinoscopy and biopsy. Treat with radiotherapy +/- chemotherapy/surgery.

  The prognosis depends on the nature and location of tumour.
• Fungal nasal disease

  most commo in young mesocephalic/doliocephalic dogs. Spores are environmental, breathed in and plaques form in some dogs. Most common fungus is Aspergillus or Cryptococcus spp, most likely in cats.

  Varisble progression; some fast (weeks), some over months.
• Common clinical signs of fungal nasal disease

  Cream or greenish nasal discharge (mucoid, mucopurulent or muco-haemorrhagic).

  Nasal planum ulceration.

  Sneezing.

  Nasal pain.

  Sometimes:

  Depigmentation

  Epistaxis

  Destruction of turbinates.
• Treatment of nasal fungal disease


  Topical treatment is more effective. Remove as much infection as possible. Treat with Clotrimazole, Enilconazole.

  Lie dog on back, ET tube in and then cuff, then flush the nose. Scrape away any fungal plaques then flush in topical treatment.