Acute and Chronic Nasal Disease

Question 1

what are the 3 main points that can be used to narrow down a differential list

Answer 1

1. local vs systemic
2. unilateral vs bilateral
3. congenital vs acquired

Question 2

what are the differential categories for nasal disease

Answer 2

infectious
inflammatory
neoplastic
misc - foreign body, etc

Question 3

what should always be asked in a history for a nasal disease presentation

Answer 3

nasal discharge characterization and chronicity

Question 4

how to classify nasal discharge

Answer 4

serous
mucoid
hemorrhage

unilateral vs bilateral

Question 5

what diagnostics should be run for epistaxis

Answer 5

CBC
BMBT
aPTT (intrinsic pathway)
PT (extrinsic pathway)

Question 6

pseudo-nasal discharge

Answer 6

discharge that comes from the lower airways NOT the nose

ex. regurgitation or reflux from GERD or hiatal hernias

Question 7

steps of a clinical exam for nasal disease

Answer 7

1. observation
2. hands-on
3. oral exam
4. neurologic exam

Question 8

observation part of clinical exam

Answer 8

• stridor, stertor
• congestion
• signs of distress
• pawing
• facial asymmetry (and discoloration)
• nasal discharge

Question 9

hands on part of clinical exam

Answer 9

• LN palpation
• ocular retropulsion
• aural exam
• Horner’s syndrome

Question 10

what to check for in an oral exam

Answer 10

• pain on extension
• depigmentation
• dental disease
• mass lesions

Question 11

what to check for in a neuro exam

Answer 11

Horner’s syndrome
- miosis
- ptosis
- enophthalmos
- 3rd eyelid protrusion

Question 12

acute nasal diseases

Answer 12

• foreign body
• feline upper respiratory tract infection
• canine infectious respiratory disease complex

Question 13

foreign body - chronicity, discharge, clinical signs

Answer 13

acute onset
+/- hemorrhage
paroxysmal reverse sneezing
facial pain and rubbing

Question 14

foreign body - diagnosis and treatment

Answer 14

dx: sedated nasal exam + probe

tx: remove the foreign body + NSAIDs
- flush nasal cavity
- often does NOT require antibiotics

complications: FB can migrate –> pneumo or pyothorax; sinonasal aspergillosus

Question 15

FURTI - etiologies

Answer 15

feline herpesvirus
feline calicivirus
chlamydia
bordetella
mycoplasma

Question 16

FURTI - chronicity, discharge, clinical signs

Answer 16

acute onset
intermittent or recurrent

sneezing
nasal discharge
ocular discharge/conjunctivitis
fever
anorexia

FHV: ocular lesions (dendritic ulcers) + facial dermatitis

FCV: oral ulcers + lameness

Question 17

feline herpesvirus

Answer 17

establishes latency in the trigeminal nerve and recrudesces during times of stress

infection with herpes is lifelong

Question 18

feline calicivirus

Answer 18

most cats are able to clear infection

only a few become carriers

Question 19

FURTI - diagnosis and treatment

Answer 19

dx: RARE - only for severe systemic signs or chronic/unresolving cases
- conjunctival and nasal PCR

tx: supportive care
- nasal flushes
- nebulization
- nutritional support
- if not improved in 10 days –> doxycycline + famciclovir

Question 20

CIRDC - etiologies

Answer 20

many
viral: rota, corona, influenza, parainfluenza, adeno, herpes, distemper, pneumovirus

bacterial: bordetella, mycoplasma, streptococcus

Question 21

CIRDC - chronicity, discharge, clinical signs

Answer 21

acute onset

cough (bordetella)
fever
anorexia
dehydration
tracheal irritation
tachypnea

Question 22

CIRDC - diagnosis and treatment

Answer 22

dx: RARE - only for severe systemic signs or chronic and unresolving cases
- PCR for mycoplasma + bordetella
- thoracic rads if chronic, severe, recurrent

tx: supportive care
- can give doxycycline

Question 23

chronic nasal diseases

Answer 23

1. dental disease (abscess, fistula)
2. feline chronic rhinosinusitis
3. canine lymphoplasmocytic rhinitis
4. canine sinonasal aspergillosis
5. feline fungal disease
6. nasal neoplasia

Question 24

dental disease (abscess, fistula) - chronicity, discharge, clinical signs

Answer 24

chronic
unilateral mucopurulent to hemorrhagic

difficulty eating
halitosis
asymmetry
fractured tooth
pain
ptyalism

Question 25

dental disease - diagnosis and treatment

Answer 25

dx: oral probing, dental radiographs, head CT tx: surgery +/- antibiotics

Question 26

feline chronic rhinosinusitis signalment

Answer 26

any age cat usually young to middle aged

Question 27

feline chronic rhinosinusitis - chronicity, discharge, clinical signs

Answer 27

chronic recurrent to waxing/waning unilateral or bilateral variable discharge w/ sneezing systemically HEALTHY cat with LOCAL signs only - congested nasal passages - erythema - swollen/edematous turbinates

Question 28

feline chronic rhinosinusitis - diagnosis and treatment

Answer 28

dx: diagnosis of exclusion - definitive dx requires BIOPSY - infectious disease testing only beneficial for viral or fungal (PCR or fungal cultures) tx: lifelong disease, requires ongoing treatment - NSAIDs/steroids - topical (inhaled) decongestants - nasal flushes - short term doxycycline if suspect bacterial component

Question 29

predisposing factors to feline chronic rhinosinusitis

Answer 29

1. altered airflow (anatomical) 2. increased mucus 3. secondary bacterial infection

Question 30

canine lymphoplasmocytic rhinitis - chronicity, discharge, and clinical signs

Answer 30

chronic recurrent waxing and waning unilateral or bilateral discharge systemically HEALTHY dog with LOCAL signs only

Question 31

canine lymphoplasmocytic rhinitis - diagnosis and treatment

Answer 31

dx: diagnosis of exclusion - definitive: biopsy tx: meloxicam followed by prednisone (after a washout period)

Question 32

canine sinonasal aspergillosis etiology

Answer 32

aspergillus fumigatus other aspergillus species cause disseminated aspergillosis

Question 33

canine sinonasal aspergillosis - signalment

Answer 33

young to middle aged RARE in brachycephalics

Question 34

canine sinonasal aspergillosis - chronicity, discharge, clinical signs

Answer 34

chronic (months to years) unilateral > bilateral mucopurulent to epistaxis sneezing w/ discharge depigmentation of the nose facial pain seizures LN enlargement increased airflow

Question 35

canine sinonasal aspergillosis - diagnosis and treatment

Answer 35

dx: - CT & rhinoscopy - lytic changes to conchae - culture: definitive diagnosis tx: debridement + azole antifungal topical - rhinoscopy + debride to clear out the fungal plaques from nasal passages up to sinuses - administer clotrimazole into the sinus for 20 min contact time requires 2-3 treatments on average

Question 36

do the destroyed nasal passages reform once canine sinonasal aspergillosis is treated

Answer 36

no - will almost always get chronic rhinitis due to decreased nasal conchae

Question 37

what are the most common feline fungal nasal diseases

Answer 37

cryptococcus aspergillus

Question 38

where does crypto and aspergillus affect the cat

Answer 38

crypto: sinonasal aspergillus: sinonasal + sino-orbital

Question 39

clinical signs - feline cryptococcus

Answer 39

sneezing discharge - bilateral mucopurulent "roman nose" seizures chorioretinitis

Question 40

clinical signs - feline aspergullis

Answer 40

erosive/ulcerative facial lesions exophthalmos same signs as canine sinonasal aspergillosis

Question 41

diagnosis - feline cryptococcus

Answer 41

latex antigen test +/- retinal exam to evaluate for chorioretinitis

Question 42

diagnosis - feline aspergillus

Answer 42

culture

Question 43

treatment - feline cryptococcus

Answer 43

fluconazole PO continue oral antifungals until latex antigen test comes back negative

Question 44

treatment - feline aspergillus

Answer 44

debridement + multimodal systemic therapy (ampho, azoles)

Question 45

most common nasal tumors in dogs

Answer 45

squamous cell carcinoma mesenchymal - fibrosarcoma, chondrosarcoma

Question 46

most common nasal tumors in cats

Answer 46

lymphoma mesenchymal - fibrosarcoma, chondrosarcoma

Question 47

palliative treatments for nasal neoplasia

Answer 47

SCC: NSAIDs lymphoma: prednisolone