Diseases of the nasal cavity Flashcards Preview

• Treatment
  • Topical tetracyclines or erythromycin
  • Systemic signs require oral doxycycline and azithromycin
• Prevention
  • Vaccination (not a core vaccine)
  • Vaccination is more reactive than other antigens

1. Outpatient treatment if possible--or isolation
2. Keep warm and hydrated
3. Remove crusts from nose and eyes, use saline nasal drops
4. Humidify air--steam vs. nebulization 
5. Topical decongestants for 1-2 days
   • Pseudoephedrine, phenylephrine (preferred), oxymetazoline
6. Systemic antibiotics for secondary bac. infection
   • Enrofloxacin, azithrymycin, amoxicillin, clavulanic acid, doxycycline, marbofloxacin?
7. Topical opthalmic solutions--antiviral? Antibac? Or both
8. Interferon
9. Oral antiviral?
10. Lysine? Does it work in FHV?
11. Anti-inflammatories--steroid vs. non-steroidal (piroxicam) for a few days

• VERY RARELY primary disease process
• Mucopurulent to purulent nasal discharge
• Transient response to antibiotics
• Usually secondary to an underlying disease process
  • Foreign body?
  • Tooth root abscess?
  • Chronic viral infection?
  • Fungal infection?
  • Neoplasia?

• Dogs--predominantly Aspergillus fumigatus
  • ​Worldwide distribution
  • Dessiminated disease in dogs often involved A. terreus, A. deflectus, or A. niger
• Cats and dogs--Cryptococcus neoformans var. neoformans
  • Often found in avian droppings/fowl manure (esp. pigeons)
  • C. neoformans var. gatii found in specific eucalyptus trees

• Sneezing, uni/bi nasal discharge
• Nasal ulceration and depigmentation
• +/- facial distortion
• Nasal airflow usually ok; turbinate destruction (compare to neoplasia)
• Most cases systemically ok

• Imaging--do before rhinoscopy or nasal flush
• Rads--can't distinguish between fungal rhinitis or neoplasia
• CT or MRI--more helpful than rads
• Rhinoscopy--white plaques
• Tissue biopsy/cytology--hyphae
• C/S--best done from plaque, not discharge

• Debridement
  • Break off plaques, soak in nose to treat nasal passage
  • Can drill hole in frontal sinus to aid in location of plaques
  • Be careful not to damage cribiform plate
• Infuse 1% clotrimazole or 2% eniloconazole into nasal cavity for 1hr
  • Rotate nose around--turn 90^o every 15 min
  • Risks: aspiration pneumonia (severe irritant), neuro signs (damaged cribiform plate--contraindication)
  • Reeat procedure every 4wks, repeat rhinoscopy, remove any plaques and repeat soak if required
• Systemic antifungal medication
  • Can use in cases of osteolysis arounf cribiform plate
  • Get a fungal sensitivity
  • Itraconazole, posaconazole, voriconazole (last 2 $$$)

When there is osteolysis

• Dolichocephalics, young adults
• Unilateral nasal discharge may become bilateral
• 20% chance of seeing hyphae on cytology of d/c
• White plaque on rhinoscopy
• Antibody titer not reliable
• C/S: from plaque, not discharge
• Rule out neoplasia: biopsy
• Clotrimazole locally

• Localized or systemic
• Unilateral or bilateral d/c
• +/- facial asymmetry
• Submandibular lymph node enlargement
• Chorioretinitis
• Organism often in nasal d/c
• C/S
• Serum titer very reliable (antigen test, not antibody)
• Conazoles systemically

Aspergillus spp.

Cryptococcus neoformans

• Live in nasal cavities and sinuses
• Worldwide distribution
• Direct transmission
• Not found in cats
• Diagnosis
  • Visualize mites in nasopharynx (size of ear mites) or visualize them in nasal cavity during rhinoscopy
• Treatment
  • Ivermectin, milbemycin (Collie breeds?), selamectin
• Not commonly found in dogs on HW medication (generally one of the ivermectins)

• Chronic inflammatory rhinitis caused by a lymphocytic and plasmocytic infiltration into the nasal mucosa in the absence of any obvious underlying etiology
  • Infectious, allergic, immune-mediated mechanisms have all been proposed
• Usually medium-large breed dogs--which are dolichocephalic
• Diagnosis made through histopathology on biopsy samples

• Clinical signs
  • Unilateral or bilateral nasal discharge
  • Mucoid/purulent discharge but can be serous or even hemorrhagic
  • Sneezing, ocular discharge, reverse sneezing, stertor
• DDx
  • Most likely to least likely: neoplasia--> fungal--> foreign body--> LPR

• CT/MRI
  • Can be normal, usually get a fluid accumulation or turbinate destruction
  • Sinus involvement--40%
  • Destruction of nasal septum, frontal sinus, cribiform plate--UNLIKELY to be LPR
• Rhinoscopy
  • Hyperaemic (red), edematous mucosa, easily traumatized, and bleeds
  • Turbinates are atrophied or destroyed
  • Cannot distinguish it between neoplasia and fungal rhinitis occasionally
• Biopsy and histopathology is needed

• No effective protocols
• Avoid any smoke (can result in LPR--allergic condition)
• Possible treatment/aids
  • Nasal steroids
  • Long-term doxycycline (immune modulatory) or azithromycin w/ NSAIDs
  • Long-term itraconazole (antifungal, appears to work)
  • Saline nasal flushes or hypertonic saline nasal drops
  • Maropitant (Cerenia)--5 days on and 2-3 days off
    • Anti-inflammatory, works inside nose

• Substance P = neuropeptide secreted by nerves and inflammatory cells
• Cerenia blocks substance P from binding to tissues
  • ​By antagonizing receptors for tachykinins (histamine, prostaglandins, serotonin, TNF-alpha, interleukins, bradykinin)
• Label use: vomiting/nausea (not licensed to block inflammation)
• Off label use: pain, inflammation of gut, nose, bladder, CNS, allergies
• 5 days on, 2 days off dosing; continuous dosing robs body of substance P which results in tremors

• Progressive clinical signs
  • Nasal discharge will often start unilateral and become bilateral
• Decreased airflow through nasal cavity due to the mass effect
• Sneezing, facial deformity, epiphora, exophthalmos, dyspnea, open-mouth breathing, hard palate abnormalities
• Dysphagea
• Neuro signs if cribiform plate is invaded
• Cannot distinguish these signs from fungal rhinitis

• Nasal discharge cytology--occasionally get lucky
• Fine needle aspirates of draining lymph nodes--occasionally get lucky
• Radiography
  • GA required
  • Could potentially rule it in, but cannot guarantee that it is ruled out
• CT/MRI
  • Much more sensitive in seeing the soft tissue destruction
• Rhinoscopy
  • See mucosal inflammation, hemorrhagic mucosa, change in mucosa
  • See mass effect w/in nose
• Nasal biopsy
  • Traumatic nasal flush
  • Rhinoscopy w/ biopsy (best)
  • Rhinotomy w/ surgical biopsy

• Histopathology required to plan treatment
  • Adenocarcinoma--most common
  • Sarcoma (undifferentiated)
  • Carcinoma, SSC, fibroma
  • Lymphoma
• Surgery--palliative, doesn't prolong survival unless used w/ radiation
• Radiation--treatment of choice for most nasal neoplasias
  • Survival 12-16 mo if used w/ surgical debulking
• Chemotherapy--used w/ lymphoma
• No treatment--prognosis poor--survival 3-6mo
• Death due to airway obstruction, euthanasia usually performed due to resp distress, persistent epistaxis or nasal discharge

• What type of neoplasm is it?
  • Better survival w/ adenocarcinomas and sarcomas after radiation
  • Undifferentiated carcinomas and SCC's have shorter survival time
• Clinical stage--how extensive is the disease?
• Species--cats live longer than dogs post-radiation therapy

• Older dogs usually >8yrs
• Dolichocephalic dogs predisposed
• Most are malignant, locally invasive, and can metastasize to regional LN
• Adenocarcinoma and SCC are most common in dogs
• Lymphoma and adenocarcinoma most common in cats
• Need biopsy for diagnosis
• Radiation treatment of choice for most

• Immotile ciliary syndrome
• Rare but is recognized in many dog breeds
• Inherited (autosomal recessive) trait
  • Affects cilia in upper and lower resp tract (bronchopneumonia)
  • Auditory tubes (ear infection)
  • Brain and spinal cord (hydrocephalus)
  • Uterine tubes
  • Ducts of the testes (male infertility, sperm incapable of mvt)
  • Some dogs will have situs inversus--Kartagener syndrome (chronic sinusitis, bronchiectasis, and reversal of the internal organs)

• Respiratory disease
  • Structural and functional changes of the cilia in the resp tract
  • Results in poor clearance of mucous from airways
  • Chronic mucous plugging and inflammation
• Affects nasal cavities, trachea, and lower airways
• Clinical signs include rhinosinusitis, bronchitis, bronchopneumonia, and bronchiectasis
• Classic presentation--young, purebred dog w/ recurrent resp tract infection/signs

• Biopsy or brush swab
• Culturing cilia cells from biopsy/BAL
• EM to assess ciliary structure
• Genetic testing available for some breeds

• Primary ciliary dyskinesia
• a = normal dog
  • 1 central pair of microtubules and 9 peripheral microtubule doublets 
• b = PCD
  • The central pain of microtubules are eccentric

• No treatment is available
• Clinical signs are progressive
  • Dogs' response to supportive therapy is progressively weaker over time

• TRUE
• TRUE
• FALSE
• TRUE