Management of Common Nasal Diseases in the Companion Animal

Transcription

1 Management f Cmmn Nasal Diseases in the Cmpanin Animal Emily Harisn DVM, DACVIM Anatmy Nasal plane Rstral prtin, supprted by cartilage Nasal Cavity Facial prtin, bne/cartilage Turbinates Mucsa and glands cnditin the air Olfactry receptrs are highly cncentrated Physilgy Regulated by ventilatr cntrl systems Influences gas exchange in lungs Heating/cling inspired air Flw f bld is ppsite f air (caudal t rstral) Filters large debris frm reaching lungs Mucsal cleaning thrugh ciliary beat Sneeze is frm stimulatin f sensry receptrs, rapid inspiratin, then invluntary expulsin f air Signs f Nasal Disease Sneezing Reverse sneezing Nasal discharge purulent, hemrrhagic, serus Stertr/snring Rule uts fr nasal discharge Nasal/Sinnasal Extranasal Allergic/lymphplasmacytic rhinitis Cagulpathies Fungal (Aspergillsis) Envirnmental agents Neplasia Hyperviscsity syndrme Dental disease IgA deficiency Freign bdy Pneumnia Naspharyngeal stensis Vmiting, regurgitatin Parasites Vasculitis Plyps (cats) Hypertensin Characterizatin Bldy Cagulpathy, primary hemstasis Hypertensin Vasculitis Hyperviscsity/hyperglbulinemia

2 Mucid Serus Depigmentatin Unilateral r bilateral? Rhinitis in Dgs Sneezing, may lessen ver time Reverse sneezing, aspiratin reflex drsal naspharyngeal Nasal discharge Bilateral>>unilateral Clear, mucid >>hemrrhagic Can change in character ver time Obstructive breathing Caudal disease may lead t pst-nasal drip (n discharge) Yunger Dlichcephalic, mesaticephalic Dachshunds Caused by infectins (rarely), aerallergens, inhaled irritants Diagnsis PE and histry Differentiate systemic frm lcal disease Rutine lab tests CBC, chemistry, UA Bld pressure Cags Thracic radigraphs Cytlgy Nt helpful typically Eucleus (Capillaria) behmi Cultures (bacterial and fungal) Nt recmmended residential bacteria, fungi Nasal passage is nt suppsed t be sterile! Asperigillus serlgy Psitive: highly suggestive Negative: des nt rule ut Lcal infectin Imaging Skull radigraphs unrewarding fr mst cases, will nt give specific cause Requires full anesthesia fr perfect views Dental radigraphs if suspect dental disease CT Thrugh assessment f nasal cavities, sinuses

3 Nature and extent f disease Cntrast t determine mucus vs. vascularized sft tissue Helps t guide pst-imaging rhinscpy/bipsying MRI Fine as well, n advantage ver CT, typically mre expensive and lnger anesthesia Rhinscpy Only after advanced imaging Naspharyngscpy via retrflexin (befre rhinscpy) May be limited due t patient size, caudal nature f lesin, and numerus flds t explre Can verlk masses r freign bdies if dne alne Mucus and bld can bscure views Evaluate fr clr, vascularity, friability, edema, plaques Lss f nrmal turbinates fungal r severe rhinitis Bipsy nly way t truly diagnse rhinitis Viral rhinitis in cats Initiates with sneezing, then abut 5 days later, mucid discharge starts Fevers cmmn Lasts fr 2-3 weeks Feline herpesvirus-1 and calicivirus accunt fr 80-90% f URTIs Vaccinatin has helped but nt slved the prblem, due t different strains and latent viruses Typically treat secndary bacterial infectins Azithrmycin r dxycycline Immunmdulatry actins Famciclvir, L-Lysine? Nasal drps, humidifiers Antihistamines (cetirizine, lratidine, diphenhydramine, chlrpheniramine) Pain cntrl if ulceratins Naspharyngeal stensis (cats) Uncmmn, cngenital r secndary t lng term viral infectins Stertr and pen-muth breathing Ballning r stenting are treatment ptins Fungal Rhinitis Nasal cavity and sinuses Dgs>>>Cats Yung t middle aged dgs, dlichcephalic Spres in husehld plants, in yard, furniture Txins prduced by fungus lead t atrphy f the turbinates and bne Can invade the brain

4 Plyps Symptms: severe purulent nasal discharge r hemrrhage Depigmentatin Diagnsis thrugh advanced imaging (CT/MRI and rhinscpy) Cultures are rarely helpful Treatment Trephinatin int sinuses and bathing passages in cltrimazle, 85% effective Oral cmb: psacnazle, terbinafine, dxycycline Cats- discharge and facial swelling/changes, exphthalms, fistulas, fever, lymphadenpathy Treatment: psacnazle, itracnazle, vricnazle Prgnsis cnsidered guarded Cryptcccus cats Obstructive rhinitis, facial swelling, crusting f nasal plane, cncurrent cnjunctivitis Surgical resectin and antifungals (itracnazle, ketcnazle, flucnazle) Very uncmmn in dgs Rhinscpy Rhintmy Typically recur in 1-2 years Cmmn in cats Naspharyngeal r nasal Treatment cnsists f plucking r if recurrent, bulla stetmy Uncmmn t recur Freign bdies Uncmmn Yung, hunting dgs Acute vilent sneezing, pawing at face Owners can ften pinpint when it happen Typically can be flushed ut under general anesthesia. If n imprvement, advanced imaging is recmmended. Parasitic rhinitis Cuterebra, Linguatala serrata, Pneumnyssides (nasal mite), Capillaria aerphila (lungs typically) Neplasia Nasal planum Squamus cell carcinma, cats>>dgs Esinphilic granulma in cats can mimic Fibrma Fibrsarcma Nasal cavity

5 Cats: lymphma vs adencarcinma >>>squamus cell carcinma Dgs: adencarcinma, unclassified carcinma, squamus cell carcinma, chndrsarcma, transitinal cell carcinma, stesarcma, rarely lymphma Typically >5yr ld Majrity are malignant Sneezing, hemrrhagic discharge Typically unilateral symptms Decreased retrpulsin f eyes Dyspnea des nt develp unless bilateral and clsing muth (sleeping) Typically caudal 1/3, extends int sinuses Diagnsis Radigraphs Require sedatin/anesthesia, difficult t interpret: ends up cstly with n definitive answer Increased density f nasal passages and lss f bne (ethmid/maxillary) CT r MR +/- Rhinscpy Nt always valuable in small patients. Hemrrhage can distrt images Difficult t explre every fld Helpful fr naspharyngeal disease r if radigraphy is nt definitive Bipsies CT guided vs. rhinscpic guided Treatment: Radiatin therapy Definitive vs. palliative Fr cats with lymphma, smetimes in cmb with chemtherapy NSAIDs dgs nly Pirxicam, melxicam, carprfen Yunan Baiya t cntrl bleeding Mst imprtant take hme pint is: client educatin is incredibly imprtant and pwerful! Prepare yur clients fr lng term management with rhinitis and treatment ptins if yu suspect neplasia.