Investigation of nasal disease in the cat--a retrospective study of 77 cases

A retrospective study was undertaken to determine the prevalence of different diseases in cats referred for investigation of chronic nasal disease, to identify historical, clinical and diagnostic features which may assist in making a diagnosis, and to provide information pertaining to outcome in these cats. Diagnoses included neoplasia (30 cases), chronic rhinitis (27), foreign body (8), nasopharyngeal stenosis (5), Actinomyces infection (2), nasal polyps (2), stenotic nares (2), and rhinitis subsequent to trauma (1). The most common neoplasia was lymphosarcoma (21 cases), with a median survival of 98 days for cats treated with multiagent chemotherapy. Cats with neoplasia were older on average than the other cats, and were more likely to be dyspnoeic and have a haemorrhagic and/or unilateral nasal discharge than cats with chronic rhinitis. Cats with neoplasia were more likely to have radiographic evidence of nasal turbinate destruction, septal changes, or severe increases in soft tissue density than cats with chronic rhinitis. It was unusual for cats with diseases other than neoplasia to be euthanased as a result of their nasal disease.     

COMPUTED TOMOGRAPHIC EVALUATION OF ANATOMIC AND PATHOLOGIC VARIATIONS IN THE FELINE NASAL SEPTUM AND PARANASAL SINUSES

The purpose of this study was to compare the prevalence of nasal septal deviation and variations of the paranasal sinuses in normal and diseased cats. Prevalence of nasal septal deviation was 86.7%, 68.4%, and 71.4% in cats with rhinitis, neoplasia, and normal cats, respectively, with no statistically significant difference (P = 0.244). There was a statistically significant difference (P = 0.01) in the magnitude of nasal septal deviation between cats with and cats without nasal disease, using a cutoff value of 1 mm for maximum distance of deviation from midline. There was a statistically significant difference (P = 0.019) between cats with rhinitis and neoplasia when comparing the presence of a mass (7.7% and 53.8%, respectively), but not when comparing for lysis of the septum. Deviation of the frontal sinus septum occurred in 27.7% of all cats, while the sphenoid septum was oblique and eccentric in 96.6% of all cats. The mean length of the frontal sinus was longer in male cats than female cats. The presence of nasal septal deviation alone cannot be used as a criterion to diagnose nasal disease, but cats with rhinitis or neoplasia have more marked deviation than normal cats. The presence of a mass and lysis of the septum were only seen in cats with nasal disease and a mass is more likely to be seen with neoplasia than rhinitis. Male cats have a longer frontal sinus than female cats. Almost all cats have an oblique, eccentric sphenoid septum.     

Radiographic signs in cats with nasal disease

Radiographic signs in 64 cats that had radiography as part of the diagnostic work-up for suspected nasal disease were reviewed in a blinded fashion. Final diagnoses in these cats were rhinitis in 27, primary nasal neoplasia in 21 and non-nasal disease in 16. The signs with highest predictive value for nasal neoplasia were displacement of midline structures (73%), unilateral generalised soft tissue opacity (70%), unilateral generalised loss of turbinate detail (69%) and evidence of bone invasion (64%). The only radiographic finding that occurred more frequently in cats with rhinitis was a nasal cavity within normal limits, and the predictive value of this sign was only 38%. Radiographic signs in cats with nasal neoplasia are similar to those reported in dogs, whereas the radiographic signs in cats with rhinitis are variable and non-specific, and may be absent.     

DIAGNOSTIC VALUE OF COMPUTED TOMOGRAPHY IN DOGS WITH CHRONIC NASAL DISEASE

Computed tomographic (CT) studies of 80 dogs with chronic nasal disease (nasal neoplasia (n = 19), nasal aspergillosis (n = 46), nonspecific rhinitis (n = 11), and foreign body rhinitis (n = 4)) were reviewed retrospectively by two independent observers. Each observer filled out a custom-designed list to record his or her interpretation of the CT signs and selected a diagnosis. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the diagnosis of each disease. The agreement between observers was evaluated. The CT signs corresponded to those previously described in the literature. CT had an accuracy greater than 90% for each observer in all disease processes. The sensitivity, specificity, PPV, and NPV were greater than 80% in all dogs with the exception of the PPV of foreign body rhinitis (80% for observer A and 44% for observer B). There was a substantial, to almost perfect, agreement between the two observers regarding the CT signs and diagnosis. This study indicates a high accuracy of CT for diagnosis of dogs with chronic nasal disease. The differentiation between nasal aspergillosis restricted to the nasal passages and foreign body rhinitis may be difficult when the foreign body is not visible.     

Rhinostomy as Surgical Treatment of Odontogenic Rhinitis in Three Pet Rabbits

Disease of the upper airways, specifically chronic rhinitis, is common in pet rabbits and is particularly debilitating in this obligate nasal-breathing species. Cases of chronic rhinitis can be mild to severe (empyema of the nasal cavities). Surgical therapy requires a thorough understanding of upper respiratory anatomy of the rabbit and is an option for chronic rhinitis cases nonresponsive to medical therapy. Diagnostic imaging aids in diagnosing the extent of the disease process and guides the surgical approach. The author reports 3 cases of surgical treatment of rabbit patients diagnosed with chronic rhinitis and empyema of the nasal cavities following advanced or end-stage dental disease.     

Evaluation of a novel immunotherapy for treatment of chronic rhinitis in cats

The pathogenesis of chronic rhinitis in cats is poorly understood and consistently effective therapies are not currently available. Therefore, randomized clinical trials were conducted to evaluate a novel immunotherapy for treatment of chronic rhinitis in adult (n=12) and young cats (n=28). In addition, cytokine profiles in cats with chronic rhinitis were compared to those of healthy cats. Cats were treated with a potent stimulator of innate immunity (liposome-IL-2 DNA complexes) and the effects of treatment on clinical signs and immune function were assessed. In adult cats with chronic rhinitis, immunotherapy led to significant improvement in frequency of sneezing but not in other clinical signs when compared to the placebo group, whereas immunotherapy failed to improve clinical signs in younger cats. Analysis of cytokine expression in cats with rhinitis did not reveal evidence of a Th2 cytokine bias in cats with rhinitis. We conclude that chronic rhinitis in cats is not a Th2-biased disease and that immunotherapy may lead to clinical improvement in adult cats with the disease.     

Nasal computed tomography

Chronic nasal disease is often a challenge to diagnose. Computed tomography greatly enhances the ability to diagnose chronic nasal disease in dogs and cats. Nasal computed tomography provides detailed information regarding the extent of disease, accurate discrimination of neoplastic versus nonneoplastic diseases, and identification of areas of the nose to examine rhinoscopically and suspicious regions to target for biopsy.     

RETROSPECTIVE ASSESSMENT OF COMPUTED TOMOGRAPHIC IMAGING OF FELINE SINONASAL DISEASE IN 62 CATS

Sixty-two cats with sinonasal disease were evaluated with computed tomography. Findings that may lead to a computed tomographic diagnosis of nasal neoplasia versus rhinitis included osteolysis of the paranasal bones, moderate to severe turbinate destruction, lysis of the nasal septum, the presence of a homogenous space occupying mass, and extension of the disease process into the orbit or facial soft tissues. These findings were not pathognomonic for neoplasia and may be associated with severe rhinitis; therefore, nasal biopsy was recommended. When compared with parallel radiographic studies, computed tomography was not more sensitive than radiographs at detecting the presence of nasal cavity abnormalities in cats with referable clinical signs but was more sensitive at localizing these changes and determining the extent of disease.     

Chronic nasal discharge in cats: 75 cases (1993-2004)

OBJECTIVE: To identify the most common etiologic diagnosis and any historical, physical, or other diagnostic variables associated with a definitive etiologic diagnosis for chronic nasal discharge in cats. Design-Retrospective case series. ANIMALS: 75 cats with nasal discharge of >/= 1 month's duration. PROCEDURES: Medical records of affected cats were reviewed for information on signalment, clinical signs, duration and type of nasal discharge, results of clinical examination, laboratory findings, and advanced imaging findings. RESULTS: A specific etiologic diagnosis for nasal discharge was identified in only 36% of cats. Neoplasia (carcinoma or lymphoma) was the most common etiologic diagnosis. Character and location of nasal discharge did not contribute greatly toward a specific etiologic diagnosis. Sneezing and vomiting were the most common concurrent clinical signs. Routine CBC, serum biochemical panel, and urinalysis did not contribute to a specific etiologic diagnosis. An etiologic diagnosis was more likely in older cats and cats that underwent advanced imaging studies and nasal biopsy. CONCLUSIONS AND CLINICAL RELEVANCE: Although advanced diagnostic testing, including imaging studies and biopsy, increases the likelihood of achieving an etiologic diagnosis, the cause of chronic nasal discharge in cats often remains elusive.     

Bovine nasal eosinophilic, granuloma with blood eosinophilia caused by Nocardia species.

OBJECTIVE: To describe a case of nocardial nasal granuloma in a Holstein heifer. CLINICAL FEATURES: The heifer showed laboured respiration and occasional coughing with granulomatous excrescences on the bilateral nasal mucosa, and a marked leucocytosis with eosinophilia. NECROPSY: Severe granulomatous inflammation with eosinophils, epithelioid cells, giant cells and Nocardia sp obstructed both nasal passages completely. CONCLUSION: This lesion resulted from chronic infection with Nocardia sp and is distinct from other forms of bovine nasal granuloma, also called atopic rhinitis or chronic granular rhinitis, which we propose should be classified as bovine allergic granular rhinitis. The most appropriate name for the present disease is bovine nasal eosinophilic granuloma.     

Computed tomographic evidence of bulla effusion in cats with sinonasal disease: 2001-2004

BACKGROUND: Sinonasal disease is common in cats; chronic inflammatory disease and neoplasia are diagnosed most frequently. Radiographic and computed tomographic (CT) findings in nasal disease have been reported, although involvement of other cranial structures has not been fully described to our knowledge. HYPOTHESIS: We hypothesized that neoplastic or inflammatory obstruction of the auditory tube associated with sinonasal disease could result in CT evidence of effusive bulla disease in affected cats. ANIMALS: 46 cats with sinonasal disease, 18 control cats. METHODS: CT images acquired in cats with (n = 46) and without (n = 18) sinonasal disease were reviewed for evidence of concurrent bulla effusion. CT findings of soft tissue or fluid opacity within the tympanic bulla or thickening of the bone of the bullae were considered evidence of effusive bulla disease. RESULTS: The prevalence of bulla effusion in cats with sinonasal disease was 28% (13/46) and was significantly higher than that observed in cats without sinonasal disease (1/18, P = .043). CT findings that were found in association with effusive bulla disease included imaging features of sinusitis and nasopharyngeal disease. The most common neoplasm associated with bulla effusion was nasopharyngeal lymphoma. Bulla effusion was not observed in any cat with nasal carcinoma. CONCLUSIONS AND CLINICAL IMPORTANCE: Findings of this study suggest that auditory canal dysfunction may play a larger role in feline sinonasal disease than was previously recognized. The implications of these findings for management of cats with chronic inflammatory or neoplastic sinonasal disease require further investigation.     

COMPUTED TOMOGRAPHIC FINDINGS OF FUNGAL RHINITIS AND SINUSITIS IN CATS

The computed tomographic (CT) findings of fungal rhinitis/sinusitis in cats were characterized. The CT images of 10 cats ranging in age from 7 to 13 years were examined. The mean age was 10.8 years and all were neutered males. Nasal aspergillosis was diagnosed in five cats, cryptococcosis in three cats, hyalohyphomycosis in one cat, and trichosporonosis in one cat. Bilateral disease was present in eight cats, seven had abnormal soft tissue attenuation in two-thirds of the nasal cavity, and six had turbinate lysis. Seven cats had also lysis of the hard palate, nasal septum, or frontal bone. One cat had lysis of the cribriform plate. Five of the nine cats whose lymph nodes were imaged had lymph node enlargement. There was contrast medium enhancement in the nasal cavity in all cats, with either a primarily peripheral rim or heterogeneous pattern. There appears to be an overlap of clinical signs, age, and CT features of cats with nasal neoplasia and those with fungal rhinitis/sinusitis.     

Rhinotomy and Rhinostomy for Surgical Treatment of Chronic Rhinitis in Two Rabbits

Chronic rhinitis is a frustrating disease presentation in rabbits for veterinarians to treat and is often characterized by failure to respond to therapy and reoccurrence. Treatment failure of rabbit chronic rhinitis cases may be due to the presence of foreign material and/or bacterial granulomas with or without bony destruction. For these patients, surgical intervention for the purpose of debridement and flushing of the affected nasal area is an effective alternative to promote healing.     

Four cats with fungal rhinitis

Fungal rhinitis is uncommon in the cat and cases of nasal aspergillosis-penicilliosis have been rarely reported. Signs of fungal rhinitis include epistaxis, sneezing, mucopurulent nasal discharge and exophthalmos. Brachycephalic feline breeds seem to be at increased risk for development of nasal aspergillosis-penicilliosis. Computed tomography (CT) imaging and rhinoscopy are useful in assessing the extent of the disease and in obtaining diagnostic samples. Fungal culture may lead to false negative or positive results and must be used in conjunction with other diagnostic tests. Serological testing was not useful in two cats tested. The cats in this study were treated with oral itraconazole therapy. When itraconazole therapy was discontinued prematurely, clinical signs recurred. Hepatotoxicosis is a possible sequel to itraconazole therapy.     

COMBINATION OF COMPUTED TOMOGRAPHIC IMAGING CHARACTERISTICS OF MEDIAL RETROPHARYNGEAL LYMPH NODES AND NASAL PASSAGES AIDS DISCRIMINATION BETWEEN RHINITIS AND NEOPLASIA IN CATS

Feline nasal diseases are a diagnostic challenge. The objective of this retrospective, cross‐sectional study was to determine whether computed tomography (CT) imaging characteristics of the medial retropharyngeal lymph nodes (MRPLN), alone or in combination with CT imaging characteristics of the nasal passages, could aid in differentiation between rhinitis and nasal neoplasia. Cats were recruited from record archives at two veterinary facilities during the period of 2008–2012. Selection criteria were presentation for chronic nasal discharge, contrast‐enhanced CT of the head that included the MRPLN, and rhinoscopic nasal biopsy resulting in diagnosis of rhinitis or neoplasia. For each CT scan, two board‐certified veterinary radiologists recorded MRPLN size, attenuation, heterogeneity, contrast‐medium enhancement, margination, shape, presence of a lymph node hilus, perinodal fat, turbinate lysis, paranasal bone lysis, and nasal mass. Both readers were unaware of patient information at the time of CT interpretation. Thirty‐four cats with rhinitis and 22 cats with neoplasia were included. Computed tomographic characteristics significantly associated with neoplasia included abnormal MRPLN hilus (OR 5.1), paranasal bone lysis (OR 5.6), turbinate lysis (5.6), mass (OR 26.1), MRPLN height asymmetry (OR 4.5), and decreased MRPLN precontrast heterogeneity (OR 7.0). The combined features predictive of neoplasia were a nasal mass with abnormal hilus (OR 47.7); lysis of turbinates/paranasal bones with abnormal MRPLN hilus (OR 16.2). Findings supported the hypothesis that combining CT features of the nasal passages and MRPLN aided in differentiating rhinitis from neoplasia in cats.     

The Treatment of Chronic Sinusitis in Six Cats by Ethmoid Conchal Curettage and Autogenous Fat Graft Sinus Ablation

Six cats with chronic recurrent rhinitis and frontal sinusitis were treated by surgical ablation of their frontal sinuses by the implantation of autogenous fat grafts and curettage of the remaining ethmoid conchae. Deep nasal bacterial cultures and skull radiographs were performed before surgery. Excellent results were achieved in four of six cats and there was significant improvement in two of six cats. Median follow-up time was 15 months. Subcutaneous emphysema over the temporal area was managed by needle aspiration and bandaging. Frontal sinus ablation with autogenous fat graft in combination with ethmoid conchal curettage appears to be an effective treatment for chronic sinusitis in cats.     

Rhinoscopy: a diagnostic aid?

Sixty dogs with confirmed chronic nasal disease were examined rhinoscopically. The relative merits of the otoscope, an arthroscope and a flexible bronchoscope as instruments are discussed. Rhinoscopy has a limited place in the investigation of chronic nasal discharge in the dog due to the volume of discharge present and induced haemorrhage. It is most useful in cases of destructive rhinitis (including aspergillosis) and foreign body obstruction.     

Aetiology and diagnosis of persistent nasal disease in the dog: a retrospective study of 42 cases

Forty-two dogs with a history of persistent nasal disease were evaluated by a combination of clinical examination, thoracic and nasal radiography, retroflexed endoscopy and biopsy, and anterograde rhinoscopy and blind nasal biopsy. A definitive diagnosis was made in 91 per cent of cases. Neoplasia was the most common diagnosis (33 per cent of cases), followed by inflammatory rhinitis (24 per cent). Other diagnoses included periodontal disease (10 per cent), aspergillosis (7 per cent) and foreign bodies (7 per cent). Adenocarcinoma was the most common tumour diagnosed. The clinical findings were found to be too variable to be used as specific diagnostic criteria. Anterograde rhinoscopy and retroflexed endoscopy had higher specificity and sensitivity than radiology for the diagnosis of neoplasia, inflammatory rhinitis, aspergillosis and foreign bodies. With a systematic approach to the investigation of persistent nasal disease, a definitive diagnosis can be successfully obtained in the vast majority of cases.     

Nasopharyngeal disease in cats: 2. Specific conditions and their management

PRACTICAL RELEVANCE: Nasopharyngeal disease is a common presenting problem in feline medicine. CLINICAL CHALLENGES: The management of feline nasopharyngeal disease can be challenging at a number of levels. In many cases, a specific diagnosis may remain elusive. Some conditions may not be curable so owners need to understand the requirement for long-term management. In addition, treatment may be compromised by poor patient compliance. AUDIENCE: This review, which is directed at any clinicians involved in the management of cats with nasopharyngeal disease, discusses acute rhinitis (cat 'flu) and a variety of conditions causing chronic rhinosinusitis/chronic nasopharyngeal disease. The intention is to assist treatment decision making by reviewing the most appropriate therapies from the options available for these patients. EVIDENCE BASE: The information presented in this article is based on peer-reviewed publications and the clinical experience of the authors.     

Rhinoscopy

This article presents a diagnostic protocol for nasal disease evaluation that provides consistent success in diagnosis of chronic cases. The protocol includes history, physical examination, blood clinical pathology assessment, radiographs, culture and sensitivity tests, rhinoscopy, histopathology, fungal serology, and allergy screening. The sequence of diagnostic procedures and their techniques are discussed, and rhinoscopic appearance of the normal nasal cavity is presented, along with findings of commonly seen nasal diseases, including neoplasia, mycotic rhinitis and sinusitis, foreign body obstruction, dental disease, allergic rhinitis, bacterial rhinitis, and idiopathic rhinitis. Rhinoscopy is a highly effective diagnostic technique with minimal morbidity and mortality that has virtually eliminated the need for exploratory rhinotomy.