A long-term study of 277 cases of equine sinonasal disease. Part 2: treatments and results of treatments

The treatments of 277 horses with equine sinonasal disease (1984-1996), described by Tremaine and Dixon (2001), are reported here. Long-term (median duration 24 months) outcomes of treatment of the more common disorders were good, with 92% of horses with sinonasal mycosis, 84% with primary sinusitis, 82% with sinus cysts, 78% with dental sinusitis and 75% with sinonasal trauma reported to have complete remission of clinical signs. However, only 33% of horses with progressive ethmoidal haematoma (PEH) and 12% with sinonasal neoplasia reported long term remission of clinical signs.     

Historical and clinical features of 200 cases of equine sinus disease

The historical and clinical findings in 200 referred cases of equine sinus disease were reviewed retrospectively. Univariable and multivariable analyses were performed to detect significant differences in historical or clinical features between various categories of sinus disease. The causes of sinus disease were classified as subacute primary (less than two months duration) (n=52), chronic primary (more than two months duration) (n=37), dental (n=40), sinus cyst (n=26), traumatic (n=13) or mycotic sinusitis (n=7), sinus neoplasia (n=10), dental-related oromaxillary fistula (n=8) and intrasinus progressive ethmoid haematoma (n=7). The majority of sinus disorders were of chronic duration at the time of referral and most (including 97 per cent of chronic primary sinusitis cases) had not responded to previous antibiotic therapy and/or sinus lavage in some cases. Clinical signs included unilateral nasal discharge in most cases, including purulent or mucopurulent discharge in all horses with primary, dental and mycotic sinusitis. Haemorrhagic nasal discharge was a feature of traumatic sinusitis and intrasinus progressive ethmoid haematomas. Firm facial swellings and nasal airflow obstruction were features of sinus cysts and neoplasms. Ipsilateral lymphadenitis was a more prominent feature of sinus disease with active infections such as primary, dental or mycotic sinusitis.     

Histopathological findings in equine sinonasal disorders.

Biopsies collected from 79 referred cases of equine sinonasal disease, including 27 horses with primary sinusitis, 10 with secondary dental sinusitis, 19 with sinus cysts, 11 with progressive ethmoid haematomata (PEH), 4 with false nostril epidermal inclusion cysts, 4 with sinonasal polyps, 3 with sinonasal mycosis and from 2 control animals were examined histologically. Observations were made on epithelial type and integrity, cellular inflammatory response, fibroplasia and presence of potential pathogens. Chronic inflammatory changes including mucosal thickening, ulceration and significant fibroplasia, were found in the sinus mucosa with most sinus disorders, similar to those found in human chronic sinusitis. Bacteria were variably present on sinusitis mucosae but their aetiological significance was unclear. The presence of apparently irreversible changes including fibroplasia in some of these sinusitis cases may explain their poor or delayed response to treatment. Sinus cysts had histological similarities to human mucocoeles. Progressive ethmoid haematomata showed recent and older haemorrhage, as did sinus cysts (and occasionally some chronic sinusitis sections), but support for a common aetiology between sinus cysts and PEH was absent.     

Equine nasal cavity and paranasal sinus disease: A review of 85 cases

Eighty-five cases of equine nasal cavity and/or paranasal sinus disease (NC-PNSD) at Washington State University were reviewed with respect to incidence, clinical signs, treatment regimen and outcome. Incidence was 1.06 percent of all equine admissions over an 8-year period (July 1, 1977–June 30, 1985). For purposes of review, cases were divided into 6 groups depending upon etiology: 1. traumatic disorders, 2. developmental disorders, 3. neoplasia, 4. primary bacterial sinusitis, 5. sinusitis secondary to dental disorders, and 6. miscellaneous conditions.No correlation between sex or breed with NC-PNSD was identified. Traumatic and developmental disorders were most common in horses under 6-years-of-age and neoplastic conditions were most prevalent in horses over 10-years-of-age.The most common clinical signs of NC-PNSD, regardless of etiology were bony swelling or abnormalities noted externally, nasal discharge, and rhinodyspnea, followed by signs referrable to the oral cavity, external draining tracts, and epistaxis. All clinical signs were usually of a chronic duration (more than 2 weeks). Procedures which were most helpful in establishing a diagnosis were radiography (92% of cases), endoscopy (38%) sinocentesis (21 %), and examination of the oral cavity (20%).Of 74 horses available for follow-up, 49 were treated. Treatment was either not recommended or was declined by the owner in 12 cases, and euthanasia was performed without treatment in 13. Forty-six cases were treated surgically. The outcome of 23 of the cases was judged successful. Five had reduced clinical signs following surgery, and 18 were unsuccessfully treated. Those disorders judged to be traumatic in origin responded best to treatment while those involving neoplasia were the least successfully treated.     

Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): treatments and long-term results of treatments

Reasons for performing study: There is limited objective information available on the treatment and the long‐term response to treatment of the different types of equine sinus disease. Objectives: To document the treatments and long‐term response to these treatments in 200 cases of equine sinus disease (1997–2009). Methods: The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental‐related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long‐term response to these treatments were retrospectively reviewed. Results: Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long‐term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment. Conclusions: More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre‐existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses.     

Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): ancillary diagnostic findings and involvement of the various sinus compartments

Reasons for performing study: There is a lack of objective information on the value of ancillary diagnostic techniques used to investigate equine sinus disease, and also on which sinus compartments are commonly affected in this disorder. Objectives: To record the ancillary diagnostic findings used to investigate equine sinus disease and to document which compartments are affected. Materials and methods: The clinical case records of 200 consecutive cases of sinus disease, including subacute (<2 months' duration) primary (n = 52); chronic (>2 months' duration) primary (n = 37); dental (n = 40); traumatic (n = 13); sinus cyst (n = 26); sinus neoplasia (n = 10); dental related oromaxillary fistula (n = 8); mycotic sinusitis (n = 7) and intra‐sinus progressive ethmoid haematoma (n = 7) were retrospectively examined. Results: Nasal endoscopy showed exudate draining from the sino‐nasal ostia in 88% of cases and a sino‐nasal fistula was present in 15% of cases. Sinoscopy was performed in 79% of cases and was of great diagnostic value. More recently, 22% of cases had fenestration of the ventral conchal bulla performed to allow sinoscopy of the rostral sinus compartments. Radiography was performed in 97% of cases and showed intra‐sinus fluid lines to be common (69% prevalence) in subacute primary sinusitis. Radiographic dental apical changes were not specific to dental sinusitis, e.g. 29% of chronic primary sinusitis cases had radiographic dental changes. Scintigraphy was performed in 20% of cases and was helpful in identifying dental apical changes when radiography was inconclusive. Overall, the caudal maxillary (78% involvement) and rostral maxillary (61%) sinuses were most commonly affected, with the ventral conchal sinus (VCS) (54% involvement) and conchofrontal sinuses (48%) less so. The VCS showed the greatest tendency to contain inspissated pus (present in 46% of all affected VCS). Conclusions: Nasal endoscopy, sinoscopy and skull radiography are of great value in diagnosing the presence and causes of equine sinus disease.     

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.     

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse. II. Radiological findings

The radiographic findings in 167 horses subjected to radiography of the facial area, nasal cavity and paranasal sinuses are recorded. Cases were grouped according to clinical diagnosis and the common and disparate radiographic features between and within groups are discussed. Dental disease occurred most frequently and accounted for about 30 per cent of cases, most of which had periapical infection. This disorder presented as two distinct clinical entities in almost equal numbers affected teeth with roots rostral to the maxillary sinus usually produced facial swelling, whereas those with roots within the sinus were generally associated with nasal discharge as a result of secondary sinusitis. In the former group periapical changes could readily be identified on radiographs, but in the latter group affected teeth could be recognised with confidence in only about half the cases. Primary sinusitis was the commonest specific condition recorded and accounted for 32 cases, three of which were mycotic. Using lateral erect projections, comparison of the radiographic features of primary sinusitis and sinusitis secondary to dental disease showed some useful differentiating signs. In four ponies, rhinitis associated with sinusitis led to disruption of the intra-nasal structures but mycotic rhinitis, nasal ulceration and an intra-nasal foreign body produced no radiographic abnormalities. Sixteen cases of suture periostitis were recorded, with varying degrees of new bone formation, and of 13 animals presented for evaluation of trauma, pre-diagnosed fractures were demonstrated in 10 and complications due to sinusitis in three.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sinoscopic Treatment of Rostral Maxillary and Ventral Conchal Sinusitis in 60 Horses

Objective— To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses.
Study Design— Case series
Animals— Horses (n=60) with suspected paranasal sinus disease.
Methods— Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses.
Results— The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis.
Conclusions— Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage.
Clinical Relevance— Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications.     

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.     

Equine Nasal and Paranasal Sinus Tumours: Part 2: A Contribution of 28 Case Reports

The clinical and pathological findings of 28 cases (27 horses, 1 donkey) of equid sinonasal tumours examined at the Edinburgh Veterinary School are presented and include: seven cases of squamous cell carcinoma (SCC); five adenocarcinomas; three undifferentiated carcinomas; two adenomas; five fibro-osseous and bone tumours; and single cases of ameloblastoma, fibroma, fibrosarcoma, undifferentiated sarcoma, melanoma and lymphosarcoma. The median ages of animals affected with epithelial, and fibro-osseous/bone tumours were 14 and 4 years, respectively. Unilateral purulent or mucopurulent nasal discharge (81% of cases) and gross facial swellings (82% of cases) were the most common presenting signs with sinonasal tumours, with epistaxis recorded in just 23% of cases. Radiology and endoscopy were the most useful ancillary diagnostic techniques. The maxillary area was the most common site of tumour origin, and only three cases were definitively identified as originating in the nasal cavity. Four of the maxillary SCC lesions originated within the nasal cavities or maxillary sinuses, while two originated in the oral cavity. Fourteen of 15 carcinomas, but only two of the 13 remaining tumours, spread to other sites in the head. Only three cases of sinonasal tumour had lymph node metastases, and none had distant metastases. In the long term, surgical treatment with seven malignant tumours was unsuccessful (6 months median survival post-operatively), but was successful with four out of five benign tumours (no regrowth at a median of 4 years post-operatively).     

Canine nasal aspergillosis

Chronic nasal discharge is a common clinical sign of disease in dogs. Canine sinonasal aspergillosis is a relatively common disease in dogs. The three hallmarks of canine nasal aspergillosis are a profuse mucoid to hemorrhagic chronic nasal discharge that may alternate with periods of epistaxis, ulceration of the external nares with crusting, and pain or discomfort in the facial region. Diagnostic imaging (preferably computed tomography, CT) of the nasal cavity and paranasal sinuses is an important component of the evaluation of dogs with signs of nasal disease. Rhinoscopy is an important part of both the diagnosis and the therapy for nasal aspergillosis. Therapeutic recommendations for sinonasal aspergillosis have included surgery and the use of several systemic and topical antifungal drugs.     

ASSOCIATION BETWEEN CLINICAL CHARACTERISTICS, COMPUTED TOMOGRAPHY CHARACTERISTICS, AND HISTOLOGIC DIAGNOSIS FOR CATS WITH SINONASAL DISEASE

The purpose of this retrospective study was to determine the association between clinical characteristics, computed tomography (CT) characteristics, and histologic diagnosis in 43 cats with sinonasal disease. All cats were evaluated with CT and nasopharyngeal endoscopic examination, with histologic diagnosis based on nasal biopsy. Fifteen cats were diagnosed with sinonasal neoplasia and 28 cats were diagnosed with rhinitis. Clinical characteristics determined to be significantly associated with neoplasia were unilateral ocular discharge (odds ratio [OR] 9.6) and the presence of a nasopharyngeal mass during endoscopic examination (OR 18.9). CT characteristics found to be significantly associated with neoplasia included: unilateral lysis of ethmoturbinates (OR 11.0), unilateral lysis of the dorsal (OR 8.3) and lateral maxilla (OR 6.9), lysis of the vomer bone (OR 6.7) and ventral maxilla (OR 28.8), and bilateral lysis of the orbital lamina (OR 4.1); unilateral abnormal soft tissue/fluid within the sphenoid sinus (OR 15.3), frontal sinus (OR 10.4), and/or and retrobulbar space (OR 12.2). Lysis of the maxillary turbinates, nasal septum, nasal bone, palatine bone, and cribriform plate were not significantly associated with sinonasal neoplasia.     

A review of swellings of the frontal region of the equine head

Gross swellings of the equine frontal area are most commonly caused by the poorly understood disorder of nasofrontal suture line periostitis that is usually self‐resolving, sinus cysts that are highly amenable to treatment, sinus tumours that in contrast usually respond poorly to treatment and facial trauma that may later lead to nasofrontal suture line periostitis. Other causes of conchofrontal sinus disease such as intrasinus progressive ethmoid haematoma, primary sinusitis and dental sinusitis seldom cause gross swellings of the overlying bones.     

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.     

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse: I. Indications and procedures in 235 cases

The radiographic procedures used for examination of the facial area and paranasal sinuses of 235 horses are reported. Clinical indications for these examinations and the diagnoses made are reviewed. Unilateral nasal discharge was the commonest reason for radiography, accounting for about one third of cases, most of which had radiological signs of paranasal sinus disease recognisable on erect lateral films. Oblique projections were required to obtain further information about the maxillary dental arcades and ventro-dorsal views demonstrated sinus expansion and extension of disease into the nasal cavity. In 24 horses with bilateral nasal discharge, the origin was usually shown to be in the lower respiratory tract and radiographic abnormalities were found in only 20 per cent of cases. Facial swelling was a feature of 25 per cent of cases; the commonest causes were premolar periapical disease, best shown on oblique views with the patient recumbent, and suture periostitis, easily demonstrated on erect lateral films. Other causes of facial swelling, which required multiple radiographic projections for evaluation, were sinus cysts and tumours and peripheral soft tissue masses. Epistaxis for which no cause could be found in the lower respiratory tract was the indication for radiography in a further 10 per cent of cases. In almost half of these a radiopaque shadow representing an ethmoid haematoma could be seen on an erect lateral film. A sinus cyst and a tumour were also recorded but most other causes of epistaxis failed to produce radiographic signs.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Long-term outcomes in dogs with sinonasal aspergillosis treated with intranasal infusions of enilconazole

Long-term outcomes (mean 38+/-17 months) were evaluated in 27 dogs with sinonasal aspergillosis after successful medical treatment using intranasal infusions of 1% or 2% enilconazole (1%, n=15; 2%, n=12). Long-term outcomes with both treatment protocols were good, with half of the dogs being asymptomatic throughout the follow-up period. The remaining dogs showed mild clinical signs compatible with chronic rhinitis/sinusitis. These clinical signs were interpreted as chronic lymphoplasmacytic rhinitis/sinusitis and episodes of bacterial rather than fungal infection. Three dogs had confirmed reinfection or relapse 2 to 36 months after clinical resolution.     

Equine paranasal sinus cysts: a report of 15 cases

The clinical and radiographic features of 15 cases of paranasal sinus cysts are described. Breed, sex and side frequency were unremarkable but two distinct categories of age incidence emerged. Onset of signs had occurred before one year of age in three cases, while all but two of the remaining 12 animals were older than nine years. The most common clinical signs were nasal airway obstruction, facial swelling and nasal discharge, often occurring in combination. Radiographic changes were recorded in all horses. Sinus opacification was a consistent finding and in several cases the bone surrounding the sinus had increased in thickness. Increase in intra-maxillary sinus pressure was demonstrated by septal displacement on ventro-dorsal radiographs in almost half the cases. Less common signs included expansion, free fluid accumulation within the affected sinus, dental distortion and displacement and mineralisation. Two horses were destroyed without treatment but in 13 animals surgical exploration was performed. Two of these were destroyed, one at the time of surgery and one five days postoperatively. In the remaining 11 cases, all accessible parts of the cyst were removed through a facial flap and drainage to the nasal meati was established. All these horses recovered satisfactorily and were followed up for periods between three months and six years without evidence of recurrence. Thirteen cysts arose in the caudal maxillary sinus and one each in the frontal and rostral maxillary compartments. Histopathological examination of portions of the cyst walls suggests that, like ethmoidal haematomas, they may originate from episodes of haemorrhage beneath the upper respiratory tract mucosa.