Chronic rhinitis in cats

Chronic rhinitis is a common and important problem in cats potentially resulting from a number of intranasal or systemic disorders. Idiopathic chronic rhinosinusitis and nasal neoplasia are the most common causes of chronic nasal disease in cats. For most cats with chronic rhinitis, diagnostic imaging, endoscopic studies, and nasal biopsy will be required to establish a diagnosis. A discussion of some of the more common causes of chronic nasal disease is presented.     

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.     

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.     

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.     

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.     

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.     

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.     

Comparison of serologic evaluation via agar gel immunodiffusion and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs

OBJECTIVE: To compare the sensitivity and specificity of serologic evaluation and fungal culture of tissue for diagnosis of nasal aspergillosis in dogs. DESIGN: Prospective study. ANIMALS: 58 dogs with nasal discharge and 26 healthy dogs. PROCEDURES: Dogs with nasal discharge were anesthetized and underwent computed tomography and rhinoscopy; nasal tissues were collected for histologic examination and fungal culture. Sera were assessed for antibodies against Aspergillus spp (healthy dog sera were used as negative control specimens). Nasal aspergillosis was diagnosed in dogs that had at least 2 of the following findings: computed tomographic characteristics consistent with aspergillosis, fungal plaques detected during rhinoscopy, and histologically detectable fungal hyphae in nasal tissue. Histologic characteristics of malignancy were diagnostic for neoplasia. Without evidence of neoplasia or fungal disease, nonfungal rhinitis was diagnosed. RESULTS: Among the 58 dogs, 21 had nasal aspergillosis, 25 had nonfungal rhinitis, and 12 had nasal neoplasia. Fourteen aspergillosis-affected dogs and 1 dog with nonfungal rhinitis had serum antibodies against Aspergillus spp. Fungal culture results were positive for Aspergillus spp only for 17 dogs with aspergillosis. With regard to aspergillosis diagnosis, sensitivity, specificity, and positive and negative predictive values were 67%, 98%, 93%, and 84%, respectively, for serum anti-Aspergillus antibody determination and 81%, 100%, 100%, and 90%, respectively, for fungal culture. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that seropositivity for Aspergillus spp and identification of Aspergillus spp in cultures of nasal tissue are highly suggestive of nasal aspergillosis in dogs; however, negative test results do not rule out nasal aspergillosis.     

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.     

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.     

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.     

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.     

Enilconazole treatment of horses with superficial Aspergillus spp. rhinitis

BACKGROUND: Mycotic rhinitis is an uncommon disease in horses with a wide range of clinical signs and treatment options based on case studies of a single or only a few individuals. Moreover, while dogs with mycotic rhinitis appear to respond well to treatment with topical enilconazole, this approach has yet to be reported in horses. OBJECTIVES: The aim of this study was to describe the clinical findings, results of diagnostic investigations, treatment, and outcome in horses with mycotic rhinitis treated with topical enilconazole. ANIMALS: Eight horses were included in the study. METHODS: Medical records from 1995 to 2007 from an equine veterinary teaching hospital were reviewed to identify cases with a diagnosis of mycotic rhinitis. RESULTS: Eleven cases were identified, of which 8 were treated with topical enilconazole. Seven of those 8 horses recovered and had normal appearance of the nasal passages on endoscopic examination. Fungal culture, where positive, yielded only Aspergillus spp. Treatment was readily performed and no adverse effects were noted in these horses. In 5 horses, long-term follow-up revealed complete recovery for an average of 5 years. CONCLUSIONS AND CLINICAL IMPORTANCE: Mycotic rhinitis owing to Aspergillus spp. in horses can be effectively and safely treated with topical enilconazole.     

Atrophic rhinitis of swine--a multifactorial disease?

Atrophic rhinitis is caused by toxigenic Pasteurella multocida strains. The infection is supported by Bordetella bronchiseptica and other widespread agents and by non-infectious factors damaging the nasal epithelium. The term "infectious multifactorial disease" means in German, that ubiquitous low-virulent agents cause disease when intensified by non-infectious factors. Atrophic rhinitis does not belong to this group but is an infectious disease, caused by a specific agent and influenced by several factors.     

Computed tomography as an aid in the diagnosis of chronic nasal disease in dogs

OBJECTIVES: To assess the use of computed tomography (CT) in the diagnosis of chronic nasal disease in dogs. METHODS: A retrospective study of 85 dogs with chronic nasal discharge due to primary nasal disease, which had undergone nasal CT and biopsy, was carried out. Medical records were reviewed for signalment, clinical signs, CT findings, endoscopic findings and histopathology. The results obtained via CT were correlated with nasal histopathology and gross anatomical observations were recorded at the time of rhinoscopy. RESULTS: Neoplasia was diagnosed in 37 dogs for which CT typically revealed a soft tissue density associated with extensive turbinate destruction. Inflammatory rhinitis was diagnosed in 40 dogs. CT disclosed either normal turbinate structures or mild to moderate turbinate destruction, with or without the presence of soft tissue densities (mucopus) within the nasal passages. Fungal rhinitis was diagnosed in seven dogs for which CT disclosed extensive turbinate destruction with hyperlucency of the nasal passages. One dog had normal CT and histopathology findings. CLINICAL SIGNIFICANCE: CT greatly enhanced the ability to diagnose chronic nasal disease in dogs, providing detailed Information regarding the extent of the disease, accurate discrimination of neoplastic versus non-neoplastic diseases, and identification of areas of the nose to examine rhinoscopically and suspicious regions to target for biopsy.     

Canine nasal septum deviation can be a normal variation and correlates with increasing skull indices

Nasal septal deviation has been studied in relation to nasal pathology and mass effect in dogs. The purpose of this retrospective, cross‐sectional study was to compare the prevalence of nasal septal deviation in dogs with rhinitis, neoplasia, and those without nasal pathology based on the facial index, skull index, and cranial index. Computed tomographic studies of the nasal cavities of dogs performed over a 5‐year period were retrospectively reviewed. This study had 233 dogs meeting the inclusion criteria with 135 dogs with no nasal pathology, 63 dogs with nasal neoplasia, and 35 dogs with rhinitis. The prevalence of nasal septal deviation, the angle, maximum distance, and longitudinal extent of deviation were recorded, as well as measurements to calculate the facial index, cranial index, and skull index. The results showed no difference in the prevalence of nasal septal deviation between dogs with nasal pathology and those without. The mean longitudinal extent of deviation and maximum distance of deviation was statistically greater for those with neoplasia compared to those with rhinitis and without nasal pathology. The longitudinal extent of deviation was inversely proportional to the cranial index, facial index, and skull index. The angle of deviation was directly proportional to the facial index and skull index. In conclusion, nasal septal deviation is an anatomic variant in different breeds of dogs with no predilection based on nasal pathology. Nasal septal deviation should be interpreted cautiously in the assessment of canine nasal disease.     

Results of rhinoscopy alone or in conjunction with sinuscopy in dogs with aspergillosis: 46 cases (2001-2004)

OBJECTIVE: To determine results of diagnostic testing, including detection of nasal or frontal sinus fungal plaques, in dogs with nasal aspergillosis. DESIGN: Retrospective case series. ANIMALS: 46 dogs with nasal aspergillosis. PROCEDURES: Medical records were reviewed for information on computed tomographic findings; rhinoscopic findings, including whether fungal plaques were seen in the nasal cavity; results of frontal sinus trephination and sinuscopy, including whether fungal plaques were seen in the frontal sinus; and results of histologic examination of biopsy specimens. RESULTS: In 38 (83%) dogs, fungal plaques were seen in the nasal cavity during rhinoscopy, whereas in the remaining 8 (17%), fungal plaques were not seen in the nasal cavity but were seen in the frontal sinus. Duration of clinical signs, proportions of dogs in which the referring veterinarian had performed a nasal examination prior to referral, proportions of dogs with computed tomographic evidence of nasal cavity cavitation or sinus involvement, and proportions of dogs with rhinoscopic evidence of destructive rhinitis were not significantly different between dogs with nasal fungal plaques and dogs with fungal plaques only in the frontal sinus. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirm that frontal sinus involvement is common in dogs with nasal aspergillosis and suggest that frontal sinus trephination and sinuscopy may aid in the diagnosis of aspergillosis in dogs, particularly dogs with rhinoscopic evidence of destructive rhinitis and computed tomographic evidence of sinus involvement that lack detectable fungal plaques in the nasal cavity.     

Nasal melanosis in three dogs

Cytologically and histologically confirmed nasal melanosis was detected by rostrocaudal rhinoscopic evaluation of three dogs with unilateral nasal discharge caused by a chronic and severe odontopathic rhinitis. The extraction of affected teeth and prolonged antibiotic therapy led to a complete resolution of nasal disease. The nasal melanosis could be considered a partial metaplastic transformation of mucosal respiratory cells with accumulation of intracytoplasmic melanin.     

Failure to identify an association between serologic or molecular evidence of Bartonella infection and idiopathic rhinitis in dogs

OBJECTIVE: To determine whether infection with or exposure to Bartonella spp was associated with idiopathic rhinitis in dogs. DESIGN: Case-control study. ANIMALS: 44 dogs with idiopathic nasal discharge and 63 age- and weight-matched control dogs without nasal discharge and no clinical signs of bartonellosis. Procedures-Serum was tested for antibodies against Bartonella henselae and Bartonella vinsonii subsp berkhoffii with indirect fluorescent antibody assays. Blood was tested for Bartonella DNA with a PCR assay. RESULTS: Results of the antibody and PCR assays were negative for all 44 dogs with idiopathic nasal discharge. One control dog had antibodies against B henselae; a second control dog had positive PCR assay results. We did not detect a significant association between assay results and group designation. CONCLUSIONS AND CLINICAL RELEVANCE: The present study failed to confirm an association between idiopathic rhinitis and exposure to or infection with Bartonella spp in dogs. Findings do not rule out the possibility that Bartonella infection may cause nasal discharge in some dogs, but the failure to find any evidence of exposure to or infection with Bartonella spp in dogs with idiopathic nasal discharge suggested that Bartonella infection was not a common cause of the disease.     

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.