Page 35 - Problem-Based Feline Medicine

3 – THE CAT WITH SIGNS OF CHRONIC NASAL DISEASE 27

● Fluconazole is better for CNS infection, but is Clinical signs
expensive (2.5–10 mg/kg PO q 12 h).
Typically, there is chronic snuffling and stertorous
Approximately 3 weeks of treatment are required respiration from the nasal region. Signs may be evi-
before there is an improvement in clinical signs. dent most or all of the time if the stenosis is severe.

A decreasing serum Cryptococcus titer is predic- Dyspnea or mouth breathing occurs with stress.
tive of recovery, but depending on the laboratory, it
Narrow external nares are visible on physical examination.
may be expensive to get the actual titer measured.
Clinical signs return if treatment is stopped too early.
Diagnosis
Ideally, treat until titer is negative, which may be
longer than 1 year. However, some healthy cats remain The diagnosis is usually based on clinical signs (nasal
antibody positive. If the cat is clinically healthy and the stridor) and physical examination (stenotic nares).
titer drops 16–32-fold, it is unlikely to relapse.
Differential diagnosis
Alternatively treat for 4 weeks after resolution of all signs,
with a minimum treatment period of 8 weeks. Relapses The features of stenotic nares (signs since the cat was a
are more common with these shorter treatment periods. young adult, cranial nasal stertor and narrow external
nares) make most other diseases unlikely.

Prognosis Treatment

Prognosis is variable. A falling titer in response to ther- Treatment involves surgical removal of the wing of the
apy suggests optimistic prognosis for cure. Prognosis is nostril.
guarded if there is CNS involvement.
Prognosis

CONGENITAL ANOMALY OF THE NOSE Prognosis is good with surgery, provided there is not
OR HARD PALATE** concurrent marked narrowing of the nasal cavity.

Classical signs SECONDARY RHINITIS ASSOCIATED WITH
DENTAL DISEASE*
● Chronic snuffling and stertorous
respiration.
Classical signs
● Dyspnea or mouth breathing.
● Narrow external nares. ● Chronic sneezing.
● Chronic unilateral or bilateral
mucopurulent nasal discharge, which may
Pathogenesis be bloody.
● Oronasal fistula.
Congenital stenosis of the external nares is common
in some breeds, e.g. Persians, Himalayans.
● The combined effects of stenosis of the external Pathogenesis
nares and reduced nasal air space cause respiratory
An oronasal fistula may result in low-grade chronic
obstruction.
rhinitis, because food and fluids enter the nose from
● Partial obstruction results in increased respiratory
the mouth.
effort and stertorous respiration.
● With stress (e.g. visit to veterinarian or cat show), An oronasal fistula usually results from advanced
stridor becomes more pronounced, and cats may periodontal disease of the canine teeth, with or with-
become severely dyspneic and mouth breath. out loss of the tooth.