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682 Nasopharyngeal Polyps

Clinical Presentation oral exam under anesthesia. Confirmation is
DISEASE FORMS/SUBTYPES based on histologic analysis. TREATMENT
Treatment Overview
VetBooks.ir • Ear (aural) polyp if mass grows into external Differential Diagnosis Nasopharyngeal polyp removal by gentle, steady
• Nasopharyngeal polyp
traction and avulsion can cure many cats.
ear canal instead of nasopharynx
• Neoplasia (e.g., lymphoma, squamous cell
carcinoma)
HISTORY, CHIEF COMPLAINT • Infectious rhinitis Recurrence rates are lower if combined with
oral prednisolone therapy or bulla osteotomy.
• Stertor • Nasal/nasopharyngeal foreign body Surgical removal may be required for aural
• Nasal discharge • Nasopharyngeal stenosis polyps in dogs.
• Sneezing • Laryngeal paralysis
• Dyspnea • Granuloma (cryptococcosis) Acute General Treatment
• Dysphagia • Hamartoma • Oxygen supplementation (p. 1146) if in
• Gagging respiratory distress
• Voice change Initial Database • General anesthesia, intubation, and
• ± Head shaking or pawing at ears in cases • CBC, biochemistry panel, and urinalysis are removal of the polyp: retract soft palate ros-
of concurrent otitis externa; concurrent usually normal. trally (spay hook, stay sutures, or Babcock
nasopharyngeal and aural polyps reported • Otoscopic exam (p. 1144): forceps), and grasp the polyp gently at the
in 18% of cats ○ Bulging of tympanic membrane from fluid base with Allis tissue forceps. Apply slow,
• ± Vestibular signs or Horner’s syndrome if or mass if otitis media present steady traction to avulse stalk of polyp
concurrent otitis externa progresses to otitis ○ Aural polyp can extend through tympanic from auditory tube/middle ear. Minor to
media/interna membrane into external ear canal. moderate hemorrhage may occur, requiring
○ Otitis externa if tympanic membrane a short period of digital pressure or local
PHYSICAL EXAM FINDINGS ruptured packing.
• Increased inspiratory noise (often stertor) • To reduce recurrence rate, oral pred-
• Mucoid to mucopurulent nasal discharge Advanced or Confirmatory Testing nisolone 1-2 mg/kg PO q 24h for 2 weeks,
(unilateral or bilateral) • Oral exam under anesthesia (p. 1125): then 0.5-1 mg/kg PO q 24h for 1 week,
• Gagging ○ Palpable mass dorsal to soft palate or mass then 0.5-1 mg/kg PO q 48h for 7-10 days
• Unilateral deafness in 35% of cats because protruding into oropharynx or ventral bulla osteotomy with removal
of concurrent middle ear disease (hard to ○ Retraction of the soft palate may increase of the epithelial lining; culture from
recognize) visualization the bulla is also indicated at the time of
• Uncommon signs include otitis externa, ○ Often, this is the only confirmatory test surgery.
submandibular swelling, regurgitation, required. • Perendoscopic transtympanic traction (PTT)
head tilt, ataxia, nystagmus, or facial nerve ○ Removal may be performed immediately and laser ablation have been described for
palsy. (see Acute Treatment). aural poly removal and may be associated
• ± Horner’s syndrome: miosis, ptosis, enoph- • Skull radiographs (seldom necessary) with lower recurrence rates.
thalmos, and third eyelid prolapse on affected ○ Increased soft-tissue density in pharynx
side (lateral or oblique lateral view) Chronic Treatment
• ± Rarely, severe inspiratory dyspnea ○ Evidence of otitis media: enlarged or Antibiotics if bacterial otitis media is suspected
thickened bulla containing increased (e.g., amoxicillin-clavulanate 62.5 mg/CAT PO
Etiology and Pathophysiology soft-tissue density (rostrocaudal view) q 12h until culture results return)
• Exact cause is unknown, but proposed ○ May be normal
causes include inflammatory conditions and • CT Possible Complications
congenital persistence of branchial arches. ○ Focal, contrast-enhancing, soft-tissue • Horner’s syndrome: ≈80% of cases after
○ The significance of herpesvirus, calicivirus, nasopharyngeal mass with stalk bulla osteotomy; can also occur with polyp
bacteria, or fungi recovered from polyps ○ Rim enhancement on CT differentiates traction avulsion alone. Usually resolves
is questionable. from fluid and other neoplasia within 1 month
• Proliferation of the auditory (eustachian) ○ Increased fluid and soft-tissue density • Otitis interna: ≈40% of cases after ventral
tube or tympanic bulla mucosal epithelium in bulla. Bulla wall is thickened and bulla osteotomy; ataxia and head tilt can
likely obstructs drainage from the middle pathologically expanded. Bilateral bulla affect quality of life.
ear. The resulting fluid accumulation and disease in 31%
inflammation (otitis media) can extend ○ Enlarged ipsilateral medial retropharyngeal Recommended Monitoring
into the inner ear (otitis interna) or drain lymph node in 62% • Re-evaluate nasopharynx, bulla, and external
through the tympanic membrane (otitis • Endoscopy: both ear canals and nasopharynx ear canal if clinical signs recur.
externa) and provokes formation of a fibrous ○ Aural polyps: pink-red, multilobulated • Repeat otoscopic exam and otic cytologic
polyp. masses in the ear canal/tympanic cavity. exam if otitis externa is present.
• Enlarged mass fills the nasopharyngeal region, Waxy cerumen is common, If intact,
obstructing caudal nasal drainage and airflow, thickening/bulging of the tympanum due PROGNOSIS & OUTCOME
and eventually impedes inspiration and to impaired auditory tube drainage is often
swallowing causing nasal discharge. seen. Myringotomy may be performed • Polyp regrowth occurs in 11%-50% of
• Alternatively, the tympanic membrane after exam. cats treated with traction avulsion without
ruptures, and the mass extends into the ○ Nasopharyngeal polyps: direct visualization concurrent ventral bulla osteotomy.
horizontal ear canal. of mass in the nasopharynx ○ Recurrence uncommon with traction
• Histologic exam removal followed by postoperative
DIAGNOSIS ○ Well-vascularized fibrous tissue covered by prednisolone
stratified squamous or columnar epithelium ○ Ventral bulla osteotomy prevents recur-
Diagnostic Overview ○ Inflammatory cells, primarily lymphocytes, rence in most cats after traction removal.
The primary method of diagnosis is visualizing plasma cells, and macrophages, present in • Deafness in affected ear often persists after
a firm, pink mass dorsal to the soft palate on the stroma polyp removal.

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