Page 1833 - Cote clinical veterinary advisor dogs and cats 4th

918 Sinusitis and Other Sinus Disorders

• Tumors associated with frontal sinusitis: older Etiology and Pathophysiology • Submandibular lymph node aspirates (bilat-
dogs • Sinusitis is usually secondary to another eral) may help detect metastatic neoplasia.
VetBooks.ir • Chronic idiopathic sinusitis: young to (see Associated Disorders) that disrupts Advanced or Confirmatory Testing
primary nasal or frontal sinus disease
• Aspergillosis: young adults
• CT and/or MRI of the nasal cavities and
normal nasal/sinus anatomy and impairs
middle-aged dogs
• Cilary dyskinesia: young dogs
drainage.
• Trauma: any age mucociliary clearance or obstructs mucus sinuses can differentiate neoplasia, fungal
rhinitis, and dental disease with more
• Due to physical continuity between the accuracy than plain radiographs but cannot
GENETICS, BREED PREDISPOSITION chambers, frontal sinus tumors can extend confirm the diagnosis in all cases. Biopsy
• Cats: brachycephalic breeds, especially into the nasal cavity, and nasal tumors can with histopathology is frequently necessary.
Persian and Himalayan for upper respira- extend in the frontal sinus. • The frontal sinus can be examined by direct
tory tract aspergillosis (both sinonasal and • Mycotic sinusitis and rhinitis can affect rhinoscopy in some dogs, but access to and
sino-orbital forms), any breed for other the nasal cavity and sinus individually or visualization of the frontal sinus is often pos-
diseases in combination. Periorbital involvement is sible only in animals with severe turbinate
• Dogs: primarily dolichocephalic breeds seen in cats. destruction.
for frontal sinusitis associated with • Chronic lymphoplasmacytic inflammation in • Trephination of the frontal sinus for exam
tumors, aspergillosis, or chronic idiopathic dogs can be a sequela to many other sinonasal and biopsy may be necessary to confirm
sinusitis diseases (p. 890). the presence of neoplasia, fungal rhinitis,
• Chronic lymphoplasmacytic rhinosinusitis in or inflammation, especially if disease is
ASSOCIATED DISORDERS cats can be a sequela to bacterial, viral (feline confined to the frontal sinus. Trephination
• Nasal tumors upper respiratory tract infection complex), may also have therapeutic value for cases of
• Nasal aspergillosis as well as mycotic infections. fungal rhinitis in dogs (p. 81).
• Chronic idiopathic or lymphoplasmacytic ○ As in dogs, the condition can be idiopathic
rhinosinusitis in cats, possibly related to an allergic TREATMENT
• Nasal or frontal sinus trauma cause.
• Abscessation of roots of the upper fourth • Primary bacterial rhinitis is rare, with most Treatment Overview
premolar (apical dental abscess), causing bacterial infections occurring secondary to When possible, the best opportunity for resolu-
maxillary sinus empyema an underlying disease process. The exception tion of sinusitis is treatment of the underlying
• Feline herpesvirus (rhinotracheitis) is bacterial rhinitis associated with ciliary primary nasal disease.
dyskinesia, which results in recurrent bouts
Clinical Presentation of sinusitis, rhinitis, and pneumonia due to Acute General Treatment
DISEASE FORMS/SUBTYPES defective mucociliary clearance. • Treatment of the underlying disease.
See Associated Disorders above. ○ Fungal sinusitis/rhinitis: antimycotic
DIAGNOSIS therapy (p. 81)
HISTORY, CHIEF COMPLAINT ○ Frontal sinus tumors: radiation therapy,
• Nasal discharge Diagnostic Overview and occasionally, surgical resection
• Intermittent sneezing Sinus diseases are generally associated with nasal ○ Traumatic injuries causing fractures of
• Focal facial swelling or deformity (tumor, diseases and probably secondary to nasal disease the frontal bone: removal of bone frag-
trauma) in most cases. ments in the frontal sinus and possibly
• Signs related to local pain reconstruction; check patency of the
○ Dullness or lethargy Differential Diagnosis nasofrontal ostium (nasofrontal opening);
○ Decreased movements of the head Nasal diseases of various origins: broad-spectrum antibiotics
○ Anorexia • Fungal rhinitis ○ Apical dental (tooth root) abscess: surgical
• Nasal neoplasia extraction of the tooth, including roots,
PHYSICAL EXAM FINDINGS • Dental disease/dental root infection (maxil- or endodontic treatment; broad-spectrum
• Unilateral nasal discharge of variable nature: lary sinus) antibiotics
mucoid, mucopurulent, or blood tinged; • Foreign bodies • For acute infection, as well as in chronic
often bloody with nasal neoplasia • Lymphoplasmacytic rhinitis idiopathic inflammation with episodes
• Diminished airflow through nasal passages/ • Nasal mites of secondary bacterial infections, oral or
nares if nasal cavity affected, except aspergil- • Chronic viral upper respiratory tract infection injectable antibiotics (amoxicillin 20 mg/kg
losis (increased airflow) in cats PO q 8h, cefadroxil 20 mg/kg PO q 8h, or
• Focal swelling, firm enlargement, facial amoxicillin-clavulanate 15 mg/kg PO q 12h)
deformity, and/or pain with atrophy or lysis Initial Database and possibly mucolytics may be needed.
of the frontal or nasal bones: • For some cases, plain radiographs of the ○ The frontal sinus is a combination of
○ Depressions or defects in frontal/nasal nasal cavities, sinuses, and dental roots can several large cavities surrounded by bone;
bone integrity from osteolysis may be be helpful in the diagnosis of trauma or systemically administered drugs often do
noted during palpation. structural lesions secondary to neoplasia, not achieve high concentrations in the
○ Dogs with maxillary sinusitis from fungal rhinitis/sinusitis, and dental disease sinus. Even very high doses of highly
fourth premolar tooth root abscessation but cannot discriminate among the various soluble drugs, preferred for systemic
may have a swelling or fistulous tract causes of nasal/sinus disease not involving therapy, may not reach adequate con-
and drainage ventral to the eye on affected structural changes. Generally considered both centrations throughout the entire sinus
side. poorly sensitive and poorly specific. cavity.
• Enlargement of submandibular lymph • CBC, serum biochemical profile, and ○ Effect of drug nebulization is unproved;
nodes is possible. Both lymph nodes may urinalysis are often unremarkable. the amount of drug delivered into the
be affected due to overlapping drainage • For cases in which there is swelling or lysis frontal sinus is unknown.
territories (lymphosomes). (which can be palpable) of nasal/facial bones
• Percussion of the sinus may induce or the frontal sinus area, fine-needle aspira- Chronic Treatment
pain or be associated with reduced tion (FNA) cytology can show neoplasia or In cases of concomitant nasal disease with loss
resonance. inflammation. of the protective filter provided by normal
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