Page 273 - Small Animal Internal Medicine, 6th Edition

CHAPTER 13 Clinical Manifestations of Nasal Disease 245

or may migrate more deeply into the nasal passages, and any of a dog reverse sneezing (Video 13.1). This approach is
delay in performing rhinoscopy may interfere with identifi- usually more efficient than having the client try to capture
VetBooks.ir cation and removal of foreign bodies. Nasal mites are also the reverse sneeze by video, although the latter is ideal.
A thorough history and physical examination is indicated
identified rhinoscopically. In contrast, cats sneeze more often
as a result of acute viral infection rather than a foreign body.
disorders. Further evaluation is needed if syncope, exercise
Immediate rhinoscopic examination is not indicated unless to identify signs of potential underlying nasal or pharyngeal
there has been known exposure to a foreign body and the intolerance, stertor, or other signs of respiratory disease are
history and physical examination findings do not support a reported, or if reverse sneezing is severe or progressive.
diagnosis of viral upper respiratory infection. In the absence of an underlying disease, treatment is
rarely needed for reverse sneezing itself, because episodes are
REVERSE SNEEZING nearly always self-limiting. Some owners report that massag-
Reverse sneezing is a paroxysm of noisy, labored inspiration ing the neck shortens an ongoing episode, or that adminis-
that can be initiated by nasopharyngeal irritation. Such irri- tration of antihistamines decreases the frequency and
tation can be the result of a foreign body located dorsal to severity of episodes, but controlled studies are lacking.
the soft palate, or it may be associated with nasopharyngeal
inflammation. Foreign bodies usually originate from grass or
plant material that is prehended into the oral cavity and that, STERTOR
presumably, is coughed up or migrates into the nasopharyx.
Most cases are idiopathic. Small-breed dogs are usually Stertor refers to coarse, audible snoring or snorting sounds
affected, and signs may be associated with excitement or associated with breathing. It indicates upper airway obstruc-
drinking. The paroxysms last only seconds and do not sig- tion. Stertor is most often the result of pharyngeal disease
nificantly interfere with oxygenation. Although these animals (see Chapter 16). Intranasal causes of stertor include obstruc-
usually display this sign throughout their lifetime, the tion caused by congenital deformities, masses, exudate, or
problem rarely progresses. blood clots. Evaluation for nasal disease proceeds as
Clients may present a dog with reverse sneeze for respi- described for nasal discharge.
ratory distress if they are not familiar with this sign. Their
ability to describe the events may be limited, and dogs will
rarely exhibit reverse sneeze during an examination. A key FACIAL DEFORMITY
historic feature of reverse sneezing is that the dog instantly
returns to normal breathing and attitude as soon as the event Carnassial tooth root abscess in dogs can result in swelling,
is over. This immediate return to normal is not characteristic often with drainage, adjacent to the nasal cavity and beneath
of more serious problems, such as upper airway obstructions. the eye. Excluding dental disease, the most common causes
Confirmation that described events indicate reverse sneez- of facial deformity adjacent to the nasal cavity are neoplasia
ing can be obtained by showing the client a video recording and, in cats, cryptococcosis (Fig. 13.5). Visible swellings can

A B

FIG 13.5
Facial deformity characterized by firm swelling over the maxilla in two cats. (A) Deformity
in this cat was the result of carcinoma. Notice the ipsilateral blepharospasm. (B) Deformity
in this cat was the result of cryptococcosis. A photomicrograph of the fine-needle aspirate
of this swelling is provided in Fig. 13.3.