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Basics ⬇

Basics

Definition

Can be serous, mucoid, mucopurulent, purulent, blood tinged, or frank blood (epistaxis); may contain food debris.

Pathophysiology

  • Secretions-produced by mucous cells of the epithelium and submucosal glands; increased production from glandular hypertrophy and hyperplasia owing to irritation of the nasal mucosa by infectious, mechanical, chemical, or inflammatory stimuli.
  • Xeromycteria-“dry nose”; facial nerve damage secondary to middle ear disease can decrease serous secretions from the lateral nasal glands leading to compensatory mucoid secretion; usually unilateral with unilateral nasal planum hyperkeratosis, ± keratoconjunctivitis sicca.

Systems Affected

  • Respiratory-mucosa of the upper tract, including the nasal cavities, sinuses, and nasopharynx; lower tract disease can also result in secretions from the upper airways.
  • Gastrointestinal-signs may be observed with swallowing disorders or esophageal or gastrointestinal diseases when secretions are forced into the nasopharynx.
  • Hemic/Lymphatic/Immune-blood-tinged discharge or epistaxis owing to platelet or hemostatic defects.
  • Ophthalmic-may have KCS ipsilaterally if there is nerve damage due to middle ear disease.

Signalment

  • Dog and cat.
  • Young animals-cleft palate; nasal polyp, ciliary dyskinesia; immunoglobulin deficiency.
  • Older animals-nasal tumors; primary dental disease (tooth root abscess).
  • Hunting dogs-foreign body.
  • Dolichocephalic dogs-aspergillosis, nasal neoplasia.

Signs

Historical Findings

  • Sneezing-often found concurrently.
  • Reverse sneezing-can be found concurrently, if nasopharyngeal involvement or passage of nasal secretions through the choanae towards the nasopharynx.
  • Important to know both the initial and current character of the discharge as well as whether it originally started unilaterally or bilaterally.
  • Stertor-owners frequently report noisy breathing, especially when animal is sleeping.
  • Response to previous antibiotic therapy common due to secondary bacterial infection.

Physical Examination Findings

  • Secretions or dried discharge on the hair of the muzzle or forelimbs.
  • May note reduction in nasal air flow, particularly with nasal neoplasia or fungal infection in the cat.
  • Concurrent dental, nasopharyngeal, or lower airway disease.
  • Bony involvement-with a tumor or fourth premolar abscess; may be detected as facial or hard palate swelling or as pain secondary to fungal or bacterial osteomyelitis or neoplasia.
  • Mucosal depigmentation of the nasal alar cartilage-observed with canine nasal aspergillosis.
  • Mandibular lymphadenomegaly-neoplasia, fungal infection, dental disease.
  • Polyp-may be visible on otoscopic exam, or pushing the soft palate down on oral exam.
  • Chorioretinitis-may be seen with canine distemper or cryptococcosis.
  • Deviation of the globe (abscess, sinoorbital aspergillosis in cats, tumors).

Causes

  • Unilateral-often associated with non-systemic processes; foreign body; dental-related disease; fungal infections; nasal tumor; facial nerve damage leading to xeromycteria.
  • Bilateral-infectious agents (e.g., feline viral rhinotracheitis or calicivirus, canine herpesvirus, canine distemper, secondary bacterial infection); IgA deficiency; airborne irritant; allergy; ciliary dyskinesia; lymphoplasmacytic or hyperplastic rhinitis, nasopharyngeal stenosis or atresia.
  • Unilateral progressing to bilateral-Aspergillus; nasal tumor.
  • Either unilateral or bilateral-epistaxis; foreign body; extranasal disease; nasal parasites, inflammatory rhinitis.
  • Extranasal diseases-chronic pneumonia, chronic vomiting, nasopharyngeal diseases.

Risk Factors

  • Dental disease
  • Foreign bodies
  • Infectious-poorly vaccinated animal; kennel situations, exposure to other animals
  • Nasal aspergillosis
  • Thrombocyte disorder-thrombocytopenia or thrombocytopathy: primary immune or secondary to infectious (i.e., rickettsial) disease or neoplasia
  • Coagulation defect due to rodenticide intoxication
  • Nasal mites-kennel-raised dogs
  • Immunosuppression, chronic corticosteroid use, FeLV or FIV infection
  • Chronic, low-grade pneumonia
  • Chronic vomiting
  • Chronic otitis (facial nerve damage)

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

Important to differentiate nasal discharge, secretions, or crusting from diseases that occur at mucocutaneous junctions, such as pemphigus, vasculitis, or leishmaniasis.

Differential Diagnosis Causes

  • Serous-mild irritation; viral and parasitic (e.g., nasal mites) disorders.
  • Mucoid-allergy; nonspecific airborne irritants; early neoplasia.
  • Purulent (or mucopurulent)-secondary bacterial or fungal infection, neoplasia.
  • Serosanguinous to epistaxis-nasal tumor and aspergillosis; secondary to violent or paroxysmal sneezing episodes; coagulopathy, platelet disorder, and systemic hypertension.

CBC/Biochemistry/Urinalysis

Results not specific for any particular cause but can detect concurrent problems; part of a thorough evaluation before general anesthesia for diagnostic procedures.

Other Laboratory Tests

  • Serologic tests-help to diagnose fungal or rickettsial disease.
  • Coagulation studies-determine platelet numbers and function, coagulation panel.
  • Immunoglobulin quantification-investigates IgA deficiency.

Imaging

Skull Imaging

  • Anesthetize and carefully position patient.
  • Perform before rhinoscopy and periodontal probing, which can cause nasal bleeding and alter radiographic density.
  • Radiography (rarely performed when CT is available):
    • Lateral view-detect any periosteal reaction; note gross changes in the maxillary teeth, nasal cavity, and frontal sinuses; evaluate air column outlining the nasopharynx for filling defects.
    • Open-mouth ventrodorsal and intraoral views (using sheet film)-excellent for evaluating nasal cavities and turbinates.
    • Rostro-caudal view-evaluate each frontal sinus (periosteal reaction and filling).
  • CT and MRI-CT superior to radiography in making diagnosis; CT and MRI help detect the extent of bony changes or CNS involvement associated with nasal tumors, fungal rhinitis, or chronic otitis.

Thoracic Radiography

Can reveal alveolar infiltrates in patient with chronic pneumonia; situs inversus or bronchiectasis in some dogs with primary ciliary dyskinesia.

Diagnostic Procedures

  • Blood pressure, platelets, and coagulation profile for epistaxis.
  • Rhinoscopy-indicated with chronic or recurrent nasal discharge; acute epistaxis; evaluate both anterior and posterior; may be contraindicated with bleeding disorders.
  • Nasal cytologic examination-nonspecific inflammation most commonly found.
  • Fungal culture-difficult to interpret; need visualized sampling of a plaque lesion; false-negatives common.
  • Bacterial culture could be useful when resistant organisms are suspected, but requires deep nasal sampling under anesthesia.
  • Biopsy of the nasal cavity-indicated with chronic nasal discharge or visualized abnormalities; multiple samples required to ensure adequate representation; may perform electron microscopy for suspected ciliary dyskinesia.
  • Bronchoscopy-indicated if there has been a history of coughing with nasal discharge.
  • Periodontal probing of all upper teeth-perform after rhinoscopy; the normal gingival sulcus: dogs, 4 mm; cats, 1 mm.
  • Schirmer tear test, otoscopic exam or CT-to evaluate for possible facial nerve damage from chronic otitis.
  • Tracheal scintigraphy and electron transmission microscopy-to confirm primary ciliary dyskinesia.

Treatment ⬆ ⬇

Treatment

Medications ⬆ ⬇

Medications

Drug(s)

  • Secondary bacterial infection-antibiotics; choose a good gram-positive spectrum of activity (e.g., amoxicillin, clavamox, clindamycin, azithromycin, cephalosporins).
  • Attempt to dry up serous nasal secretions-decongestants (ephedrine: dogs, 10–50 mg total PO q8–12h, to a maximum of 4 mg/kg; cats, 2–4 mg/kg q8–12h); topical vasoconstrictors (neosynephrine at 0.25–0.5% q8–24h or oxymetazoline at 0.25% q24h) but for a limited period of time-less than 1 week-these drugs do not treat a specific cause and could induce damage to the nasal mucosa.
  • Dental-associated rhinitis-antibiotics; dental surgery as indicated.
  • Foreign body-removal, antibiotics.
  • Nasal parasites-ivermectin (300 µg/kg PO or SC weekly for 3 weeks) or milbemycin (in collie and similar breeds at 1 mg/kg PO weekly for 3 weeks) to treat Pneumonyssoides; fenbendazole (50 mg/kg PO q24h for 10 days) to treat Eucoleus (nasal nematode).
  • Nonspecific inflammation-prednisolone (1–2 mg/kg PO q12–24h) or piroxicam (0.3 mg/kg PO q24–48h).
  • Canine nasal aspergillosis-topical treatment with enilconazole or clotrimazole.
  • Feline cryptococcosis or sporothricosis-itraconazole (5–10 mg/kg PO q24h) or fluconazole (50 mg/cat q12h).
  • Feline aspergillosis-topical therapy, itraconazole.
  • Neoplasia-radiotherapy and chemotherapy.
  • Xeromycteria-oral administration of ophthalmic pilocarpine in an attempt to stimulate nasal secretions.

Contraindications

  • Ephedrine-in cardiac patients
  • Ivermectin-in collies and similar breeds

Precautions

  • Itraconazole-anorexia, nausea, vomiting, and high liver enzymes
  • Rebound phenomenon-reported with overuse of topical nasal vasoconstrictors

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

  • Nasal discharge and sneezing-note changes in frequency, volume, and character.
  • Repeat rhinoscopy-indicated to ensure adequate response to treatment of fungal rhinitis.
  • Recheck thoracic radiographs or bronchoscopy-monitor response to treatment for chronic pneumonia.

Possible Complications

  • Loss of appetite-especially in cats.
  • Extension of primary disease (e.g., fungal infection, tumor) into the mouth, eye, or brain.
  • Respiratory distress-with nasal obstruction.
  • Involvement of the cribriform plate in dogs with aspergillosis-CNS damage during topical drug therapy is a risk.

Miscellaneous ⬆

Miscellaneous

Associated Conditions

  • Sinusitis
  • Dental disease
  • Secondary causes-coagulopathy, pneumonia, cricopharyngeal disease, megaesophagus

Age-Related Factors

Middle-aged to old patients-often associated with dental or neoplastic conditions.

Pregnancy/Fertility/Breeding

The safety of most recommended drugs has not been established in pregnant animals.

Abbreviations

  • CNS = central nervous system
  • CT = computed tomography
  • FeLV = feline leukemia virus
  • FIV = feline immunodeficiency virus
  • KCS = keratoconjunctivitis sica
  • MRI = magnetic resonance imaging

Authors Cécile Clercx and Brendan C. McKiernan

Consulting Editor Lynelle R. Johnson

Client Education Handout Available Online

Suggested Reading

Cohn LA. Canine nasal disease. Vet Clin North Am , 2014, 44:75–89.

Doust R, Sullivan M. Nasal discharge, sneezing and reverse sneezing. In: King LG, ed., Textbook of Respiratory Disease in Dogs and Cats. Philadelphia: Saunders, 2004, pp. 17–29.

McKiernan BC. Sneezing and nasal discharge. In: Ettinger SJ, Feldman EC, eds., Textbook of Veterinary Internal Medicine, 4th ed. Philadelphia: Saunders, 1994, pp. 79–85.