Section: Veterinary Care In-depth
Diagnosis In-depth
Certain diagnostic tests must be performed to make a definitive diagnosis of rhinitis and sinusitis and exclude other disease processes that may cause similar symptoms. A complete history, description of clinical signs, and thorough physical examination are all an important part of obtaining a diagnosis, and potential underlying cause. In addition, the following tests are recommended:
A complete blood count (CBC) is often within normal limits; however, an elevated white blood cell count may be present in cases with systemic infection, and mild anemia (low red blood cell count) may be present with chronic nasal bleeding.
A biochemical profile may be within normal limits; however, it is necessary to rule out concurrent disorders.
A urinalysis is usually within normal limits.
Fungal serology (various blood tests to diagnose fungal infections) may help diagnose disorders such as aspergillosis and cryptococcus.
Skull, nasal, dental and chest radiographs (X-rays) may be very helpful in diagnosing several causes of rhinitis and sinusitis including tumors, dental disease, foreign bodies, trauma, pneumonia, and malignancies (spread of tumor into the chest).
Coagulation (clotting) profiles should be performed when epistaxis is evident to rule out other disorders. In addition, they should be considered prior to biopsy of the nasal cavity.
Bacterial cultures of the nasal cavity may be helpful in determining if there is bacterial infection and appropriate antibiotic therapy. It should be noted that although occasionally the primary cause of rhinitis and sinusitis, bacterial infection often is a secondary invader.
Cytology may confirm fungal, cancer or parasitic causes of rhinitis and sinusitis. It is a relatively noninvasive diagnostic test that can be performed by your veterinarian.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions. These tests are not always necessary in every case, but they may be of benefit in certain individuals, and are selected on a case-by-case basis. These include:
Computed tomography (CT) scan or magnetic resonance imaging (MRI) are advanced techniques that often necessitate referral to specialty practices. These are more sensitive in diagnosing an underlying etiology.
Rhinoscopy is a procedure that allows us to visualize directly and sample tissue from the nasal cavity. It does necessitate general anesthesia, as well as the expertise of a specialist, and transfer to a facility that has the proper equipment. It may be very helpful in definitively diagnosing certain cases.
Rhinotomy (surgical exploration of the nose) and biopsy may be required for definitive diagnosis if other less invasive techniques fail to provide adequate tissue.
Therapy In-depth
Most patients are stable, and can be treated as outpatients as long as they are monitored closely for response to therapy. With appropriate therapy, and/or the identification and treatment of the underlying disorder, many patients do quite well, and some can expect to see a full recovery. In some, response to therapy can take longer and occasionally, response may be poor. It is very important that all recommendations by your veterinarian are followed very closely, and any questions or concerns that arise during the treatment protocol are addressed immediately.
Specific therapy depends on the underlying cause.
Humidification of the environment and keeping the external nares clean and dry are helpful regardless of the underlying cause.
Cure is unlikely with chronic viral rhinitis and sinusitis. Control of the more severe clinical signs with appropriate medication is often necessary, and treatment is often lifelong.
Antifungal therapy, either topical, instilled through surgically placed tubing into the sinuses, or systemically, administered orally, may be indicated in cases of fungal rhinitis and sinusitis.
Anti-inflammatory therapy (corticosteroids) may be indicated in cases of allergic or immune mediated rhinitis and sinusitis.
Rhinotomy may be necessary to remove chronically infected tissue, foreign bodies, polyps and tumors.
Radiation therapy may be indicated in patients with nasal cancer.
Chemotherapy may be helpful in cases of nasal lymphosarcoma.
Antibiotic therapy selected on the basis of bacterial culture and sensitivity. It is important to administer all medication as directed by your veterinarian. Occasionally, extended or repeat antibiotic courses are in order. In some cases, long term administration is necessary.
Follow-up Care
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Administer all prescribed medication as directed. Alert your veterinarian if you are experiencing problems treating your pet. It is important that the pet owner takes note of any clinical setbacks or onset of new clinical signs and alert the veterinarian at once.
General blood work (complete blood count, biochemical profile) may need to be re-evaluated as recommended by your veterinarian.
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