Felis ISSN 2398-2950

Sinusitis

Synonym(s): rhinitis, rhinosinusitis

Contributor(s): Kim Willoughby

Introduction

  • Rhinosinusitis is a chronic disease of cats.
  • Cause: primary - frequently acute upper respiratory tract infection.
  • Signs: chronic nasal discharge and sneezing.
  • Diagnosis: is based on history, radiology, biopsy and exclusion of other causes of chronic nasal discharge.
  • Treatment: antibacterials and mucolytics form the mainstay of treatment. Surgery may be indicated.
  • Prognosis: for a full recovery - poor. Long-term disease and recurrence is most likely with medical management. Surgery may be curative in some cases.

Pathogenesis

Etiology

Infectious causes

  • Feline herpesvirus 1 (FHV-1)  Feline herpes virus: feline rhinotracheitis virus  - acute FHV infection frequently causes severe rhinitis and sinusitis, in conjunction with ocular and other signs. This acute inflammatory reaction can lead to a more chronic process. There is some experimental evidence that FHV can be osteolytic, and it is possible that FHV can directly damage the turbinates.
  • Feline calicivirus (FCV)  Feline calicivirus  - acute FCV infection most commonly causes serous ocular and nasal discharges, and oral or nasal ulceration. The inflammatory reaction in the nasal chambers is not as severe as for FHV but chronic rhinitis may still result.
  • Bordetella bronchiseptica  Bordetella bronchiseptica  - acute disease with B. bronchiseptica causes rhinitis and coughing. In other species, eg pigs, B. bronchiseptica is osteolytic and the role of B. bronchiseptica in feline respiratory disease is currently under study.
  • Cryptococcus neoformans  Cryptococcus neoformans  - a rare mycotic infection, this disease is typified by the production of granulomata in the nasal chambers, which can protrude from the nostril.
  • Parasitic - Capillaria aerophilla  Capillaria aerophilaMammomongamous ierie. Rare causes of rhintitis

Non-infectious causes

  • Foreign bodies Foreign body migration  - blades of grass or bones are most common. Usually migrate from oropharynx and cause chronic irritation and inflammation.
  • Facial trauma - as a result of road traffic accident, falling, dog bites, airgun pellets, etc. Turbinate or hard palate damage may lead to chronic inflammation.
  • Nasopharyngeal polyp  Nasopharyngeal polyp  - may present initially as rhinitis with purulent nasal discharge. Dyspnea and ear disease are commonly also present.
  • Nasal neoplasia  Nasal cavity: neoplasia  - may present as rhinitis but tends to cause progressive disease.
  • Dental disease  Periodontal disease  - periodontal pockets may invade the maxilliary sinuses or nasal cavity causing local inflammatory reaction. Exposure of the pulp or tooth loss may also allow secondary infection of the nasal cavity.
  • Allergic rhinitis  Rhinitis  - inhaled allergens, eg pollen, duct, moulds, etc leading to hypersensitivity.
  • Irritant rhinitis - chronic exposure to dust from, eg cat litter, sawdust can cause rhinitis.
  • Congenital abnormalities of the nasal bones, turbinates or septum.
  • Nasal vomiting, occasionally seen in brachycephalic cats.

Predisposing factors

General

  • Acute nasal disease of whatever cause.

Specific

  • Neoplasia.
  • Nasopharyngeal polyp.
  • Foreign body.
  • Dental disease.
  • Facial trauma.
  • Allergic rhinitis.
  • Cryptococcus neoformans.

Pathophysiology

  • Chronic rhinitis/sinusitis occurs secondary to infectious disease, chronic inflammatory disease or turbinate damage.
  • The chronic inflammatory reaction predisposes to secondary infection and bacterial rhinitis.
  • Causative factor   →   destruction of normal structure of mucosa and/or turbinate   →   loss of non-specific defenses and immunological function   →   bacterial overgrowth   →   chronic bacterial rhinitis, with osteochondritis and development of niduses of infection in sinuses and nasal bones.
  • Chronic inflammation   →   hyperplasia of mucous membrane and increased goblet cell numbers   →   overproduction of mucous   →   physical obstruction to air and mucous flow   →   dyspnea, nasal discharge, sneezing.
  • Chronic inflammation and discharge   →   occlusion of nasofrontal duct (links frontal sinus to nasal cavity)   →   unilateral or bilateral sinusitis.

Timecourse

  • Clinical signs extending over more than 4 weeks are classified as chronic rhinitis/sinusitis.

Epidemiology

Infectious agents

  • Cats with chronic rhinitis due to infectious agents can be a source of infection for other cats in the household or other premises.
  • FHV: the carrier status for FHV is well known. Cats recovering from acute infection become lifelong latently infected carriers, shedding virus sporadically following a period of stress.
  • FCV: the carrier status for FCV is also well established. Cats recovering from acute FCV infection shed virus for some weeks to months. Some cats shed virus for years.
  • B. bronchiseptica: the carrier status for this organism is still under study. It is however, known that cats can carry B. bronchiseptica and pass it on to their kittens.

Diagnosis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prevention

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Willoughby K & Coutts A (1995) Differential diagnosis of nasal disease in cats. In Practice 17 (4), 154-161 VetMedResource.
  • Van Pelt D R & Lappin M R (1994) Pathogenesis and treatment of feline rhinitis. Vet Clin North Am Small An Pract 24 (5), 807-823 PubMed.
  • Cape L C (1992) Feline idiopathic rhinosinusitis - a retrospective study of 30 cases. JAAHA 28 (2), 149-155 VetMedResource.
  • Coulson A (1988) Radiology as an aid to diagnosis of nasal disorders in the cat. Vet Annual 28, 150-158 VetMedResource.
  • Hawkins E C (1988) Chronic viral upper respiratory tract disease in cats - Differential diagnosis and management. Comp Cont Ed Pract Vet (Small Anim) 10 (9), 1003-1013 AGRIS FAO.
  • Anderson G I (1987) The treatment of chronic sinusitis in six cats by ethmoid conchal curettage and autogenous fat graft sinus ablation. Vet Surg 16 (2), 131-134 PubMed.

Other sources of information

  • August J R (1994) Chronic sneezing. In: Consultations in Feline Internal Medicine 2.Philadelphia: W B Saunders Company. pp 273-278. ISBN 0-7216-4674-3.
  • Levy J K & Ford R B (1994) Disease of the Upper Respiratory Tract. In: The Cat- diseases and Clinical Management. Ed: R G Sherding. New York: Churchill Livingstone. pp 947-978. ISBN 0-443-08879-9.


ADDED