Referral and Evaluation of Nasal Diseases
Nasal diseases of both the dog and cat are common in veterinary medicine. Unfortunately primary neoplasms of the nasal cavity are often present and do not always have classic symptoms upon presentation to the family veterinarian. As with any cancer, early detection and treatment are key to success in controlling these problems. Many of the pets referred to AVS that have nasal tumors diagnosed have had multiple treatments and diagnostic procedures performed prior to referral. This often results in delay in diagnosis and ample time for the cancer to progress. The most common primary nasal tumors in the dog are carcinomas. They tend to spread locally and only metastasize late in their course. With the advent of MRI and CT, the extent of their local spread is well characterized and can be quite extensive with invasion into the maxillary bone, the contralateral nasal cavity, the palate, medial wall of the orbit and even thru the cribriform plate into the olfactory lobes of the brain. Extensive local spread causes the prognosis with radiation therapy to be markedly diminished. Pets with nasal tumors are presented with multiple different signs. They commonly have nasal obstruction. This is manifested by signs of nasal congestion, abnormal breathing sounds such as stridor and stertor, sneezing and excessive reverse sneezing, restlessness and difficulty sleeping. They often have unilateral hemorrhage, mucoid, serous or mucopurulent discharge if secondary infection is present. A part of my physical examination of these pets is to cover one nostril and listen for airflow through the other. Pets with nasal tumors will usually have complete or near complete obstruction to airflow thru the affected side. The family veterinarian’s role in these cases is to be suspicious of a tumor when any of these signs are present and to provide an early referral to a specialist who can perform MRI or CT and obtain a definitive diagnosis. I recommend that the veterinarian perform a CBC, chemistry profile, urinalysis and thoracic radiographs then refer it as soon as possible. At the present time, many of my referrals have already had a skull radiograph and an attempt at rhinoscopy that have yielded little information, delayed the diagnosis and cost the owner money. These diagnostic procedures should not be performed!! Treatment with antibiotics at the time of referral is left up to the judgment of the referring veterinarian however decongestant and antihistamine trials offer slight and only transient improvements and again – DELAY THE DIAGNOSIS. Sonny is a 10 year old Golden Retriever presented to us for unilateral epistaxis. The signs were noticed about 6 weeks prior to presentation. Antibiotics had been prescribed and skull radiographs were reported to show a mass. A rhinoscopy was non diagnostic.