Nasopharyngeal polyps in cats

An Anatomical Study Using Computed Tomography, Magnetic Resonance Imaging, and Rhinoscopy of the Nasal Cavity of Domestic Cat (Felis silvestris catus L.) and Big Cats: Lion (Panthera leo leo L.), Leopard (Panthera pardus kotiya L.), and Cheetah (Acinonyx jubatus jubatus S.)

The objective of this work was to study the normal anatomy of the nasal cavity of the three species of big cats (leopard, lion, and cheetah) compared to the domestic cat through the use of computed tomography, magnetic resonance imaging, and rhinoscopy. Computed tomography allowed us to clearly visualize the entire bony and cartilaginous framework that supports the nasal cavity. Magnetic resonance imaging permitted better visualization of the soft tissues of this cavity. On the other hand, rhinoscopy enabled the direct visualization of the mucosa of the vestibule and nasal cavity, which is very useful in the diagnosis of masses or foreign bodies. Furthermore, with this technique, it has been possible to observe several small orifices from the nasolacrimal duct, the pharyngeal auditory tube, and the lateral nasal gland. Computed tomography, magnetic resonance imaging, and rhinoscopy are useful tools in analysis of the anatomical characteristics of the nasal cavity in these species.

Rigid normograde rhinoscopy-assisted traction-avulsion removal of small middle ear polyps from the auditory tube in five cats

CASE SERIES SUMMARY

This study aims to describe a novel minimally invasive technique for the removal of small middle ear polyps from the auditory tube openings in cats. Five cats with clinical signs of otitis externa and/or otitis media, and/or upper respiratory tract inflammation were included. All cats underwent pharyngolaryngoscopy under anaesthesia, CT scan of the head, neck and thoracic cavity, video-otoscopic examination, retrograde nasopharyngoscopy and normograde rhinoscopy. The five cats described in this study were all found to have significant respiratory tract inflammation (rhinitis, sinusitis, nasopharyngitis, otitis media) with small polypous protrusions from the auditory tube openings. A normograde rhinoscopy-assisted traction-avulsion (RATA) removal of these small polyps was performed in all cases without complications. The rostral nasopharynx was visualised by a unilaterally normograde advanced rigid endoscope passing the choana, and polyps were removed using a grasping forceps introduced in the contralateral nostril. Telephone follow-up revealed clear improvement in all cases. One of the cases was re-evaluated with a CT scan and endoscopy 4 weeks after treatment. The CT scan showed a significant improvement with no abnormalities in both external ear canals and air opacity in both tympanic bullae. Video-endoscopic examination revealed intact tympanic membranes with mild chronic abnormalities and patent auditory tube openings upon normograde rhinoscopy.

RELEVANCE AND NOVEL INFORMATION

Rigid normograde RATA is a novel, minimally invasive and effective technique for the removal of small middle ear polyps from auditory tube openings in cats with otitis media.

Otitis media and interna with or without polyps in cats: association between meningeal enhancement on postcontrast MRI, cerebrospinal fluid abnormalities, and clinician treatment choice and outcome

OBJECTIVES

The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians' therapeutic choice in cats with otitis media and interna (OMI).

METHODS

This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded.

RESULTS

Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer's test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks).

CONCLUSIONS AND RELEVANCE

No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.

Feline upper respiratory tract disease - Computed tomography and laboratory diagnostic

Background and Aim

Upper respiratory tract disease (URTD) is prevalent in cats, and diagnosis can be challenging. This study aimed to determine the most common causes of cat URTD in Latvia and describe computed tomography (CT) and laboratory diagnostic findings.

Materials and Methods

The present retrospective study included a total of 94 cats who were diagnosed with URTD. All cats underwent CT, and 50 of them had additional diagnostic tests, such as histology and respiratory infection polymerase chain reaction (PCR) testing.

Results

The most common CT finding was rhinosinusitis (55.32%) followed by nasal neoplasia (26.6%) and nasopharyngeal polyp (14.89%), but in three cats, a cause of respiratory symptoms was larynx neoplasia, nasal dermoid cyst, and an oronasal fistula. PCR test showed that the most cause of rhinosinusitis was Mycoplasma felis. Nasopharyngeal polyp as the primary diagnosis was identified in 14 cats from 3 months to 6 years, with an average age of 1.85 ± 1.915 years, and 54% of cats were female. Nasal neoplasia as a primary CT diagnosis was determined in 25 cats at the age of 5-18 years, with an average age of 10.56 ± 3.416 years. Histology diagnosis included four types of neoplasia - squamous cell carcinoma, sarcoma, adenocarcinoma, and aplastic carcinoma.

Conclusion

This study describes the most common CT and laboratory findings in cats with URTD. Included information will be helpful for general veterinary practitioners and researchers and will update their knowledge on feline URTD.

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

OBJECTIVES

The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis.

METHODS

In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling.

RESULTS

The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3-250.0; P = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5-344,349,142.0; P = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2-1000; P = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0-45.7; P = 0.047) and wide excursions of the head (95% CI 1.0-45.7; P = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5-50.0; P = 0.015).

CONCLUSIONS AND RELEVANCE

Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.

Feline bilateral inflammatory aural polyps: a descriptive retrospective study

BACKGROUND

Feline inflammatory aural polyps (IP) have been reported as solitary growths, yet bilateral polyps may occur more commonly than described previously.

OBJECTIVES

To identify the prevalence and risk factors associated with bilateral feline IP within a population of cats evaluated at a veterinary teaching hospital over a 10 year period.

ANIMALS

Twenty-five cats with histologically confirmed IP.

METHODS AND MATERIALS

A retrospective study was performed by searching computerized medical records of cats seen at The University of Tennessee Veterinary Teaching Hospital from 2005 to 2015. Keywords used for the search included "feline polyp", "ventral bulla osteotomy", "inflammatory polyp ear canal" and "nasopharyngeal polyp".

RESULTS

Cats were separated into groups with unilateral or bilateral disease. Six of 25 (24%) cats had bilateral IP. Twelve cats had computed tomography performed (four of six with bilateral IP; eight of 19 with unilateral IP). Clinical signs, history of upper respiratory infection, post-treatment complications, and IP recurrence with and without local and systemic steroid administration were studied between groups and no differences were identified. In four of six cats with bilateral disease, the second polyp was identified with advanced imaging performed at the time of referral.

CONCLUSIONS AND CLINICAL IMPORTANCE

These findings demonstrate that bilateral IP occur more frequently than reported previously and establish a prevalence for bilateral IP. These findings also highlight the value of advanced imaging techniques in diagnosing bilateral IP.

Primary nasopharyngeal polyps: a case series on a rare clinical entity

Primary non-neoplastic polyps originating from the nasopharynx have not been reported in the English language literature. We present the clinical and histopathological features of three primary nasopharyngeal polyps. Clinical data of three patients with primary nasopharyngeal polyps treated at the Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University between 2005 and 2015 were analyzed and presented. Three male patients from 45 to 63 years presented with nasopharyngeal masses. CT or MRI examination showed nasopharyngeal space-occupying lesions. Two patients were initially diagnosed with nasopharyngeal angiofibroma and one patient with nasopharyngeal carcinoma. After surgical excision, based on the histological examination, the tissue masses were all diagnosed as inflammatory polyps. Histologically, the polyps demonstrated significant oedema, collagen deposition, leukocytic infiltration, and epithelial remodelling. Primary nasopharyngeal polyps represent a distinct clinical entity and should be considered in the differential diagnosis of nasopharyngeal masses.

Per-endoscopic trans-tympanic traction for the management of feline aural inflammatory polyps: a case review of 37 cats

Feline aural inflammatory polyps are benign growths originating from the tympanic cavity or the Eustachian tube. They usually occur in young cats, which present either signs of otitis externa and otitis media, or respiratory signs, depending on the direction of polyp growth. Neurological signs are also reported. Simple traction and ventral bulla osteotomy (VBO) are the most common techniques used for treating this condition in cats; corticosteroids are recommended to reduce risk of recurrence given the inflammatory nature of the disease. The most common complications after treatment are Horner's syndrome, polyp recurrence and facial nerve paralysis. The aim of this report is to describe the per-endoscopic trans-tympanic traction (PTT) technique for treating feline aural inflammatory polyps and to report the short- and long-term follow-up of this procedure. PTT allowed resolution of the aural inflammatory polyps in 94% of cats during a mean long-term outcome of 19 months. Three cats (8%) developed Horner's syndrome immediately after the PTT procedure, which resolved within a few weeks, and five cats had polyp recurrence (13.5%). Only two cats had a poor outcome and were diagnosed with chronic otitis media at 22 months, and chronic otitis media and polyp recurrence at 46 months after the PTT procedure, respectively. PTT was shown to be an effective technique for treating aural inflammatory polyps and registered fewer neurological complications (8%) than VBO (57-81%) or simple traction (43%), and a recurrence percentage (13.5%) similar to VBO (0-33%) and much lower than traction alone (57%).

Inflammatory polyps of the nasal turbinates of cats: an argument for designation as feline mesenchymal nasal hamartoma

Inflammatory polyps of the nasal turbinates (IPNT) in cats are benign growths that are histologically distinct from feline nasopharyngeal polyps. Most cats with IPNT are presented at less than 1 year of age with sneezing, noisy breathing and epistaxis, but without mucoid or mucopurulent nasal discharge. Histologically, IPNT are characterised by the presence of woven bone as part of the proliferating stroma and erythrocyte-filled spaces. These unique histological features are analogous to nasal hamartomas (NH) of children, specifically chondromesenchymal hamartoma (NCMH) and sinonasal fibro-osseous hamartoma (SFOH), which also result in signs of nasal obstruction, sneezing and epistaxis. In our study, clinical and histopathological features in five cats with IPNT were compared with published descriptions of NH in children. We conclude that the terminology 'feline mesenchymal nasal hamartoma' provides a more accurate description of the disease currently termed IPNT, and has the added advantage of being consistent with its human counterpart.

Megaesophagus in a 6-month-old cat secondary to a nasopharyngeal polyp

A 6-month-old male domestic shorthair cat was presented for a 3-month history of dysphagia and upper respiratory signs. The cat was diagnosed with a generalized megaesophagus secondary to a large nasopharyngeal polyp that extended into the cervical esophagus. The polyp was removed by traction and a left ventral bulla osteotomy was performed to remove the polyp base. The cat's clinical signs resolved and follow-up radiographs 14 days after surgery revealed resolution of the megaesophagus. To the authors' knowledge, this is the first report of resolution of megaesophagus after removal of a nasopharyngeal polyp in a cat.

Inflammatory polyps and aural neoplasia

Although aural neoplasia is a relatively uncommon entity in companion animals, it remains a group of heterogeneous conditions that can have a significant negative impact on quality and duration of life of dogs and cats. Chronic ear disease that responds poorly or partially to empiric therapy should raise the suspicion that an underlying condition, such as neoplasia, may be the perpetrator of inflammation. Early diagnosis followed by appropriate therapy improves the likelihood of disease control and prolonged survival.