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  Discussion on Unilateral green nasal discharge
Author Message
New Member:
katie4

Posted on Thursday, Jan 27, 2011 - 1:55 pm:

Hi DrO,

My lovely 5yo dressage horse has developed a unilateral copious green nasal discharge from one nostril. It started a few days after she had the dentist in to power-tool her teeth as she has congenital absence of one upper back molar and had developed severe waves on the biting surface of the teeth on that side. I'm fairly confident that the cause of the discharge is this dental work.

So far she has had a one week course of antibiotics which, predictably, had no effect. Since she is well in herself I then waited a month in the hopes that it would drain and clear on its own. It has not. I have just asked the vet to prescribe a months course of antibiotics for her but was concerned when I found out that the antibiotic she is getting is Sulphonamide.

Which antibiotic would you recommend in a situation like this? I did question the choice of Sulphonamide and was told "penicillin is still a good antibiotic for horses". Since Sulphonamide is not a penicillin this did not fill me with confidence!

Many thanks for your help. I'm starting to worry that this might be turning into more than an infected diastema or a tooth infection although my horse is still 100% well in herself and in full work (despite green goo pouring out of her nose).
Moderator:
DrO

Posted on Friday, Jan 28, 2011 - 7:53 am:

I think oral trimethoprim-sulfa (either sulfamethoxazole or sulfadiazine) is a good first choice as it is wide spectrum, inexpensive, and a low complication rate. You can read more about this at HorseAdvice.com » Treatments and Medications for Horses » Antibiotics and Antimicrobials » Trimethoprim -Sulfa.
DrO
New Member:
katie4

Posted on Tuesday, Feb 22, 2011 - 5:35 pm:

Hi DrO many thanks for your reply. Bizarrely despite being told my mare was on Sulphonamide when I looked at the box she is actually on Sulphadiazine. She's been on it for 3 weeks now and there is some improvement although her maxillary sinus still looks as if it is slightly swollen. 10 days ago it was a definite bulge on one side of her face so its gone down significantly. Her nose is now clear when she's in the stable and only produces green goo when she's been cantering for 5-10 minutes.

I'm still hoping this will clear up just with antibiotics but the vets aren't optimistic. They are saying that most cases of sinusitis as severe as hers need washing out via a hole bored through the . Still hoping it won't come to that!
New Member:
katie4

Posted on Tuesday, Feb 22, 2011 - 5:37 pm:

Oops, that should have said "a hole bored through the bone over the sinus."
Moderator:
DrO

Posted on Tuesday, Feb 22, 2011 - 8:37 pm:

I have seen some of these that improved on antibiotic alone but many don't. There is a lot more detail on this in the article associated with this discussion area.
DrO
Member:
katie4

Posted on Wednesday, Oct 5, 2011 - 3:31 pm:

Update on this case: My mare had to have two big (fist sized) flaps raised above two of her sinuses, an abnormal tooth removed and all the inspissated secretions curetted out plus twice daily flushing with saline and antibiotics for 5 days. The surgery went smoothly but unfortunately she developed a severe thrombophlebitis from the indwelling cannula in her neck. The entire length of her jugular vein filled with infected clot and she was desperately ill.

I thought we were going to lose her at one point but fortunately she slowly improved although her neck was dripping pus for 6 weeks before it finally cleared up. All in all it was a very unpleasant experience.

And now, 4 months after that horse finally recovered from her operation and subsequent infection my younger horse who is 3 has developed sinusitis too! I can't believe it. This one started dripping bright yellow watery fluid from her left nostril 10 days after she had had her teeth rasped and her wolf teeth taken out. The wolf teeth were big and difficult to remove and a small fragment of the root of the one on the left snapped off and was left in her jaw.

In view of my previous experience I called the vet immediately and got some antibiotics for her. Unfortunately they didn't stop the infection progressing and today, 4 weeks after the first signs of sinusitis, she too has purulent material dripping out of her left nostril. She has just had x rays and an endoscopy which confirmed sinusitis but no cause for the sinusitis was found. So she's had two holes made in her skull, big enough for a 16G needle to be inserted and she will be flushed twice a day with saline and antibiotics for the next 5 days.

I've been told that the chances of her sinusitis resolving despite the surgery is only 58% which is depressing to say the least! Do you have any more information about chronic primary sinusitis and its prognosis please DrO? And do you think the tooth rasping could have caused this second case of sinusitis just as it did the first? (I'm not trying to apportion blame here, just curious as to why I've been so unlucky as to get two horses with sinusitis 10 days after they had dental work.)
Member:
canter

Posted on Thursday, Oct 6, 2011 - 7:07 am:

Very rough luck, Michelle - I am sorry you have had to go through all this. Best wishes for your young mare's recovery.
Member:
vickiann

Posted on Thursday, Oct 6, 2011 - 6:10 pm:

This is dreadfully bad luck.

Don't know much about this kind of a problem but surely wish you better luck in the future.

What a stressful situation!
Member:
frances

Posted on Friday, Oct 7, 2011 - 7:33 am:

You poor thing - what a horrible situation. Seems hard to believe the two cases are a coincidence. I'll be interested to hear DrO's opinion.

Meanwhile, all the best to you and your horses.
Member:
katie4

Posted on Friday, Oct 7, 2011 - 6:55 pm:

Many thanks for the sympathy. It is a horrible situation to be in... again!

The small holes for flushing the sinuses weren't doing the job well enough so she's now got a catheter inserted into her face and sewn in place. Poor little mare. Apparently its her rostral maxillary sinus that is full of pus. I do hope she gets better.
Moderator:
DrO

Posted on Saturday, Oct 8, 2011 - 12:11 pm:

Hello Michelle,
That is bad luck. As to the cause, is it possible that working of the teeth can cause sinusitis has to answered yes. The tooth roots extend into the floor of the sinuses so a fracture that creates a communication between the oral cavity and the sinus certainly can cause a sinusitis. However for a young horse this would be quite rare for a floating and wolf tooth removal. Leaving a small fragment of root does not generally cause problems and the problems would not extend into the sinus typically but show up as inflammation and infection around the site of removal. Had their been such a incident radiography is likely to show the fracture and track.

Has the purulent discharge been cultured? Until the cause of the infection has been determined prognosis of any kind is very iffy. Sinusitis uncomplicated by a ongoing cause (like oronasal fistula) has a good prognosis assuming a organism sensitive to your antibiotic.
DrO
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