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  Discussion on Sinusitis
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Member:
clauee

Posted on Thursday, Dec 1, 2016 - 12:36 pm:

Hi Dr. O. We have a horse just arrived at our barn October 1st. General health is good, 9 year old gelding. He has a history of a broken nasal bone that caused clear nasal and eye discharge, but has been followed by vet and completely recovered. He still tends to have clear nasal discharge every time we have rain or damp temperatures. Other than that he eats VERY slowly, chews the hay and spits it out. The teeth have been checked by vet with no evidence of anything wrong. Previously this horse used to dunk his hay in water, but he cannot do it here (he is kept out 24/7 and the hay is not served close the waterer). We suspect he doesn't eat enough but also has a history of being hard to keep and not big appetite. Here is the situation: three weeks after arrival, the horse started purulent unilateral nasal discharge (no fever or any other symptom of infection). The is a strong odor from the discharge. The vet diagnosed sinusitis, and treatment started with a 10-day general antibiotic (sulfa), with no result. Had a second course of more specific antibiotic (ceftiofur) for 8 days along with expectorant for 14 days and it seemed to be efficient. We are still finishing the expectorant treatment. Horse went 4 days without symptoms after antibiotic treatment was over, but the purulent nasal discharge started again yesterday (on a rainy day). Horse has good shelter and he uses it, and still has no fever or energy/general condition issue. He is kept with one other horse who never got any symptom of bacterial infection whatsoever. We have been keeping other horses away and cleaning the environment daily (except for the pasture buddy). Should we consider this condition as contagious? If symptoms persist the vet thinks we should bring the horse to hospital for further investigation. What do you think? What are the next steps? Thank you!
Member:
clauee

Posted on Thursday, Dec 1, 2016 - 12:48 pm:

Oh and one more thing : we found a bot in this horse's manure. We are waiting to end his current treatment to give him an Eqvalen. Horse has been wormed with Strongid at the end of summer.
Moderator:
DrO

Posted on Tuesday, Dec 6, 2016 - 8:24 am:

Hello clause,
I would say you have 2 choices, a longer course of antibiotic or further diagnostics that would include scoping and radiography. Conditions you describe are not usually contagious.
DrO
Member:
clauee

Posted on Sunday, Dec 11, 2016 - 11:59 am:

Thank your DrO for your response; We will speak with the vet tomorrow. Would you suggest the same antibiotic (Naxcel)? How does a horse get a condition like this? Is it just a bacteria in the environment that affects him and not the other horses? From the article, since the discharge has a strong smell and the horse eats slowly + dunks the hay in water, we would think a teeth infection could be the cause.... but the teeth seem normal by physical exam from the vet... unless this requires radiography to be diagnosed? We gave him the Eqvalan paste today, hopefully this will help his eating habits eventually. His energy level is good, and general condition quite stable for now.
Member:
clauee

Posted on Monday, Dec 12, 2016 - 5:52 pm:

Today there was a little blood in the nasal discharge, after the horse has been worked. We spoke with the vet and he will come for scoping this week. The horse has no fever, LOTS of energy, and appetite is good.
Moderator:
DrO

Posted on Wednesday, Dec 28, 2016 - 7:59 am:

Hello clauee,
Somehow I missed your last 2 posts. Unfortunately there is little to add because we don't have a diagnosis yet, only a symptom. As for the choice of antibiotic that is a judgement best made by your veterinarian but Naxcel could be a good choice if your horse does not react to the injections severely. Did you get a scoping and a diagnosis?
DrO
Member:
clauee

Posted on Thursday, Dec 29, 2016 - 9:30 am:

Hi Dr. O
The equine hospital vets are in lockout and not accepting any horse in for this type of diagnosis right now (they accept life-threatening emergencies only). Our vet has been very busy on the road due to this situation, so further investigation will be in January (unless the horse's condition worsens until then). For now the symptoms are so mild, one would have to know and look very closely for signs of nasal discharge... Also the horse is in a very good state (energy, appetite, etc) despite the unsteady winter weather, so it is not considered a priority right now... We keep monitoring the horse closely and will be waiting til January!
Member:
clauee

Posted on Tuesday, Jan 24, 2017 - 9:04 am:

Hello Dr. O
The horse has been scoped yesterday. The horse's symptoms had not worsened in the past couple of weeks, but sill there was occasional snotty discharge from one nostril, especially after exercise. We found out the sinus seem clear, but some infection was found at the entrance of guttural pouches (According to owner, the horse had never contracted strangles before). The vet suggested further diagnostics at the hospital since he could not say if the infection comes from the guttural pouch itself or has been secondary to something else; The smell from the discharge is awful. For sure flushing will be required but the horse will be going to our local vet school for more diagnosis and to find the root cause of this infection.
Moderator:
DrO

Posted on Saturday, Jan 28, 2017 - 3:06 pm:

Hello clauee,
I think the foul odor warrants further work up for a cause and hopefully a permanent solution. Let us know the results.
DrO
Member:
clauee

Posted on Tuesday, Jan 31, 2017 - 5:48 pm:

Hi Dr. O; The horse has been to hospital for diagnosis today and will be kept in for surgery: I don't have all the details yet, but from what I've been told so far, there is a sinus cyst that could continue growing to a point it would cause facial distortion... It will have to be removed, which will be done by the end of the week. Can you give me more info on this condition? thank you
Moderator:
DrO

Posted on Wednesday, Feb 1, 2017 - 10:23 am:

Hello clauee, there is too little information to do anything other than define "sinus" and "cyst". Important is to know what is the origin (infected tooth root?), what tissues are involved (bone and which ones?), and is it infected and if so with what type organisms that are sensitive to what medications?.
DrO
Member:
clauee

Posted on Wednesday, Feb 1, 2017 - 12:48 pm:

Thank you Dr.O. We will know more today after surgery...
Member:
clauee

Posted on Monday, Feb 6, 2017 - 7:56 am:

The horse had surgery last week. There was no cyst. The vet went with a camera and finally found a grape of pus, in a secluded spot of the sinus behind the eyes. They were able to flush everything out, but were not able to identify the origin of the infection if it is secondary to some other cause. The teeth were ok, guttural pouch and bloodwork also. For now the diagnosis refers to a primary sinusitis that could not drain or respond to antibiotics because of the location in the sinus. There is still a possibility it could be secondary to teeth infection, so if the symptoms come back, they will proceed to a cT scan for further investigation. The horse is back to the barn now and seems to be recovering just fine! We have antibiotics to give him (trimethoprim sulpha), so I guess the involved organism is bacterial.
Moderator:
DrO

Posted on Tuesday, Feb 7, 2017 - 8:20 am:

Well clauee the encouraging news is that this may be a primary event that has been treated properly (I would like to know the culture results) and has a good prognosis to not come back, particularly if the organism is identified and there is a appropriated antimicrobial. Unfortunately there still seem to be some unknowns but that is always true.
DrO
Member:
clauee

Posted on Wednesday, Feb 15, 2017 - 8:02 pm:

Hi Dr.O
The vet will come on Monday to take away the pins, I will ask if the organism has been identified... The last antibiotic was given on Saturday morning. The horse is doing fine, but we still have blood draining (we were told it is normal, but how many days can we expect this?). Also, on Sunday afternoon, the horse had a thick nasal discharge on the same side... Is this normal drainge? Or should we call the vet sooner if there is discharge that isn't clear?
Moderator:
DrO

Posted on Friday, Feb 17, 2017 - 7:28 pm:

These are not questions I can answer, your surgeon would be the best source for this. I would call about the nasal discharge if it was cloudy.
DrO
Member:
clauee

Posted on Monday, Feb 20, 2017 - 1:24 pm:

Thank you Dr. O
We saw the vet today and unfortunately the surgeon did not do the test to identify the organism. The horse is doing good, and there is no more blood draining. We haven't seen any other evident, thick, cloudy discharge, although there is always a little discharge on that side when the horse moves more. There is a little necrosis odor also, but we were told this could be normal due to tissues recovering. We will monitor closely, and hopefully with a little more time it will lead to a complete recovery!
Member:
clauee

Posted on Saturday, Mar 4, 2017 - 1:06 pm:

Well, bad news: the symptoms came back. We have occasional purulent unilateral discharge (triggered by light exercise, temperature changes and especially rainy weather). When there is discharge, there is a necrosis smell.... The horse will be going back to vet hospital for a cTscan and treatment according to the root cause of the infection.
Member:
clauee

Posted on Thursday, Mar 23, 2017 - 1:48 pm:

Hi Dr. O
The horse went back to hospital for a cTScan; The origin of infection is a tooth root: one is definitely infected, two other are suspected. They went on surgery to extract the obviously infected tooth, but after 3hour they still could not get it out... So they stopped to pause for a day and they will try again today. Can you give me some information about how a tooth gets infected, and what are the recommendations after extraction (feeding, care, etc.)? Thank you
Moderator:
DrO

Posted on Sunday, Mar 26, 2017 - 8:35 am:

Hello clauee,
Check out HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Disorders of the Mouth and Teeth where most of your questions are answered. Of course care for your horse must be prescribed by your veterinarian.
DrO
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