Sneezing and Nasal Discharge in Cats

Overview of Feline Sneezing and Nasal Discharge

Sneezing is a reflex of the upper airways, activated to explosively discharge irritating material from the nasal cavity. In cats, it is usually caused by the irritation of sensitive nerve endings in the mucous membrane that lines the nose. Nasal discharge is another sign of nasal disease or irritation.

Although normal cats may occasionally sneeze or have nasal discharge (similar to human beings), severe, chronic or recurrent bouts of sneezing or nasal discharge suggest a more serious problem. Sneezing and nasal discharge often occur together.

Nasal discharge can be categorized by character: serous (clear), mucoid (cloudy), blood tinged, bloody (epistaxis) or a combination of these. It is also categorized by location: unilateral (one nostril vs. bilateral (both nostrils); chronicity (acute vs. chronic); and associated signs of disease. For example, nasal bleeding could suggest injury, a tumor, bleeding disorder or a tick-borne infection.Sneezing and nasal discharge can be caused by dozens of conditions. Some causes are brief and self-limiting such as acute viral infections. Other problems are recurrent such as seasonal allergies. Still others – such as tumors or lodged nasal foreign bodies – are relentless and chronic unless the problem can be resolved.Nasal disease can affect cats of any age. Younger cats are more likely to be affected by communicable respiratory infections (viruses in most cases) or birth defects (such as cleft palate, ciliary dyskinesis, or imperforate posterior choanae). Older cats with sneezing/nasal discharge are more likely to have chronic dental disease or tumors. Outdoor cats are more prone to inhalation of foreign bodies, such as fox tails plant awns, that can lead to acute and then chronic upper airway problems. Some fungal infections are more common in cats (e.g. cryptococcus).

What to Watch For

• Sneezing and nasal discharge, which are the hallmark symptoms of nasal and sinus disease
• Rubbing the nose or pawing at the face
• Gagging
• Excessive swallowing (from post-nasal drip)
• Bleeding from one or both nostrils
• A foul smell from the mouth or nose
• Pain
• Swelling over the bridge of the nose
• Noisy breathing
• Loss of appetite
• Weight loss
• Lethargy (lack of energy)

Diagnosis of Sneezing and Nasal Discharge in Cats

Veterinary care should include diagnostic tests to determine what is causing the sneezing or nasal discharge and to direct subsequent treatment.

There are several potential diagnostic tests. Recommendations will depend upon the likelihood of the potential diagnosis. The tests may include:

• Physical examination and history including: examination for swellings; type of nasal discharge, airflow through the nostrils; ability of your pet to breath with the mouth closed; size and shape of lymph nodes; oral (mouth) cavity examination; and assessment of the eyes. Thorough examination of the upper airways is difficult without anesthesia. Acute causes of nasal discharge or sneezing – especially when caused by a respiratory viral infection – may be diagnosed from the history and clinical circumstances.
• General blood screening rarely identifies the cause of the nasal discharge. However, blood tests are recommended to look for secondary disease and concurrent problems and to minimize anesthetic risk.
• A platelet count and coagulation screen to assess for possible causes of bleeding.
• A nasal swab and microscope examination of the cells (cytology).
• Specialized blood tests for fungus infections.
• Examination of the nasal cavity and posterior choanae (back of the nose) using endoscopes.
• Flushing and cytology of the nasal cavities.
• Skull X-rays.
• Computerized tomography (CT).
• Biopsy of the nasal tissue (mucosa).

Treatment of Sneezing and Nasal Discharge in Cats

Treatment depends on the cause of the nasal discharge or sneezing. There is no “general” treatment for these symptoms.

Home Care

Recommendations for home care will depend upon the underlying cause of the problem.

Monitor your cat for any abnormalities so that you can discuss them with your veterinarian. If general treatments do not clear up the symptoms, a diagnosis must be sought using appropriate tests.

Administer all treatments as recommended by your veterinarian. You may clean discharges from the nose. Many cats eat based on their sense of smell. Often if your cat cannot smell the food, he will not eat it. You can warm food in the microwave or feed a canned food that may be smellier to encourage your cat to eat.

Preventative Care

Vaccinate your cats against upper respiratory infections.

In-depth Information on Sneezing and Nasal Discharge in Cats

The following list emphasizes the most important causes of nasal discharge.

• Infectious diseases – viral and bacterial: Rickettsial infections (also lead to bleeding disorders), bacterial infections (usually secondary to something else)
• Infectious diseases – fungal diseases (mycotic infections) – Aspergillus, Penicillium, Rhinosporidium, Sporothrix
• Nasal mites (tiny insects)
• Dental disease with infection of the tooth roots
• Inflammatory diseases of the nasal cavity such as
• 1) lymphocytic plasmacytic rhinitis – an “immune” or nonspecific response of the nasal mucosa (lining cells) to an injury or stimulation
• 2) idiopathic (no known cause) including “allergic” rhinitis
• Neoplasia– tumors or cancers, including: adenocarcinoma, chondrosarcoma, fibrosarcoma, mast cell tumor, osteosarcoma, squamous cell carcinoma
• Polyps – inflammatory benign growths
• Congenital diseases – ciliary dyskinesis (lack of normal microscopic hairs, cleft palate (food leaks from mouth to nose), imperforate posterior choanae openings (nasal discharge cannot drain)
• Foreign bodies
• Trauma
• Bleeding disorders – abnormal clotting of blood manifested as a “nose bleed” caused by: immune-mediated thrombocytopenia, thrombocytopathia, Ehrlichiosis, hyperglobulinemia, polycythemia, hyperviscosity syndromes and hypertension
• Extranasal diseases leading to nasal discharge: pneumonia, swallowing disorders, deficiency in local immunity (IgA)

Nasal discharge may not be obvious, due to the tendency of cats to lick secretions from their noses. Discharge is more noticeable as the volume increases, character of discharge changes, other physical abnormalities occur or secretions accumulate on the nostril, over surrounding hair or nasopharynx (causing retching or reversed sneezing).

Nasal discharge comes from several sources, including mucous cells and glands in the nose. Secretions usually move caudally (away from the nostril) by the mucociliary apparatus (small hair-like projections) and when they reach the nasopharynx (where the nasal cavity meets the throat) they are swallowed. When secretions accumulate to the exterior, it suggests that there is an increased production of secretions or an obstruction to drainage.

Veterinarians know that certain types of discharges are more likely with certain diseases, but there is overlap. Nasal discharge is not specific for any one problem but can actually be related to a number of different diseases or disorders.

Unfortunately, in older cats, nasal neoplasia (cancer) is a very common cause of recurrent and progressive (becomes more severe with time) nasal discharge.

Diagnosis In-depth

Diagnostic tests used to determine the cause of nasal discharge will be considered by your veterinarian based on findings from the physical examination, prior tests results, or lack of response to empiric therapy. Most tests for evaluation of nasal discharge are best accomplished with sedation or general anesthesia. The evaluation for nasal discharge may include an oral examination, nasal examination, cytology (examination of cells), biopsy, culture, radiography or computerized tomography.

• Although routine blood screening rarely identifies the cause of nasal discharge, it can identify concurrent disease and help to assess anesthetic risk.
• A platelet count and coagulation screen is important in cases of epistaxis (bleeding from the nostrils).
• A nasal swab and microscope examination of the cells (cytology) is helpful in suspected cases of certain cancers.
• Specialized blood tests for fungus infections may be appropriate.
• Radiography – General anesthesia is usually necessary for optimal positioning. Nasal X-rays can be very difficult to interpret and a second opinion by a veterinary radiologist (a specialist) is helpful in some situations.
• Rhinoscopy – is a procedure that consists of looking into the nose (front and back) with a lighted instrument or endoscope. This is performed under anesthesia to visualize and biopsy the nasal cavity as needed.
• Culture – Secondary infection is common with most causes of nasal disease. A culture will help determine which organisms are present but one should understand that the normal nasal cavity is colonized by bacteria and sometimes by fungus.
• Biopsy – Tissue samples should be submitted for histopathology to assist in the diagnosis. Samples may be obtained by exploratory surgery (usually a last resort), by endoscopic direct biopsy (rhinoscopy) or by blind biopsy using an endoscopic pinch biopsy forceps without directly seeing the abnormal tissue).

Depending on the situation, your veterinarian might recommend additional diagnostic tests to exclude or diagnose other conditions and to provide optimal medical care for your pet. Some examples include:

• Serology – can be used for diagnosis of fungal-based nasal discharge.
• Computed tomography (CT) – available at referral institutions and excellent for determining the amount and extent of bony involvement of a nasal tumor.
• Magnetic resonance imaging (MRI) – available at referral institutions and helpful for determining the amount and extent of bony involvement of a nasal mass.
• Surgery – Exploratory surgery can expose the nasal cavity, procure a biopsy, culture and remove foreign bodies.

Treatment In-depth

• Optimal therapy of any serious or persistent medical condition depends on establishing the correct diagnosis. There are numerous potential causes of nasal discharge and before any treatment can be recommended, it is important to identify the underlying cause. Initial therapy should be aimed at the underlying cause.
• Antibiotics may be used to treat some infectious disease process, but the primary cause, such as tooth root abscess, must be also treated. Nasal discharge that is unresponsive to antibiotics is a common finding with cancer.
• Nasal fungal disease may be treated with antifungal therapy.
• Polyps are treated with surgery.
• Foreign bodies are removed with rhinoscopy, endoscopy or surgery.
• Nasal tumors are treated with radiation, +/- surgery or chemotherapy.