Anjop J. Venker-van Haagen Ear, Nose, Throat, And .

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3-87706-635-6 00I-05018.04.200512:03 UhrSeite IAnjop J. Venker-van HaagenEar, Nose, Throat, and Tracheobronchial Diseases in Dogs and Cats

3-87706-635-6 00I-05018.04.200512:03 UhrSeite II

3-87706-635-6 00I-05018.04.200512:03 UhrSeite IIIAnjop J. Venker-van HaagenEar, Nose, Throat, andTracheobronchial Diseasesin Dogs and Cats

3-87706-635-6 00I-05018.04.200512:03 UhrSeite IVAnjop J. Venker-van Haagen, DVM, PhD, DECVSFormer Associate Professor of Veterinary Ear Nose and Throat DiseasesFaculty of Veterinary MedicineDepartment of Clinical Sciences of Companion AnimalsUtrecht University, The Netherlands 2005, Schlütersche Verlagsgesellschaft mbH & Co. KG, Hans-Böckler-Allee 7, 30173 HannoverE-mail: info@schluetersche.dePrinted in GermanyISBN 3-87706-635-6Bibliographic information published by Die Deutsche BibliothekDie Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available in the Internet at http://dnb.ddb.de.The author assumes no responsibility and make no guarantee for the use of drugs listed in this book.The author/publisher shall not be held responsible for any damages that might be incurred by therecommended use of drugs or dosages contained within this textbook. In many cases controlledresearch concerning the use of a given drug in animals is lacking. This book makes no attempt tovalidate claims made by authors of reports for off-label use of drugs. Practitioners are urged to followmanufacturers’ recommendations for the use of any drug.All rights reserved. The contents of this book, both photographic and textual, may not be reproduced inany form, by print, photoprint, phototransparency, microfilm, video, video disc, microfiche, or any othermeans, nor may it be included in any computer retrieval system, without written permission from thepublisher.Any person who does any unauthorised act in relation to this publication may be liable to criminalprosecution and civil claims for damages.

3-87706-635-6 00I-05018.04.200512:03 UhrSeite VContentsContentsAbbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . VIIIPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5.21.5.31.5.41.5.51.5.61.5.71.61.6.11.6.2The Ear . . . . . . . . . . . . . . . . . . . . . . . .1Functional considerations . . . . . . . . .1The ear as sensory organ . . . . . . . . .1Middle ear matches differentimpedances . . . . . . . . . . . . . . . . . . . .2Organ of Corti, sensory organfor hearing . . . . . . . . . . . . . . . . . . . . .3Ascending and descending pathwaysfor hearing . . . . . . . . . . . . . . . . . . . . .5Vestibular organ, the key to posturalreflexes and eye movement . . . . . . .5History and clinical signs . . . . . . . . .6History . . . . . . . . . . . . . . . . . . . . . . . .6Clinical signs . . . . . . . . . . . . . . . . . . .7Physical examination . . . . . . . . . . . . .9Special diagnostic techniques . . . . .9Otoscopic examination . . . . . . . . . . . 10Diagnostic imaging of the ear . . . . . . 12Tympanometry . . . . . . . . . . . . . . . . . . 15Neurological examination for vestibulardysfunction . . . . . . . . . . . . . . . . . . . . 16Hearing tests . . . . . . . . . . . . . . . . . . . 16Congenital diseases of the ear . . . . . 19Congenital deformity of theexternal ear . . . . . . . . . . . . . . . . . . . . 19Congenital deafness . . . . . . . . . . . . . 19Inflammatory diseases of the ear . . . 21Primary and secondary skin diseases ofthe auricle . . . . . . . . . . . . . . . . . . . . . 21Perichondritis and chondritisof the auricle . . . . . . . . . . . . . . . . . . . 23Cold agglutination and cutaneousvasculitis of the auricle . . . . . . . . . . . 24Inflammatory diseases of the external earcanal . . . . . . . . . . . . . . . . . . . . . . . . . . 24Inflammation of the tympanicmembrane . . . . . . . . . . . . . . . . . . . . . 30Inflammatory disease of themiddle ear . . . . . . . . . . . . . . . . . . . . . 30Labyrinthitis . . . . . . . . . . . . . . . . . . . . 34Tumors of the ear . . . . . . . . . . . . . . . . 35Malignant tumors of the auricle . . . . 35Malignant tumors of the externalear canal . . . . . . . . . . . . . . . . . . . . . . . .52.5.12.5.22.6Tumors of the middle ear . . . . . . . . .Trauma to the ear . . . . . . . . . . . . . . .Trauma to the auricle . . . . . . . . . . . . .Auricular hematoma . . . . . . . . . . . . .Trauma to the external ear canal . . .Trauma to the tympanicmembrane. . . . . . . . . . . . . . . . . . . . . .Trauma to the temporal bone . . . . . .Ototoxicity . . . . . . . . . . . . . . . . . . . . .Hearing in dogs and cats . . . . . . . . .Hearing and hearing loss in dogs . . .Brain stem auditory evokedresponses in dogs . . . . . . . . . . . . . . .Hearing and hearing loss in cats . . .Brain stem auditory evoked responsesin cats . . . . . . . . . . . . . . . . . . . . . . . . .The Nose and Nasal Sinuses . . . . . .Functional considerations . . . . . . . . .Regulation and conditioning of theinspiratory and expiratory airflow . . .Mucosal cleaning . . . . . . . . . . . . . . . .Olfaction . . . . . . . . . . . . . . . . . . . . . . .Specific functional systems . . . . . . .History and clinical signs . . . . . . . . .History . . . . . . . . . . . . . . . . . . . . . . . .Clinical signs . . . . . . . . . . . . . . . . . . .Physical examination . . . . . . . . . . . .Special diagnostic techniques . . . . .Diagnostic imaging . . . . . . . . . . . . . .Rhinoscopy . . . . . . . . . . . . . . . . . . . .Olfactory tests . . . . . . . . . . . . . . . . . .Congenital diseases of the noseand nasal sinuses . . . . . . . . . . . . . . .Congenital malformation of thenasal plane . . . . . . . . . . . . . . . . . . . .Nasal dermoid sinus cysts . . . . . . . .Congenital cerebrospinal fluid fistulaCongenital malformation of thefrontal sinuses . . . . . . . . . . . . . . . . . .Congenital ciliary dysfunction . . . . . .Rhinitis and sinusitis . . . . . . . . . . . . .Infectious rhinitis and sinusitis . . . .Noninfectious rhinitis andsinusitis. . . . . . . . . . . . . . . . . . . . . . . .Tumors of the nasal plane, the nasalcavity, and the frontal sinus . . . . . . 6575960606262626263636872V

3-87706-635-6 00I-05018.04.200512:03 UhrSeite .33.63.73.7.13.7.23.83.8.13.8.23.8.3VITumors of the nasal plane . . . . . . . . .Tumors in the nasal cavity . . . . . . . . .Tumors in the frontal sinus . . . . . . . .Trauma to the frontal sinus andthe nose . . . . . . . . . . . . . . . . . . . . . .Trauma to the frontal sinus . . . . . . . .Trauma to the nose . . . . . . . . . . . . . .Epistaxis . . . . . . . . . . . . . . . . . . . . . . .Management of acute epistaxis . . . .Causes of epistaxis . . . . . . . . . . . . . .The diagnostic plan . . . . . . . . . . . . . .Management of intermittent epistaxisof unknown origin . . . . . . . . . . . . . . .The Pharynx . . . . . . . . . . . . . . . . . . . .Functional considerations . . . . . . . . .Auditory tube serves to equalizeatmospheric pressure . . . . . . . . . . .Swallowing . . . . . . . . . . . . . . . . . . . . .History and clinical signs . . . . . . . . .History . . . . . . . . . . . . . . . . . . . . . . . .Clinical signs . . . . . . . . . . . . . . . . . . .Special diagnostic techniques . . . . .Pharyngoscopy . . . . . . . . . . . . . . . . .Diagnostic imaging of the pharynx . .Electromyography of the pharyngealmuscles . . . . . . . . . . . . . . . . . . . . . . .Congenital deformities and disordersof the pharynx . . . . . . . . . . . . . . . . . .Hypoplasia of the soft palate . . . . . .Congenital malformation of the softpalate . . . . . . . . . . . . . . . . . . . . . . . .Hyperplasia of the soft palate . . . . .Choanal atresia . . . . . . . . . . . . . . . . .Craniopharyngioma (Rathke’s pouchtumor) . . . . . . . . . . . . . . . . . . . . . . . . .Pharyngitis . . . . . . . . . . . . . . . . . . . . .Nasopharyngitis . . . . . . . . . . . . . . . . .Oropharyngitis and tonsillitis . . . . . .Pharyngeal mucocele . . . . . . . . . . . .Tumors of the pharynx . . . . . . . . . . . .Blunt and penetrating injuries of thepharynx . . . . . . . . . . . . . . . . . . . . . . .Blunt pharyngeal injuries . . . . . . . . .Penetrating pharyngeal injuries . . . .Dysphagia . . . . . . . . . . . . . . . . . . . . .Causes of dysphagia . . . . . . . . . . . . .Diagnosis in dysphagia . . . . . . . . . . .Therapy in dysphagia . . . . . . . . . . . .1.2The Larynx . . . . . . . . . . . . . . . . . . . . .Functional considerations . . . . . . . . .The glottic closure reflex . . . . . . . . . .Respiratory movements of theglottis . . . . . . . . . . . . . . . . . . . . . . . . .4.1.3 Movements of the glottis invocalization . . . . . . . . . . . . . . . . . . . .4.1.4 Action of the glottis in coughing . . . .4.1.5 Supplementary innervation of thedog’s intrinsic laryngeal muscles . . .4.2History and clinical signs . . . . . . . . .4.2.1 History . . . . . . . . . . . . . . . . . . . . . . . . .4.2.2 Clinical signs . . . . . . . . . . . . . . . . . . .4.3Special diagnostic techniques . . . . .4.3.1 Laryngoscopy . . . . . . . . . . . . . . . . . . .4.3.2. Diagnostic imaging of the larynx . . .4.3.3 Electromyography of the intrinsiclaryngeal muscles . . . . . . . . . . . . . . .4.4Congenital deformities anddisorders of the larynx . . . . . . . . . . . .4.4.1 Congenital glottis stenosis . . . . . . . .4.4.2 Congenital subglottic stenosis . . . . .4.4.3 Laryngeal hypoplasia . . . . . . . . . . . .4.5Laryngitis . . . . . . . . . . . . . . . . . . . . . .4.5.1 Benign laryngeal masses . . . . . . . . .4.5.2 Ventral midline approach to thelaryngeal cavities to expose largemasses . . . . . . . . . . . . . . . . . . . . . . . .4.6Tumors of the larynx . . . . . . . . . . . . .4.6.1 History and clinical signs oflaryngeal tumors . . . . . . . . . . . . . . . .4.6.2 Imaging of laryngeal tumors . . . . . . .4.6.3 Laryngoscopy for laryngeal tumors . .4.6.4 Therapy for laryngeal tumors . . . . . .4.7Blunt and penetrating injuriesto the larynx . . . . . . . . . . . . . . . . . . . .4.7.1 Blunt laryngeal injuries . . . . . . . . . . .4.7.2 Penetrating laryngeal injuries . . . . . .4.8Laryngeal paralysis and functionaldisorders of the larynx . . . . . . . . . . . .4.8.1 Neurogenic laryngeal paralysis . . . . .4.8.2 Laryngeal spasm . . . . . . . . . . . . . . . .4.8.3 Paradoxical vocal fold movement . . .4.8.4 Sensory laryngeal paralysis andlaryngeal dysfunction . . . . . . . . . . . 161

3-87706-635-6 00I-05018.04.200512:03 UhrSeite VIIContents55.15.1.1The Trachea and Bronchi . . . . . . . . . .Functional considerations . . . . . . . . .Trachea and bronchi facilitate therespiratory airflow . . . . . . . . . . . . . . .5.1.2 Trachea and bronchi condition therespiratory air . . . . . . . . . . . . . . . . . . .5.2History and clinical signs . . . . . . . . .5.2.1 History . . . . . . . . . . . . . . . . . . . . . . . .5.2.2 Clinical signs . . . . . . . . . . . . . . . . . . .5.2.3 Physical examination . . . . . . . . . . . .5.3Special diagnostic techniques . . . . .5.3.1 Diagnostic imaging . . . . . . . . . . . . . .5.3.2 Bronchoscopy . . . . . . . . . . . . . . . . . .5.4Congenital diseases of the tracheaand the bronchi . . . . . . . . . . . . . . . . .5.4.1 Hypoplasia of the trachea . . . . . . . . .5.4.2. Collapse of the trachea . . . . . . . . . . .5.4.3 Segmental tracheal stenosis . . . . . . .5.4.4 Congenital ciliary dysfunction . . . . . .5.5Tracheitis and bronchitis . . . . . . . . . .5.5.1 Infectious tracheobronchitisin dogs . . . . . . . . . . . . . . . . . . . . . . . .5.5.2 Infectious tracheobronchitisin cats . . . . . . . . . . . . . . . . . . . . . . . . .5.5.3 Noninfectious tracheobronchitis . . .5.5.4 Bronchiectasis . . . . . . . . . . . . . . . . . .5.5.5 Prolapse of the dorsal ligament oftrachea and main stem bronchi . . . 6.2.2Foreign bodies in the tracheobronchial tree in dogs . . . . . . . . . . . .Foreign bodies in the tracheobronchial tree in cats . . . . . . . . . . . . .Tracheitis caused by aspiration . . . .Tumors of the trachea and bronchi . .Tracheal trauma . . . . . . . . . . . . . . . . .Trauma to the cervical trachea . . . . .Trauma to the thoracic trachea . . . . .Tracheal stenosis . . . . . . . . . . . . . . . .Airway management . . . . . . . . . . . . .Endotracheal intubation . . . . . . . . . .Cricothyroidotomy . . . . . . . . . . . . . . .Tracheostomy . . . . . . . . . . . . . . . . . . .Permanent tracheostoma . . . . . . . . .Tracheal T-tube . . . . . . . . . . . . . . . . . .193193194195196197198199200202202203205Cranial Neuralgias and Facial andTrigeminal Paralysis . . . . . . . . . . . . .Cranial neuralgias . . . . . . . . . . . . . . .Glossopharyngeal neuralgia . . . . . . .Trigeminal neuralgia . . . . . . . . . . . . .Facial and trigeminal paralysis . . . . .Facial paralysis . . . . . . . . . . . . . . . . .Trigeminal paralysis . . . . . . . . . . . . . .209209209209210210211191189VII

3-87706-635-6 00I-05018.04.200512:03 UhrSeite VIIIAbbreviationsAbbreviationsADCAnalog-to-digital converterkHzKilohertzB.O.S.Brachycephalic obstructivesyndromeMRIMagnetic resonance imagingNd-YAG laserBAERBrain stem auditory evokedresponseLaser using Yttrium-AluminumGarnet with Nd ionsNSAIDsBERABrain stem evoked responseaudiometryNonsteroidal anti-inflammatorydrugsCPGCentral pattern generatorCRDsComplex repetitive dischargesCTComputed tomographyDACDigital-to-analog converterdB SPLVIIIDecibel sound pressure GElectromyogram/ElectromyographyF generationsOffspring generationsFISH and RHmappingMethods for gene mapping usedfor association studiesHzHertzi.d.Inside diameterIgImmunoglobulinNTSNucleus tractus solitariusp 0.01The probability that the result isdue to chance is less than 1 in100 (highly significant)P generationParent generationSLNSuperior laryngeal nerve/Craniallaryngeal nerveT-tubeT-shaped tracheal tubeVTrigeminal nerveVIIFacial nerveIXGlossopharyngeal nerveXVagus nerveXphPharyngeal branch of the vagusnerveXIIHypoglossal nerve

3-87706-635-6 00I-05018.04.200512:03 UhrSeite IXPrefacePrefaceAmong my fellow members of the InternationalVeterinary Ear Nose and Throat Association(IVENTA), the reason for marking out specialization in diseases of the ear, nose, throat, and tracheobronchial tree is clear. They recognize thatmany of the diseases of these organs have similar clinical signs, similar infectious etiology, orsimilar regulatory mechanisms, and that theseorgans share cranial nerves for the execution oftheir functions.Most of the knowledge in this field has beenprovided to veterinarians—and regularly updated by—the major textbooks of small animalinternal medicine and small animal surgery. Thetextbook presented here aims not only to provide a more complete overview of diseases ofthe ear, nose, throat, and tracheobronchial treebut also to increase understanding of the functions of the respective organs for hearing, olfaction, swallowing, vocalization, and conditioning inspired air for gas exchange in the lung.Each chapter begins with functional considerations of its subject and ends with a clinicaltopic chosen for its uncommon complexity. Thebook is readily accessible through a detailedlist of contents and an elaborate index. It isintended to provide information of interest toacademics as well as practitioners and students.I am grateful to Dr. Bruce Belshaw for editingthe English language with care and experience.Mr. Joop Fama handled the figures and madethem shine, and I am grateful both for hisknowledge and for the time and care he gave tothe work. Dr. Ulrike Oslage at Schlütersche Verlagsgesellschaft invited me to write this textbook and I thank her not only for the opportunity but also for the free hand which I had inpreparing it. Dr. Simone Bellair at SchlüterscheVerlagsgesellschaft fine-tuned the writtenmaterial and the various pictures into a bookand I am grateful for her professional skill.I hope that readers will find this a pleasantand useful book and that interest in this fieldwill continue to develop the science of ear,nose, throat, and tracheobronchial diseases indogs and cats.Utrecht, May 2005Anjop Venker-van HaagenCat. China, second halfof the 18th century. Catshows signs of severedyspnea: mouth breathing and fear.(From: Rijksmuseum,Diary 1999, week 44,with permission).IX

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3-87706-635-6 00I-05018.04.200512:03 UhrSeite 1Functional considerations1 The Ear1.1 Functional considerations1.1.1 The ear as sensory organThe ear is a sensory organ that has evolved to receive and transform the air waves or vibrationsthat we call sound into a code of neural impulses to be conveyed to the brain. The resulting distinct patterns of neural activity in the brain arethen integrated with information from other sensory systems to guide behavior.52 The first stageof this transformation occurs in the external andmiddle ear, which collect sound waves and amplify their pressure, so that the sound energycan be successfully transmitted from air to thefluid that fills the cochlea of the inner ear. In theinner ear the signal is divided into simpler, sinusoidal components, with the result that the frequency, amplitude, and phase of the originalsignal are faithfully converted by the sensoryhair cells into encoded electrical activity in theauditory nerve fibers.52 In the brain the earlieststage of central processing occurs in thecochlear nucleus, where the peripheral auditoryinformation diverges into a number of parallelcentral pathways. These include the superiorolivary complex, where the information from thetwo ears interacts to aid in localizing the soundin space. The cochlear nucleus also projects tothe inferior colliculus of the midbrain, a major integrative center and the first place where auditory information can interact with the motor system. The inferior colliculus is an obligatory relayfor information traveling to the thalamus andcortex, where more complex aspects of soundare processed.52External ear. The external ear is the portion lateral to the tympanic membrane. It consists ofthe external auditory canal and its cartilaginousextension, the auricle. The medial part of theauditory canal is surrounded and supported by1the temporal bone. The auricle is covered withskin which continues as the lining of the auditory canal. This skin is thin and in the medialpart of the auditory canal it has little subcutaneous tissue, but in the lateral part it bearsnumerous hair follicles and ceruminous andsebaceous glands. Both the bony and the cartilaginous parts of the auditory canal provide anopen passageway for air to the tympanic membrane. The tympanic membrane is the medialboundary of the auditory canal and its lateralcomponent is formed by the epithelium of theskin lining the auditory canal. In mammals theauricle and the auditory canal are togetherregarded as a simple funnel that collects andcrudely filters sound. In humans, however, theauricle and auditory canal increase the acousticpressure at the tympanic membrane of soundsin the 1.5 kHz to 5 kHz range, which is the frequency range most important

Anjop J. Venker-van Haagen Ear, Nose, Throat, and Tracheobronchial Diseases in Dogs and Cats 3-87706-635-6_00I-050 18.04.2005 12:03 Uhr Seite III

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