Horse with chronic sinusitis - help!

[Sarah_R]

My horse previously had a bad tooth, which was extracted in May 2024. An additional tooth had to be taken out to get to the tooth needing removal. Prior to that he had a very thick, foul smelling odor from his right nostril. Antibiotics cleared it up twice but when they didn’t work anymore, the tooth was taken out.

Things were fine for several months - until around October. Tonka again developed nasal discharge out of the same nostril, but it was not the same foul smell and was on and off. Vet was called and he went back on SMZ’s, which cleared it up but then it came back. X-rays were taken but this time, the vet did not think it was tooth related. He went in for a sinus lavage, but when he got there, the vet did not think that was warranted. (took more x-rays). So, he went back home. It came up again. The vet switched his antibiotic to doxycycline for one month. Cleared up, but after a while of being off the antibiotic, it came back. Another vet in the practice looked at him and felt it was sinus related, but not tooth related. I scheduled another sinur lavage which he had this past Monday. He stayed until Thursday and had four sinus flushes. Vet said there was still some there and did a Cushings test which was in the high normal range so he is now on a low dose of Prascend. There is a very real possibility that he developed ulcerss while at the vet as well - because he usually loves his grain mixture but was not finishing that at the vet, but was eating the hay. He is not normally stalled and does not like it. So, he also came home with omeprazole. He got an Excede shot while at the vet, and gets another one on Sunday. But even when I picke dhim up, there was the thick nasal discharge in his nose. It does not seem to be any better at all. His face is swollen, which they did not feel concerned about. The first night he was home, he again, did not finish his grain mixture. But did eat hay. I’ve now cut the amount of his grain down tremendously, and am giving him just 2 cups of senior, along with 1.25 cups of Outlast, a pelleted vitamin supplement and some soaked timothy/alfalfa pellets. He is eating it. I’ve put his hay in a slow feeder hay net, and added straight alfalfa to his mix of Orchard/Alfalfa and Coastal…so he has a blend of hay. Of course, he loves the alfalfa and I know that is good for him stomach. But the nasal thing is lingering. It does now have a smell, but not as strong as when he had the bad tooth. I do not want to take him back to the vet, because he obviously did not do well there. I am not sure what the next step is or if I just wait another couple of weeks and see if it gets better with him being on Prascend and the second dose of Excede. But something is telling me it won’t. Does anybody have an experience with this? I’ve never dealt with this before.

[Simkie]

Has anyone run a culture and sensitivity through any of this, to target an appropriate antibiotic?

Has he been scoped with the flushing to see if there’s something unexpected in there?

Is he still on the omeprazole? Did you see any improvement with that? If not, he might have an ulcer type that needs a different type of medication. Scoping the stomach could be worthwhile.

[Sarah_R]

He just started the omeprazole and has shown improvement on that. He’s only had 2 does.

No, a sensitivity test or culture was not performed. Not sure why they didn’t do that before jumping to another antibiotic or assuming it is Cushings. I do not want to haul him to the vet and make the ulcers worse now if possible. I do not thinak they scoped his nasal passage either.

[Simkie]

Great that the omeprazole is helping, keep going with that.

I would absolutely press for a culture & sensitivity, which can be done at your farm. It’s just collecting snot in a “clean” way.

Scoping can also be done in the barn, depending on temp (tough below freezing.) If your vet doesn’t scope in the field, starting with the c/s is reasonable, but if a targeted antibiotic still doesn’t kick it, I’d personally prioritize a look see.

[Sarah_R]

Thank you. I’m going to see if this second dose of Excede improves things and if not, ask for that to be done. I don’t think they scope in the field but will ask. Thank you for your guidance.

[Simkie]

Good luck! I hope the Excede surprises you and winds up working after all

[JB]

Did I miss how long he was on SMZs?

My vet likes to treat most sinus issues with a solid 60 days of SMZs, as she sees too many of them “come back” (ie they were never really gone, just “gone”) on the typical duration.

[4horses]

My horse in college had blood tinted nasal discharge. First thing they did was scope her to see what was going on.

I would want an equine dentist to check his teeth in case this is a tooth issue. Not an equine vet, an equine dentist.

I would probably scope 1st, get a culture 2nd, and have an equine dentist look 3rd. As I think the answer will show up somewhere in there.

My mare was diagnosed with sinusitis and fortunately it cleared up with SMZ tmp.

[cayuse]

I have dealt with this in a mini. He had a complicated sinus issue from a bad tooth and when that tooth was removed, it fractured and the root was left complicating things even more. He ended up having to have surgery to open up his sinus and remove a hardened “ball” of old pus and then about 1 week of lavage and 6 weeks of antibiotics, both oral and IM. The vet said if there is repeated infections, this ball of pus can form and it is very difficult to treat with antibiotics and that’s when the infection turns chronic. You may have to have some imaging done to see exactly what’s going on with the sinus, my mini had an MRI (or ct scan, I forget) and his care plan went from there.
Also get a culture if you can. My mini did not get cultured at first and his infection was resistant to the SMZ’s.

[Sarah_R]

For the tooth, he was on SMZs for quite a while not sure they just said to keep him on them until he could get an appointment so I guess it was over a month or maybe 2 including the post extraction that time. But then 5 months later this starts up again. He went on them again for 2 weeks, seemed like it had cleared but then it came back. The next time, they switched to doxycycline for 30 days - maybe more - I had a cannister and they said to give it until gone. But once again, it came back. At least with the SMZ’s and the doxy, it did clear up while in treatment. This Excede doesn’t seem like its doing anything, and his face is still swollen 3 days after the last flushing - so not sure how long that should take.

[Sarah_R]

OMG!!! I just talked to a vet to get clarification and ask about the scoping. They said they have to do a sinus “flap”, which requires breaking a bone in his face and cutting him and he would have staples in his face to do that. I asked about the culture and sensitivity test and they said in order to get a non contaminated sample, it would require the same thing. They can swab the nasal passageway, but it would be a contaminated sample and could skew the results. I am literally crying right now. I don’t know how far to go with Tonka. He is 24 years old. Ulcers. Cushings. And now this sinus thing. Excede does not appear to be doing a thing.

[Simkie]

I would really seek an additional opinion.

A culture & sensitivity on the drainage is better than NO culture & sensitivity.

A simple scope of the upper airway and gutteral pouches may provide some additional info and does not require a bone window.

What they’re suggesting might be the BEST, gold standard, way to look further, but less invasive methods are not worthless. Info gained might not be as complete, but can still aid in guiding treatment decisions.

Especially with an older horse, there’s certainly a balancing act between going all out on medical intervention & his quality of life (and your $$$!) Not going all out doesn’t mean “less” measures aren’t worthwhile to consider.

Best of luck, and I’m sorry your vet didn’t lay out an entire SPECTRUM of ways to proceed. That’s always what I expect.

[anonevent]

Along with all of the other advice, I wanted to mention a treatment I heard about yesterday on the Horses In The Morning podcast. If you’re anywhere near Foxhall Equine in Maryland, they have a salt room that might be worth trying. I believe they mentioned another farm with one, but I don’t recall that facility’s name off hand. The owner describes it on the podcast at about 25 minutes into the Feb 22 episode.

Salt Room Therapy | Equine Respiratory Therapy | Halotherapy

[Sarah_R]

I did call back. They want me to continue the second dose of Excede (will be given today). Then, the nasal swab will be taken on Tuesday. I’ll drive it up there if I have to as the vet will be doing rounds all day long. There is a 5 day wash out period to switch antibiotics, but they say the culture will take a week anyway, so by that time, I should hear if they were able to grow anything. I’m going to ask about giving a longer course of whatever antibiotic it should be. The equine dentist is also supposed to be looking at his latest xray. I hope to know what he has to say on Tuesday. I am suspicious that this is linked to the tooth removal. Maybe part of the tooth was left in there? Just seems coincidental that it is the same side that he was having a problem with before. they had mentioned when the tooth was removed that they may need to flush his sinus then, but decided that was not needed. I have pictures of the teeth taken out but can’t seem to attach them here.

[cayuse]

This is what they told me also, but in hindsight they wish they had tried with the C&S done nasally. If my mini had been on the correct antibiotic we may have avoided a second bone flap surgery and complications. I advocated for the change and got shot down. I wish I had advocated harder.
.
For your horse I would get a second opinion. Probably from someone who is familiar with doing sinus surgeries and has done many of them, as they have the most experience. This issue may be above what your vet can deal with.

[cayuse]

We posted at the same time. Glad to hear about the culture.

[Sarah_R]

That surgery sounds very invasive. Tonka is 24 and already developed ulcers just from being there 3 days for the flushes. How complicated was it for you and your mini to recover from? The sound of it just makes my heart hurt. Oh, went back and re-read your post. Ugh. That could very well be what is going on with Tonka.

[cayuse]

I’ll be honest, it was difficult for him as he’s a mini and their teeth/sinus are really hard to get too because of their size. I think in a big horse the surgery would be easier. My mini also developed ulcers and we kept him on ulcer meds throughout the ordeal. I’m going to say it took a couple of months before he seemed back to himself 100%. He was in the hospital about 4 days the first time and a week the second.
If you are in New England I can let you know who I used as vets.

[Simkie]

That’s great that they agreed to run the c/s. I really hope it provides some clarity!

Has he had any radiographs of his head? I apologize if I missed it if you’ve mentioned. That would be another non invasive way to potentially get some info. Both about his teeth, or any other oddities. I have a friend with a horse who had a sinus tumor diagnosed via radiograph. Iirc, the only symptom was recurring nasal discharge.

[4horses]

I would really really want an expert at equine dentistry to look at this horse. Not just x rays but have them examine and probe all his teeth.

My old mare had horrible teeth and I think with any old horse, that would be at the very top of the list for causing sinusitis. My old mare had multiple “worn out, fractured, missing or ready to fall out” teeth by the end of her life. We did remove the fractured tooth and I swore I would never put her through that again as she didn’t eat for a week afterwards.

Fortunately she was okay after that, but if she had needed any more drastic interventions I would have chosen euthanasia. She had multiple issues (lameness, arthritis, cushings). I did no more dentals after that as even a floating would put her off her feed for a couple days. The vet said she probably had arthritis in her jaw.