Sinusitis Help

[kiwichick]

Help!
My 5yo cob came down with a severe ‘horse flu’ back in January, was rushed to equine hospital with a severe snotty discharge from his left nostrol. Was scoped, diagnosed as severe flu (which never made any sense - no other horses in the barn caught it, was the middle of summer, and he hadnt left the property in months) anyway given a hefty course of antibiotics, and rescoped 2 weeks later clear. Horse had a watery eye for some time, I had that checked also, no issues.
Fast forward to around 2 months ago, my horse sounded congested in breathing (exactly how Jan started) thought he was coming with a cold and heavily supported his immune system with all sorts of things, it didnt get better or worsen, so off to the big vet hospital.
Its probably important to mention, at no point was there any nasal discharge at all, nor any temperature. It was also the right nostrol this time.

Scope couldnt even fit up the nostrol as it was completely obstructed. Appeared to be a growth on the xrays, and he was left to have a hole drilled in and further camera diagnostics.
When they drilled the hole around 3-4ltrs of pus was removed. It was flushed daily for around 6 days from memory, was given antibiotics and had more xrays and a full dental exam. No cause could be identified and I was told it was truly a case of primary sinusitis and just bad luck. Bacteria was sent away and antibiotcs were effective on that.
Its around a month later now, last night during a bowen therapy session I thought his breathing didnt sound right again, it sounds a little rattly and in that same sinus. Bowen managed to get some fluid draining and it was clear.
It appears that there is some issue with this horses nasal drainage, or sinus. I did notice the eye was weeping again last night for the first time.

Im not asking for a way to get out of treating him at the vets, he will be going back to the vet. What I am after is anyone elses experience with sinusitis.
In my studies I cant find any other case of zero nasal discharge, which makes it extremely hard to know whats going on in there. Also very unusual for a horse so young to have issues.
Ive read constant drilling has a poor prognosis with the bones likely to eventually cave in.
Obviously the cost this year has been huge (its over 4k already this far) and I havent been able to do a thing with him all show season.
Any advice?

[csaper58]

The horses I have known with Sinusitis either had infected/broken teeth or guttural pouch infections.

Have you received a lab report with the name of the organism cultured from the pus?

Is it possible to take the horse to a specialist for a 2nd opinion?

[kiwichick]

hi csaper58
Yes the lab report was done and the strep was a common one found all around in the environment and was sensitive to the AB he was on.
He had several lots of xrays and a full dental exam, the exam found a slab fracture on a bottom jaw tooth, but nothing on the top (been referred to a specialist for that too, thats coming in a month)
The horse has been scoped a number of times now and no issues with gutteral pouch, the only real possibility was that its allergy based and thats causing inflammation which is causing infection.
My main fear is that we get back to there, where he has so much infection in there its shifted the line of the nasal bones, but still had not ruptured or purged into any nasal discharge.
im still totally at a loss as to why there was no discharge, and the opening of the sinus itself they found no cysts or any root cause. They literally found no cause, however if its coming back, there is very clearly an underlying cause.
He went to the specialists, there is no one better than there.

[csaper58]

@kiwichick

hi csaper58
Yes the lab report was done and the strep was a common one found all around in the environment and was sensitive to the AB he was on.
He had several lots of xrays and a full dental exam, the exam found a slab fracture on a bottom jaw tooth, but nothing on the top (been referred to a specialist for that too, thats coming in a month)
The horse has been scoped a number of times now and no issues with gutteral pouch, the only real possibility was that its allergy based and thats causing inflammation which is causing infection.
My main fear is that we get back to there, where he has so much infection in there its shifted the line of the nasal bones, but still had not ruptured or purged into any nasal discharge.
im still totally at a loss as to why there was no discharge, and the opening of the sinus itself they found no cysts or any root cause. They literally found no cause, however if its coming back, there is very clearly an underlying cause.
He went to the specialists, there is no one better than there.

Strep equi? strep py? There are many types of strep.

S. equi is the organism that causes strangles and can lie dormant in a horse until the horse undergoes some stressful event. It usually hides in the guttural pouches.

A slab fracture of a cheek tooth on a 5 yr old horse is unusual. To me, that sounds like an injury rather than chewing damage. I would want the dentist to sedate the horse use a speculum & light and thoroughly examine the entire mouth.

A weeping eye that is not injured or irritated may be a blocked tear duct or a sign of facial pain, or sinus pressure…

Is there anything the horse could be inhaling that could lodge in the sinus? Any scrap fiberglass, irritating plants?

Are there mice/rats in the barn?

[csaper58]

Here is a link with a chart that shows when a horse’s permanent teeth appear. You can see that the 4th premolar does not come in until the horse is 4 yrs. Retained baby caps cause the molar to be impacted and cause sinusitis. Your horse is the right age for that.

https://www.horsejournals.com/equine-dental-care chart is about half way down the page and titled ‘When Do Horses’ Teeth Erupt’

http://www.evds.net.au/articles/equi…and-physiology has a picture of a horse with sinusitis due to teeth, 3rd pic from the top.

[Halt_Near_X]

My experience with a poorly-draining sinus infection was not good, unfortunately.

I spent two years and had three different vet practices involved (including the university, at the end). We never found a cause–no teeth issues, no guttural pouch issues, no cyst, no nothing. She did drain some, but there was always more stuff flushed out of the sinus than you would have expected for the amount of drainage. What she did drain was runny, but what was in her sinus cavity was always thick and cottage cheese-y. [It’s been years, and I don’t remember exactly what they were calling the discharge or all the medical details, so pardon the extreme layman’s terminology.]

I never got an explanation. She just didn’t seem to drain right, or else the junk she was producing was so thick to start that it couldn’t drain. Ultimately I euthanized.

The very last thing we tried was a c-flap surgery and the vets enlarged the drainage holes in her sinus to try to encourage her to drain better in the future. This should have given her a few years’ relief, at least, but within weeks she had healed over. The vets had been fairly optimistic going into the surgery and said they had never seen a horse heal over as quickly as she did, so I think that’s an approach that had worked successfully for them before. Just not this time.

Since you have a known tooth issue, hopefully your experience ends better than mine. For what it’s worth, I lost track of the number of times I had vets say “I’ve never seen that before” or call in other vets/vet techs so they could get a look at what they were seeing. Even for a really challenging sinus case, my mare was apparently an outlier.

[FatCatFarm]

I’m currently going through a similar experience with a mini, kind of. This is an approx. 6yr old mini gelding who is just 29" tall. Started draining white mucous from one nostril. No cough; no fever; no change of appetite so I just watched it thinking it was a cold or seasonal allergy. But it persisted. Tried pennicillin then Tucoprim; then Exceed - all to no avail. Just had the vet out and did head x-rays looking for a dental issue but his teeth look great. I’ve just called Auburn’s Large Animal Hospital to see if they can to a Head CT on him. My vet, who says he’s recently seen this type of presentation several times, is not optimistic and thinks it’s a mass of some kind and the outcome for those is never good. He’s an adorable $100 mini and of course my favorite. We also did a culture but it came back as inconclusive because there are so many contaminants in the nasal cavity that it’s hard to get a good read. He just had a final injection of Exceed last Thursday and the draining is back and looking custardy. I’m worried.

Very sorry to hear about your horse. I hope you get to the bottom of it and get it resolved.

[kiwichick]

Thankyou everyone for the responses.
So my horse was treated at the university last time, and a very highly regarded vet the first time (with the apparent flu)
I spoke to another vet last night after attending my horse and I felt he has some filling in the face, and the eye was weeping again.
I gave him a background and he said it sounds unusual and my horse is going in on Tuesday for further diagnostics, and likely the outcome will be the bone flap surgery. This vet is a respiratory specialist.
Halt near x - your experience has me particularily interested as my gut feel is this is a drainage issue.
The horse had full head xrays which showed the accumulation as it turned out to be has altered the bones in his face, and yet still there was zero nasal discharge.
He also had further xrays and a full dental workup at the university where all they could find was a slab fracture on the bottom jaw, and they catagorically ruled this out as anything to do with the cause of the sinusitis.
If my horse has chronc sinusitis I can deal with that, ultimately I will do whats best for him and move on. The xray showed that the accumulation was starting to invade the other sinus, like a huge growth, he had no airflow through the left side at all, and soon would have had none on the right, ie it was going to kill him.
I cant find in all my searchings another case of sinusitis where there was no nasal discharge and I feel like this is the key element to this.
Again thanks for all the feedback, im hoping it ends well, but its looking like im on a hiding to nothing to be honest.

[kiwichick]

And in regards to the type of Strep, it escapes me now sorry, they did tell me. Im still waiting the vet report on it all for the insurance so far, so will chase that up today (again)

[kiwichick]

Sorry I should have read all the posts before replying.
In regards to the environment he is in, certainly like any horse if he is determined to get anything in there, he could.
He was initially in a barn and stabled at night, I was concerned that the stabling may be causing an allergic reaction (this was what the university said they would treat him for next as he has a cough warming up, always has)
Luckily I moved 100km away the week he had the hole drilled.
He has since been moved to a big pasture where he is out 100% of the time.
The only real difference between 2 weeks ago and now (2 weeks ago his nose had clear liquid in it sometimes, now its bone dry) is that the drill hole in his head has closed over completely.
He looks absolutely AMAZING, he is shiny and fat and happy, you wouldnt know he is sick.
He has been on loads of probiotics and herbs designed to support his immune system since he came home.
He was only on antibiotics for about 8 days when he came home, and only flushed for 6, I wonder if it was all done just a bit quickly (he got chucked out of hospital for becoming too difficult to handle)

[Halt_Near_X]

If you want more information about what I went through with my mare, feel free to PM questions to me. I’ll answer as best as I can remember the details!

[csaper58]

OP…no horse is perfect, if he is shiny, healthy and happy, and his runny nose does not affect his quality of life Perhaps the issue can be tolerated until it becomes troublesome to the horse?

[RedHorses]

Yours sounds rather more extreme, but I have one who has sinus drainage issues. In his case I find that exercise (of the fast canter type is best, but anything sweat inducing helps) seems to loosen it up, and if I can get his head down quickly after the ride we can get some pretty dramatic drainage. I take him in, untack and give him something in a feed tub on the ground. Some days it’s like turning on a tap. It’s usually just one side at a time, but occasionally both nostrils drain. At one time he only did it in the winter. Now he officially has Equine Asthma (COPD, heaves) and has it year round.

If he doesn’t get enough help draining, I can hear a catch in his breathing.

I give him Omega Alpha’s Respi Free as well. If I give 30-45cc to him before I ride the mucus is much thinner and comes out more easily. In the summer he gets 45cc every morning with his antihistamines in it.

The cause of the excess mucus seems to be allergies. It’s always white to translucent. I did ask the vet about it and was told not to worry unless either the colour or consistency changed, or the amount increased. I periodically ask the vet the same question and get the same answer.

I once said to a barn rat who saw it while she was eating her lunch “It looks like your yoghurt.” :lol: It is a bit thinner than yoghurt, but sufficiently close to elicit a grossed out reaction from the barn rat.

[kiwichick]

Interestingly the 2 different vets that have seen him thus far, have both said that if there is a reoccurance they will treat for (Allergies the first vet) and Asthma the university.
The vet I am going to today I am going to see if I can get an allergy treatment for him.
I managed to get the fluid out by doing large doses of MSM, and im back to clear drainage again, its pretty clearly a drainage issue. I did read a paper that said 25% of horses with this condition reinfect as the inflammation around the sinus drainage basically blocks it again, so ive calmed down a bit. That appears to be whats happening here, I can tell when there is pressure as the eye starts weeping again.

Will see what today brings

[kiwichick]

I will keep updating this for anyone interested.

I took him back to the vet yesterday, even though I felt that drainage had been restored to clear liquid, he still sounded ever so slightly rattly in there. We lunged him to see if that bought on any change in breathing, and actually pus started to come out his nose!

We did a scope, again not guttural pouch and clearly that sinus, xrays then showed complete blockage in the sinus of infection again. Its 5 weeks since he had the hole drilled and twice daily flushing.

He is booked in this afternoon for the C flap surgery to open up the sinus completely and try and find what is producing all this pus.

Prognosis is good if we can find a why and clear it, prognosis is poor if there literally is nothing to be found (bearing in mind the university did a full investigation and found nothing to cause it)

My horse is young and the medical treatments are taking a huge toll on his personality. We flatly couldn’t get him into the crush yesterday, even heavily sedated.

I am hoping for good news, but not really expecting it at this point.

[kiwichick]

The bacteria grown was:
Aerobic 1 Shewanella putrefaciens

[alterhorse]

Hoping for a positive outcome.
Intranasal foreign bodies are rare in horses, but that might explain the persistence of the infection.
A fungal granuloma of the paranasal sinus may be a posability.
The bacterial infection is sencodary in both scenarios.

[kiwichick]

So yesterday he had C Flap surgery and they made a large hole in the front. The pus poured out like a tap, the pictures are exactly like the one on google that I was sure must be photoshopped.
There was a very large sinus cyst sitting at the bottom of the cavity partially blocking the drainage (Yahoo I was right about the drainage)
the cyst was removed and needed to be placed into 2 specimen jars its so large.
They are going back in today to make sure they havent missed anything, and then post op care for a week or so in the hospital.
Im very lucky that the vet persisted in finding that cyst as it was difficult to see and ultimately he only felt it.

This should be the end of it once this has healed, and im very grateful something was found. So it was secondary sinusitis not primary as initially diagnosed.
My horse is a very lucky horse.

[alterhorse]

Glad to hear the good news.
Hope he recovers quickly and without complication.

[Peggy]

Sounds like good news at least. Good on you for being a persistent, proactive horse owner.