Historical and clinical features of 200 cases of equine sinus disease.
Authors: Dixon P M, Parkin T D, Collins N, Hawkes C, Townsend N B, Fisher G, Ealey R, Barakzai S Z
Journal: The Veterinary record
Summary
# Editorial Summary: Equine Sinus Disease — A Retrospective Analysis of 200 Cases When presented with a horse exhibiting nasal discharge or facial swelling, understanding the underlying aetiology of sinus disease is critical for directing appropriate treatment; this retrospective review of 200 referred cases classified sinus disorders into eight categories—subacute primary (n=52), chronic primary (n=37), dental-related (n=40), sinus cysts (n=26), traumatic (n=13), mycotic (n=7), neoplastic (n=10), and intrasinus progressive ethmoid haematomas (n=7)—using statistical analysis to identify distinguishing clinical features. The most striking finding was the chronicity and treatment resistance encountered: the majority of cases presented as chronic disease, with 97% of chronic primary sinusitis cases having failed previous antibiotic therapy and/or sinus lavage, suggesting that initial management frequently proves inadequate. Clinical presentation varied meaningfully by category—purulent or mucopurulent nasal discharge characterised primary, dental and mycotic sinusitis, whilst haemorrhagic discharge indicated traumatic sinusitis or ethmoid haematomas, and firm facial swellings with airflow obstruction pointed towards cysts or neoplasms, with ipsilateral lymphadenitis being particularly prominent in actively infected cases. These findings provide practitioners with a practical diagnostic framework: the nature and laterality of nasal discharge, presence of facial swelling, and lymph node involvement can guide provisional diagnosis and inform whether sinus endoscopy, imaging and dental evaluation are warranted before pursuing empirical treatment protocols.
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Practical Takeaways
- •Sinus disease in referred horses is typically chronic and resistant to standard therapy; classification into eight distinct categories based on historical and clinical presentation should guide diagnostic approach and treatment planning
- •Nasal discharge character and location (unilateral), combined with presence or absence of facial swelling and lymphadenitis, provides clinically useful guidance for differentiating between infectious (primary/dental/mycotic) and non-infectious (traumatic/cyst/neoplasia) sinus disease
- •Failure to respond to antibiotics and sinus lavage in chronic cases warrants investigation for dental disease, cysts, neoplasia, or fungal infection rather than continued medical management alone
Key Findings
- •Eight distinct categories of equine sinus disease were identified, with chronic primary sinusitis (n=37) and dental-related sinusitis (n=40) being prominent causes among 200 referred cases
- •97% of chronic primary sinusitis cases failed to respond to previous antibiotic therapy and/or sinus lavage, indicating treatment-resistant disease at referral
- •Purulent or mucopurulent discharge was characteristic of primary, dental, and mycotic sinusitis; haemorrhagic discharge distinguished traumatic sinusitis and ethmoid haematomas; firm facial swellings and airway obstruction distinguished sinus cysts and neoplasms
- •Ipsilateral lymphadenitis was a prominent clinical feature in actively infected sinus disease (primary, dental, and mycotic sinusitis) but not in non-infectious conditions