Reverse sneezing can be sign of nasal problem

Q I have a 12-year-old Papillon who occasionally will have what I am told is reverse sneezing. I understand that this condition is not supposed to be serious, but it seems when it happens, it wears him out. Can you tell me what causes this and any way to treat it? He is already on Benadryl twice a day for allergies.

A: As you may have noted, dogs and cats do not blow their noses. If something is in or irritating their nasal passages, they might sneeze as we do to force it out of their nostrils or they might do what your dog is doing.

A reverse sneeze is where they forcefully inhale inward through their nostrils. It may occur one time or multiple times. It looks terrible to us as the observer, but is not a life-threatening event.

The key to differentiating this from a true life-threatening breathing problem is to watch their mouths. If they are having trouble getting enough oxygen, they will open their mouths to breath, especially when inhaling.

With a reverse sneeze, the mouth is closed and they inhale through their nostrils. This results in a jet of air moving through the nasal passages and hopefully clearing out the problem.

Some pets will have reverse sneezing where no underlying problem can be identified. However, it also can be the first symptom of underlying nasal disease. Dogs and cats can get nasal problems just like people do. For humans, the problem is usually associated with an allergic reaction to something. This is because the inflammatory cells that cause allergies are concentrated in our noses.

This is not the case for pets. It is rare that dogs and cats manifest allergies as nasal disease. Instead, the inflammatory cells that cause allergies are more concentrated in their skin. So instead of having sneezing and runny eyes, they have itchy skin. Even substances they inhale such as pollen will cause itching more often than sneezing.

Irritants

So what can make our pets sneeze and sometimes reverse sneeze? Environmental irritants are one cause. These do not result in an allergic reaction but rather irritate the nasal passages, directly resulting in inflammation.

Cigarette smoke is a common culprit. Household cleaners and air fresheners might result in irritation as well. The obvious treatment is to remove the irritant or remove the pet form the irritant.

Nasal tumors, unfortunately, are another major concern in pets. The nasal passages consist of many different tissues, and tumors can arise from any of them. They may start in the nasal passages or sinuses. They might just obstruct the airway or they might produce excessive mucus that will result in sneezing and snorting. Some tumors may erode blood vessels, causing a nose bleed.

The frustrating thing in pets is that they are so good at masking symptoms from us that by the time we recognize there is a problem, the tumors have been growing for months.

The location of these tumors makes surgical removal difficult. This leaves radiation therapy and chemotherapy. Surprisingly, some pets can do well for extended periods with treatment. Fortunately, these tumors are usually slow to spread.

Unidentified objects

Foreign bodies are another possible cause for reverse sneezing. These objects may be inhaled through the nostrils or, more commonly, snorted from the back of the throat up over the soft palate and into the back of the nasal passages.

We have removed a 5-inch piece of corn stalk from the nose of a Labrador that was hunting with his owner in a field of cut corn.

Pieces of toys, food or plants often are snorted up over the soft palate. Grass is a common foreign body problem for cats. They love to chew on it. Several times a year, a cat will present for sneezing, choking and excessive swallowing. The blade of grass has usually gotten wedged up over the soft palate. The serrations on the edge of the grass allow it to move in only one direction. Every time they sneeze and snort, the grass gets stuck further.

Other causes

Dogs and cats may have fungal organisms growing in their nasal passages and sinuses. These result in inflammation and mucus production and can erode bone.

They can even result in neurologic problems if they grow into the brain. In our area, it is rare, but there are nasal parasites that infect pets.

Tooth root abscesses also may result in nasal symptoms. Their tooth roots are deep and the bone that separates the nasal passage from the root is thin. In some cases, the abscess will drain into the nose and not the mouth.

Cats can get viral upper respiratory infections just like humans, but not the same virus, so it's not contagious to us.

Treatment

Diagnosing what the problem is can be difficult. The nose is a complicated organ in dogs and cats with hundreds of folds of tissue called turbinates. This makes it difficult to visualize every part. Radiographs might reveal changes if the problem invades bone and might help isolate one region of the nose, but overall they are usually not definitive.

A CT scan allows for visualization of the sinuses and nasal passages. The CT images allow us to peek into all of these nooks and crannies.

A rhinoscope, a thin tube with a camera on the end, allows us to look directly. It cannot go into every area, so is best combined with the CT scan. If we see a blade of grass, we can remove it, and if we see a tumor, get a biopsy.

Even if nothing specific is observed, we always get biopsies, as sometimes looking for microscopic changes is the only way to get the answer.

Last week, a 14-year-old Shi Tzu was brought in for reverse sneezing. I warned the parents that in a dog this age a tumor is always a concern. They were convinced it was an acorn, as she constantly eats them. The CT scan revealed only excessive mucus.

At first, I could not see anything but the mucus on the rhinoscopy. As I cleared all of this discharge, I discovered an acorn that had been bitten in half. The irregular edges were preventing her reverse sneezing from moving it.

As you can see, there are a lot of causes for reverse sneezing. Only by knowing the cause can we know how to treat the patient.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Got a question? Email it, along with a photo of your pet, to petdocs@postandcourier.com.