Mycotic rhinitis is complex and frustrating to treat, especially in animals with invasive disease, such as soft tissue involvement or extension into the orbit and supporting bones of the nose. Surgery alone appears to be unhelpful; systemic antifungal drugs have a limited success rate (70%) and can be toxic. Topical instillation treatments have higher success rates (85% to 90%) but not all patients respond well. Of the three dogs described in this report, one (a guide dog) did not respond to several drug therapies; one dog was refractory to drug treatment and showed progressive signs of disease; and one dog had advanced invasive disease at presentation. Via a dorsal approach, the author surgically exposed the nasal and/or frontal sinus and performed partial turbinectomy, clearing all abnormal soft tissue in all three cases. The wound dressing, a proprietary product that produces sustained release of povidone-iodine, was applied and retained with a "tie-over." The dressing was replaced every 48 to 72 hours under general anesthesia until all exposed areas were covered with healthy granulation tissue, at which time the rhinotomy was closed by soft tissue reconstruction. No evidence of fungal infection was present at follow-up for 20 months after surgery.
COMMENTARY: Just as one swallow does not make a summer, three cases do not necessarily make a series; but the success of this radical therapy in three refractory cases of mycotic rhinitis bodes well for the future. The ingenuity of the author in developing a method that allows prolonged exposure of povidone-iodine dressings to infected tissue should be appreciated by all who try to manage this frustrating disease.
Use of topical povidone-iodine dressings in the management of mycotic rhinitis in three dogs. Moore HA. J SMALL ANIM PRACT 44:326-329, 2003.