Frontal Sinus Trephination and Instillation of Pluronic Antibiotic Gel for Pseudomonas Chronic rhinosinusitis.
At Cat Specialist Services we are trialling a novel treatment for cats suffering from Pseudomonas infection in their nasal cavity and sinus cavity.
What is Pseudomonas?
- Pseudomonas is a type of bacteria that can be a normal part of the bacteria in a cat's nose. However in cats that have had previous cat flu infections or with other underlying disease causing damage to the delicate structures in the nose, Pseudmonas can take hold and cause significant infections that get deep into the bones of the nose and sinuses. Over years they can cause a lot of damage to normal bone and tissue. As a bacteria, they are also very effective at becoming resistant to standard antibiotics.
How is Pseudomonas Chronic rhinosinusitis in cats usually treated?
- This is an extremely challenging condition to treat and it is important to note that cats will very rarely be cured of the condition as often the changes to the nasal tissues are permanent and recurrence is common. Many treatments are often tried including a variety of antibiotics and anti-inflammatories. Nebulisation can be helpful to break up nasal discharge. Nasal flushing (under anaesthesia) or eye drops can sometimes help alleviate symptoms however symptoms inevitably return.
How can you tell if the infection is in the sinus?
- In many cats with Pseudomonas infection, the infection gets in the sinuses. These are air filled spaces in the skull behind the eyes and nose. It is very difficult to clear these infections once they are established in that location as normal antibiotics will not penetrate easily into the tissue.
- We identify the involvement of the sinuses on a CT scan and this helps to direct which side (they are on the left and right sides) require treatment.
What is trephination?
Trephination is the technique where we place a small hole through the bone into the sinus. We then flush any material out (there is often pus like material) and help improve the drainage from the sinus into the nasal cavity. We will frequently send off samples to the laboratory to confirm the type of infection and which antibiotic the infection is sensitive to.
What is the gel?
The pluronic gel is specially engineered to be liquid when cold and when it warms to body temperature it solidfies into a thick paste. It is a carrier for an antibiotic (typically gentamicin) which is effective at killing Pseudomonas. By instilling the antibiotic into the sinus in this way we are hoping that we will be able to destroy more of the Pseudomonas than by giving antibiotic by tablets alone, particularly as the Pseudomonas may be resistant to many of those types of antibiotic.
Are there any risks?
We have treated a number of cats using this technique now and we have not had any significant complications, however potential risks could include trauma to the eye if there is leakage of material to the space behind the eye (retro-orbit) or possible adverse reactions to the antibiotic itself.
Is this procedure painful?
- Yes it is possible that this procedure would cause some discomfort, however it is likely that your cat already has a significant headache from their sinus infection! We will always give your cat pain relief and most cats that have this procedure performed will stay overnight so that we can give them some strong pain killers. They generally go home the following day with pain medications for the next few days.
- Most cats don't show any signs of discomfort and are eating well within a few hours of the procedure.
Does it work?
- We have had good success with the treatments so far, however it is important to note that we are not aiming to cure your cat (although with mild symptoms this could be possible). Our aim is to get the longest time possible in between treatments where your cat is comfortable and their symptoms are mild.
- Currently cats seem to require this treatment every 6-12 months.
How can I get this treatment for my cat?
- You would need to organise an appointment with our feline veterinarians. They will assess your cat and discuss the options with you.