Ask The Vet: Upper Airway Concerns

Answered by, Elizabeth Weber, DVM, Ocala, FL
Courtesy of AAEP

Question: I am concerned that my 12-year-old horse may have a sinus infection. I have been administering him penicillin for the last five days. At first, he had drainage from one side of the nose that ran clear and then both sides began running like water. He would not eat or drink. Then it became green discharge from both sides, which eventually cleared, but now it is white and yellow. He is eating a little hay and feed, but he seems to have a problem chewing. I don’t know if it’s sinus or tooth related and unfortunately, I cannot afford a veterinarian bill. 

Answer: Sounds like your horse is having a little bit of a rough start to the new year.

Dental issues in horses can certainly cause some of the symptoms that you describe. Fractured or infected teeth can cause poor appetite, difficulty chewing, and/or sinusitis (infected sinus) that would result in nasal discharge. They could also cause excessive salivation or bloody discharge from the mouth. However, the nasal discharge in these cases is more commonly only from one side, unless there are multiple teeth on both sides of the mouth that are affected. The best way to begin investigating for dental issues would be a thorough oral examination by your veterinarian using an oral speculum, which would allow the veterinarian to see the entirety of the mouth. If any broken or infected teeth were identified, they would need to be removed.

Sinusitis, or a sinus infection, can occur secondarily to dental issues as discussed above, or be primary as a result of an upper respiratory infection. Again, the nasal discharge in these cases is typically only from one side of the nose, and swelling or deformity of the horse’s face on the affected side may be seen as well. Endoscopic examination of the respiratory tract and percussion of the sinuses (tapping them to listen to the sound produced over each sinus – they should be filled with air!) are some of the primary ways that a veterinarian could begin to determine if your horse has a sinusitis. If this were the case, culture of the sinuses to determine an appropriate antibiotic therapy and flushing of the sinus would be the treatment.

A bacterial upper respiratory infection, particularly one involving the guttural pouches, can also cause the symptoms that you describe, and is more likely to cause discharge from both nostrils rather than just one. It could also cause depression, poor appetite, and/or fever, depending on the case.  Endoscopy of the upper airway, including the guttural pouches, would be the best way to diagnose this. If this is the case, culture to determine the infecting bacterium and the best antibiotic choice would be the next step. However, if there is infection in the guttural pouches, it often needs to be addressed directly with flushing and/or instilling penicillin gel directly into the pouches. Some causes of guttural pouch infection, such as streptococcus equi equi (commonly known as strangles), can be very contagious between horses, so it is important to try to avoid contact between your horse and other horses (both directly and indirectly, such as on your hands, clothes, or buckets) until a diagnosis is made.

Although I understand that you were trying to help your horse feel better, it is generally a good rule of thumb to not administer antibiotics to your horse without consulting with your veterinarian first. It is important to make sure that the condition you are treating is one that actually requires antibiotics (generally speaking, a bacterial infection), and if so, that an appropriate antibiotic is used for a full course of treatment so that the condition resolves completely. Using antibiotics unnecessarily or for incomplete courses of treatment can not only mean your horse doesn’t get better, but can contribute to the problem of antibiotic resistance, leading to more difficult to treat infections down the road.

You mentioned being unable to afford a veterinary bill at the moment. As a horse owner myself, I can certainly sympathize with that! Unfortunately, there are several things that could cause the symptoms you describe, and some degree of diagnostics (beginning with a thorough physical exam) will be required to determine what the cause is, and therefore what course of treatment is best. Sometimes, attempting a variety of treatments without first doing the diagnostics to determine the root cause of the problem can end up costing you more money at the end of the day if the treatments do not work. If you are unable to pay with cash or check, many veterinarians accept credit cards these days. If a standard credit card is not an option, CareCredit and Scratchpay both allow you to apply for payment plans specifically for veterinary expenses and may be better for your situation. Another option would be to ask a friend or family member for a loan.

Best of luck with your horse and I hope that you and your veterinarian are able to get him feeling better soon!