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Equine veterinary journal2026; doi: 10.1002/evj.70319

Associations between treatments and response to treatments from a large multicentre study of equine sinonasal disease.

Abstract: No large study has examined the treatment and response to treatment of horses with sinonasal disease confirmed by computed tomography (CT). Objective: To report the treatment and response to treatment of referred cases of equine sinonasal disease. To explore associations between case outcome and clinical and endoscopic features, CT findings, disease subtypes, and treatments in a multivariable model. Methods: Retrospective case series. Methods: Data were collected from medical records from 19 equine hospitals on cases of sinonasal disease, all of which underwent CT imaging. Case outcome was obtained from clinical records, and/or by contacting clients and referring veterinarians. Logistic regression analysis was used to examine associations between treatments and outcome and to identify associations between clinical and imaging variables and case outcome. Results: Sinoscopic debridement with maxillary septal bulla fenestration was performed in 615/1299 (47.3%, 95% CI 44.6-50.1) horses where information on this parameter was available. Nasofrontal and maxillary sinusotomies were performed in 324/1302 (24.9%, 95% CI 22.6-27.3) and 93/1299 (7.2%, 95% CI 5.8-8.7) horses, respectively. Sinoscopic lavage was performed in 711/1299 (54.7%, 95% CI 52.0-57.4) cases, usually following other procedures. Sinoscopic treatment was associated with a higher likelihood of cure, and nasofrontal sinusotomy with a lower likelihood of cure, but difficult cases may have had more sinus osteotomies. Primary, dental and mycotic sinusitis had the highest complete cure rate (all over 79%), while sinonasal neoplasia (7.3%) and PEH (40.4%) had the lowest cure rates. Oral extraction OR 2.43 (95% CI 1.67-3.54, p < 0.001) and sinoscopic treatment OR 1.68 (95% CI 1.19-2.36, p = 0.003), were associated with increased likelihood of cure while cases treated by nasofrontal osteotomy were less likely to achieve cure OR 0.62 (95% CI 0.42-0.89, p = 0.011). Variables retained in the final multivariable model of clinical and endoscopic features, CT findings, disease sub-types and treatments, as significantly associated with cure that included 750 cases were: Final diagnoses of: Progressive ethmoid haematomas (OR 0.17, 95% CI 0.08-0.37, p < 0.001), sinonasal tumours (OR 0.02, 95% CI 0.00-0.06, p < 0.001) or Dental sinusitis (OR 0.38, 95% CI 0.19-0.76, p = 0.006) all having lower likelihood of cure than primary sinusitis. Cases that had undergone oral extractions were significantly more likely to be cured than those that did not (OR 3.1, 95% CI 1.66-5.81, p < 0.001). Cases treated by nasofrontal osteotomy were less likely to achieve cure (OR 0.38, 95% CI 0.24-0.61, p = 0.001) than those treated by other methods. Cases with bone hyperostosis graded as 'moderate or severe' were less likely to be cured than those with 'none or mild' (OR 0.54, 95% CI 0.35-0.82, p = 0.004). Conclusions: Retrospective study with incomplete data for some cases. Conclusions: Oral extraction and sinoscopic treatments were associated with the highest likelihood of complete cure.
© 2026 EVJ Ltd.
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Publication Date: 2026-09-09 PubMed ID: 42713759DOI: 10.1002/evj.70319Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study examined treatments and associated outcomes in horses with sinonasal disease confirmed by CT from multiple equine hospitals.
  • The goal was to analyze which treatments and clinical features predict a higher chance of cure using statistical models.

Study Purpose and Design

  • To report treatment modalities and response rates among a large population of horses diagnosed with sinonasal disease via computed tomography (CT).
  • A retrospective case series design was used involving review of medical records from 19 equine referral centers.
  • Data included clinical exams, endoscopic findings, CT imaging results, surgical treatments, and follow-up case outcomes.
  • Statistical analysis employed logistic regression to find associations between treatment types, clinical features, disease subtypes, and the likelihood of cure.

Types of Treatments Examined

  • Sinoscopic debridement with maxillary septal bulla fenestration: Performed in about 47.3% of cases; involves minimally invasive removal of diseased tissue through a scope.
  • Nasofrontal sinusotomy: A surgical opening of the nasofrontal sinus, done in about 24.9% of cases.
  • Maxillary sinusotomy: Surgical opening of the maxillary sinus, conducted in 7.2% of cases.
  • Sinoscopic lavage: Irrigation of the sinuses using an endoscope, used in about 54.7% of cases and generally following other treatments.
  • Oral extraction: Removal of diseased teeth contributing to sinus disease.

Key Findings on Treatment Outcomes

  • Sinoscopic treatments (debridement and lavage) were associated with a higher likelihood of complete cure compared to other treatments.
  • Nasofrontal sinusotomy was associated with a lower likelihood of cure, potentially reflecting that this treatment was reserved for more difficult or severe cases.
  • Oral tooth extraction was strongly associated with improved outcomes, indicating the importance of addressing dental-related sinus disease.

Outcomes by Disease Subtype

  • Primary sinusitis, dental sinusitis, and mycotic sinusitis: All had high cure rates over 79%.
  • Sinonasal neoplasia (tumors) and progressive ethmoid hematomas (PEH): These had lower cure rates, 7.3% for neoplasia and 40.4% for PEH, suggesting poorer prognosis.

Multivariable Statistical Model Results

  • The final model incorporated clinical/endoscopic features, CT findings, disease subtypes, and treatments in 750 cases.
  • Significant predictors of lower cure likelihood included:
    • Progressive ethmoid hematomas (OR 0.17)
    • Sinonasal tumors (OR 0.02)
    • Dental sinusitis (OR 0.38) compared to primary sinusitis
    • Bone hyperostosis graded moderate or severe (OR 0.54)
    • Nasofrontal osteotomy treatment (OR 0.38)
  • Significant predictors of higher cure likelihood included oral extraction (OR 3.1).

Interpretation and Clinical Implications

  • The results highlight the complexity of treating equine sinonasal disease, with varied prognosis depending on the underlying cause.
  • Less invasive sinoscopic techniques and addressing dental causes improve chances of cure.
  • More invasive surgeries like nasofrontal sinusotomy might be markers of severe/complex disease rather than causing lower success directly.
  • Severe bone changes detectable on CT imaging predict a lower cure chance, indicating chronic or advanced disease.

Study Limitations

  • Retrospective design limits control over data completeness and uniformity.
  • Some cases had incomplete outcome data.
  • Potential bias as more severe cases may be selected for certain surgical interventions, influencing associations between treatment type and outcome.

Conclusions

  • Oral extraction and sinoscopic treatments were associated with the highest likelihood of complete cure in equine sinonasal disease.
  • Advanced diagnostics with CT combined with clinical assessment help guide optimal treatment choice and prognosis estimation.
  • Further prospective studies could strengthen evidence on the effectiveness of different treatments and their timing.

Cite This Article

APA
Dixon P, Barnett T, Parente E, Morgan R, O'Leary JM, Vlaminck L, Talbot A, Gillen A, McGinley T, Brennan M, Tremaine H, Pollaris E, Dobbs E, Anghileri B, Wright L, Olsson E, Olijnyk J, Alexandre C, Townsend N, Northwood A, Mair T, Shaw D, Reardon RJM. (2026). Associations between treatments and response to treatments from a large multicentre study of equine sinonasal disease. Equine Vet J. https://doi.org/10.1002/evj.70319

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Dixon, Padraic
  • Independent Veterinary Consultant, Edinburgh, UK.
Barnett, Tim
  • Rossdales Equine Hospital, Newmarket, UK.
Parente, Eric
  • New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA.
Morgan, Rhiannon
  • IVC/Evidensia, Bristol, UK.
O'Leary, John Mark
  • School of Veterinary Medicine, University College Dublin, Dublin, Ireland.
Vlaminck, Lieven
  • Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium.
Talbot, Alison
  • School of Veterinary Science, University of Liverpool, Liverpool, UK.
Gillen, Alexandra
  • School of Veterinary Science, University of Liverpool, Liverpool, UK.
McGinley, Tom
  • Liphook Equine Hospital, Hampshire, UK.
Brennan, Moses
  • Rainbow Equine Hospital, Yorkshire, UK.
Tremaine, Henry
  • B&W Equine Hospital, Gloucestershire, UK.
Pollaris, Elke
  • Morette Equine Clinic, Asse, Belgium.
Dobbs, Erica
  • Rood and Riddle Equine Hospital, Lexington, Kentucky, USA.
Anghileri, Ben
  • Oakham Veterinary Hospital, Leicestershire, UK.
Wright, Linda
  • IVC Evidensia, Helsingborg, Sweden.
Olsson, Elin
  • IVC Evidensia, Strömsholm, Sweden.
Olijnyk, Jonathan
  • Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Alexandre, Charles
  • Faculty of Veterinary Medicine, University of Liege, Liege, Belgium.
Townsend, Neil
  • Three Counties Equine Hospital, Worcestershire, UK.
Northwood, Adam
  • Royal Veterinary College, London, UK.
Mair, Tim
  • Bell Equine Veterinary Clinic, Mereworth, Kent, UK.
Shaw, Darren
  • The Roslin Institute, University of Edinburgh, Midlothian, UK.
Reardon, Richard J M
  • The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK.

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