Reverse sneezing in dogs

Overview

Reverse sneezing is a reflex, an involuntary reaction triggered by irritation, rather than the name of a specific disease. The nasopharynx lies behind the nasal cavity, above the hard and soft palate.

In a normal sneeze, air flows out through the nose; in reverse sneezing, it flows inwards. Coughing involves rapid, forceful expulsion of air from the lungs.

A snorting episode can look like respiratory distress even when it is a reflex that settles on its own. With a typical brief episode, the dog is normal both before and afterwards.

The phenomenon is also called paroxysmal respiration, meaning breathing that occurs in episodes.

Causes

Irritation and possible underlying disease

Dust, allergens or other upper airway irritants can trigger the reflex. Strong excitement, including becoming worked up during an everyday situation, can also trigger an episode.

Eating or drinking very quickly may be associated with the onset of an episode. Plant material entering the nose or nasopharynx can cause repeated irritation.

A viral, bacterial or fungal respiratory infection may also underlie the signs. Nasal mites are a possible cause, but other nasopharyngeal problems can produce the same symptom.

Digestive problems involving vomiting may also be associated with reverse sneezing. An overlong soft palate can irritate the nasopharynx in brachycephalic airway syndrome.

Other possible causes include nasopharyngeal tumours or other tissue masses. In some dogs, investigations find no explanation, and the condition is called idiopathic.

Lower airway disease may also be associated with reverse sneezing, even though the snorting originates in the nasopharynx. Nasal mites live in a dog's nasal passages and sinuses, where they can irritate the lining.

What has been found in studied patients?

A study published in 2022 investigated reverse sneezing in a group of 30 dogs. Inflammatory airway disease was found in 57%.

A structural or functional airway disorder was found in 27% of these dogs. A foreign body in the nose or nasopharynx was found in 10%.

No diagnosis was reached in 7%, or two dogs. These figures describe the patients included in the study, rather than the likely diagnosis for every dog that snorts at home.

Risk factors

Reverse sneezing can occur at any age, so it is not limited to puppies or older dogs. Both males and females can be affected, whether neutered or not.

It occurs in all breeds, but is described more often in dogs weighing under 15 kilograms than in larger dogs. Short-skulled breeds, such as Pugs and Bulldogs, are more prone to episodes.

In the 30-dog study, dogs under five kilograms accounted for 50% of patients. Those weighing 5–15 kilograms accounted for 27%, while dogs weighing 15–30 kilograms made up 17%.

Dogs over 30 kilograms accounted for 7% of those studied.

Typical symptoms

An episode begins as a sudden series of repeated inhalations with a loud snorting or grunting sound.

• Your dog stands still during the episode.

• The neck stretches out and the head may tilt backwards.

• The elbows may point outwards while the dog stands.

• The nostrils widen as your dog noisily draws air through the nose.

• The mouth generally stays closed and the lips may draw back.

An episode usually lasts seconds to about a minute, but snorting can sometimes continue for several minutes. Intervals vary, and not every dog has episodes equally often.

In the 2022 study, 60% of patients had shown symptoms for more than three months. In the same group, 60% had episodes more than once a week.

Nasal mite infestation may also cause an itchy nose and repeated head shaking. A reduced sense of smell may affect a tracking dog's work when nasal mites are responsible.

Nasal mites alone do not usually affect a dog's general condition, so a feverish or listless dog should not be assumed to have an ordinary parasite problem.

Complications and consequences

The outlook depends on the cause

Occasional reverse sneezing in an otherwise healthy dog very rarely causes actual complications. Most affected dogs have a good outlook, even if the sound is frightening.

However, progressively worsening breathing may be caused by a disease or foreign body narrowing the airway. Severe narrowing can lead to respiratory failure, which is different from a brief snorting episode.

Even nasal mite treatment does not always remove every observed sign if another upper airway condition is present at the same time.

Diagnosis at the vet

Identifying the episode and other signs

The vet combines your account of the symptom history with examination findings. The assessment distinguishes reverse sneezing from similar respiratory sounds, such as signs associated with tracheal collapse.

A dry, goose-honking cough is consistent with tracheal collapse or kennel cough, for example. Nasal tumours, polyps and foreign bodies in the mouth or nasal passages are other causes to distinguish.

In the 2022 patient study, 63% of dogs had another respiratory sign alongside reverse sneezing. Nevertheless, 63% of dogs in that study had a normal routine clinical examination.

Further tests for persistent signs

Allergy investigations may be considered if the pattern of signs or other findings suggests an allergic cause. If symptoms persist, a thorough examination of the mouth and throat can be performed under sedation.

Head X-rays or nasal endoscopy may be used to look for a foreign body or tissue mass. CT shows the nasal cavity and sinuses in detail if signs suggest disease in these structures.

If both imaging and nasal biopsies are needed, imaging is usually performed first. Nasal endoscopy can also examine the nasopharynx by turning a flexible scope behind the soft palate.

Nasal mite infestation can be confirmed if mites are seen during endoscopy or in a nasal wash sample. The sound alone cannot confirm nasal mites, which often need to be seen directly for diagnosis.

If there is a nosebleed, the vet may also test blood clotting and platelet numbers. Investigation of persistent nasal signs may include checking the teeth and looking for a fistula, an abnormal connection between the mouth and nasal cavity.

Nasal flushing to look for mites is usually performed under general anaesthesia while protecting the airway.

Nasal discharge may range from watery to pus-like or bloody, depending on tissue damage and inflammation. If another condition is suspected, a blood count, blood biochemistry and, when needed, a urine sample help assess the overall situation.

Pus-like discharge often contains inflammatory cells, while bloody discharge indicates bleeding into the nasal cavity.

Treatment

During a brief episode

An occasional mild episode does not usually need medication or other specific treatment. Staying calm and gently reassuring your dog during it may help.

You can try gentle stroking of the neck or head if a familiar brief episode makes your dog anxious. A typical episode ends on its own, after which normal breathing returns without intervention.

Treating an identified underlying cause

For repeated or severe episodes, the vet prescribes treatment according to the suspected or confirmed cause found during investigation. If signs are allergy-related, the vet may consider medication to relieve allergic symptoms.

Suspected nasal mites may be treated with a vet-chosen antiparasitic medicine on the basis of strong clinical suspicion. A good response has been described in more than 85% of cases, but that figure concerns treatment of the parasite infestation.

The vet may prescribe an anti-inflammatory medicine for symptom control in some dogs. Surgery to shorten an overlong soft palate may help a dog that also has genuine breathing difficulty.

Parasite treatment results do not apply to every episode

A Swedish study published in 2009 treated 48 dogs whose signs were consistent with nasal mites. Infestation had not been confirmed in any dog; inclusion was based on compatible symptoms.

At the end of follow-up, eight weeks after the start, 35 dogs were symptom-free. This represented 73% of dogs treated on the basis of symptoms.

Thirteen dogs still had symptoms, although some had improved from the start. Results relied on owners' observations, so the study does not establish that every treated dog actually had nasal mites.

Prevention

Not every episode can be prevented by removing an identified irritant, because the cause often remains unclear. Reducing tobacco smoke and strong smells is sensible for a dog whose episodes are associated with these triggers.

Reduce pulling pressure on the neck if episodes begin when your dog pulls on the lead. Reducing dust exposure can remove one source of nasopharyngeal irritation from everyday life.

Direct or indirect contact with another dog is a possible route of nasal mite transmission. In areas where nasal mites occur, local dogs can also be affected, rather than only imported dogs.

Sharing retrieving objects may increase the possibility of nasal mite spread during dog activities.

Important for dog owners

Observations for the next examination

Record when snorting begins, what your dog was doing immediately beforehand and how long the episode lasts. Also note whether your dog returns to normal and whether coughing or nasal discharge occurs. This makes changes easier to recognise than relying on memory.

Keep the length of an individual episode separate from how often episodes happen. A symptom diary can record both the days with snorting and the number of episodes noticed that day. Bring the record to the appointment.

Frequent or severe signs need veterinary assessment even if each individual episode passes.

Pus-like nasal discharge alongside snorting is a reason for investigation.

There is no evidence that canine nasal mites infect people.

Frequently asked questions

Is reverse sneezing dangerous?

An occasional episode is usually harmless if your dog is otherwise normal before it and immediately afterwards. However, bluish or grey mucous membranes and laboured breathing are signs of respiratory distress requiring emergency help.

Does snorting always mean nasal mites?

Nasal mites can cause snorting, but a foreign body or other nasopharyngeal irritation can trigger a similar episode. Infestation can be confirmed by finding a mite during endoscopy or nasal flushing, so the sound alone does not identify the cause.

How can I stop a reverse sneezing episode?

A typical mild episode usually stops on its own, and normal breathing resumes without medication. You can reassure your dog and gently stroke the neck or head if they accept touch. A dog with severe or repeated episodes needs veterinary assessment.

How does reverse sneezing differ from coughing?

During reverse sneezing, a dog draws air rapidly and repeatedly in through the nose, producing a snorting or grunting sound. A cough expels air in a short, forceful burst from the lungs, distinguishing it from snorting during inhalation.

Does my dog need nasal endoscopy?

Persistent or recurrent signs may be investigated with a mouth examination under sedation, imaging and, when necessary, nasal endoscopy. Endoscopy looks for problems such as a foreign body or tissue mass, so the choice of tests depends on the suspected underlying cause.