Dog reverse sneezing: is it serious?

What is a reverse sneeze, exactly?

It is the opposite of a normal sneeze. In a normal sneeze the air rushes out through the nose. In a reverse sneeze the air is pulled sharply in, and the opening to the windpipe is shut at the same time. That is what makes the noise.

The trigger sits at the back of the nose, above the roof of the mouth. Something irritates that area and sets off a reflex. Your dog then takes a run of loud, fast breaths in. It looks like very hard work to breathe. It is not, and that is why so many owners ring us sure their dog was choking.

The posture gives it away. Your dog stands still. The neck stretches out and the head tips back. The elbows point outwards. The nostrils flare, the mouth stays shut, and the lips pull back. A fit can last a few seconds or a few minutes, and it can come back at odd intervals.

Is your dog actually reverse sneezing, or coughing?

This is the single most useful thing on this page, because the two get mixed up constantly and they lead to different places.

• A reverse sneeze pulls air in. Mouth closed, neck stretched out, nostrils flared, several rapid snorting inhalations in a row, then it stops and your dog is completely normal.
• A cough pushes air out. Mouth open, often a retch or a swallow at the end, and it tends to keep happening over days rather than arriving in one dramatic fit.

The confusion matters most in small dogs. There is a condition called tracheal collapse, where the rings of cartilage that hold the windpipe open go weak. It causes a dry, harsh, honking cough that keeps coming back, and it turns up most in small and toy breeds from middle age on. A honking noise in a middle-aged Pomeranian is worth a proper look rather than an assumption.

If what you are hearing is a cough, that is worth a visit in its own right, and we are happy to look at it with you.

What sets it off?

Often nothing you will ever pin down. Most of the time the nose is simply clearing dust, pollen or some other irritant.

Other things that can set it off:

• Excitement, or pulling hard against a lead
• Eating or drinking too fast
• Something caught in the upper airway, such as plant material
• Infections of the nose and throat
• Nasal mites
• A growth in the nose
• Disease lower down in the airways
• The narrow airway of a flat-faced breed, including a long soft palate
• An upset stomach, including vomiting

In plenty of dogs no cause is ever found. That is a normal answer, not a gap.

Grass seeds are the one to watch. A dog that suddenly starts reverse sneezing hard and often after being out in long dry grass is a different problem from a dog that has done it now and then for years. A runny nose on one side only points the same way. That dog gets seen this week.

Flat faces are the other. Short-muzzled dogs such as pugs, French bulldogs and bulldogs snort, snuffle and sneeze more, because of the way their airways are built. Many of them work harder to breathe than they should. In these breeds the noise can be one part of a bigger airway picture.

Is reverse sneezing serious?

Usually not. For most dogs the fits are occasional and mild, no treatment is needed, and they go straight back to normal on their own. The outlook is excellent. In many dogs no cause is ever found, and they live with it happily for years.

There is a second half, and it matters. A reverse sneeze is a sign that something has irritated the lining at the back of the nose. When a dog does it often, or the fits are getting worse, that irritation is worth looking into properly.

What we find, in rough order of how common it is:

• Inflammation in the nose and throat. This is the commonest by a distance.
• The way the airway is built, especially in flat-faced and very small dogs.
• Something stuck in the nose or the back of the throat. Less common, and it will not settle by itself.

A normal examination does not close the question. Plenty of dogs with a real problem in the nose look perfectly well on the table. That is why we image frequent or worsening fits rather than watch them.

It is reported more in smaller dogs and in flat-faced breeds. Whether small dogs truly get it more, or their owners simply sit close enough to hear it, nobody has established.

What can you do while it is happening?

Stay calm, because your dog is reading you. Most fits stop on their own within a minute.

Some owners find these settle a fit faster:

• A gentle rub of the throat
• Covering the nostrils for a second or two, which prompts a swallow
• A soft puff of air towards the face, which does the same thing
• Simply comforting your dog and speaking quietly

These are things owners tell us help, not a treatment. Never hold down a dog who is frightened, and never hold the nose of a dog who is struggling. If you are unsure, let the fit run and ring us.

The one thing worth doing every time: film it. Thirty seconds on your phone beats any description, because episodes almost never happen in the consult room, and it is the fastest way to tell a reverse sneeze from a cough without a single test.

What would we do about it?

We start with the history, an examination and your video. For a dog who does this now and then and is otherwise well, that is often where it ends, and we will say so.

Where the fits are frequent or severe, we look further. Treating for allergies and for mites is often the first step, to see whether things settle. If they do not, the next steps can include a sedated look inside the mouth and throat, X-rays of the head, and a small camera passed into the nose to look for a growth or something stuck. A dog with a long soft palate and other breathing trouble may do better with surgery to shorten it.

None of that is a fixed sequence. What we do is decided for your dog, on the day, and we will talk you through each step before it happens.

X-ray and ultrasound are here at Macquarie Veterinary Hospital, so the first round of imaging happens in the same place.

CT scans are done at our sister practice, Advanced Vet Care in Lane Cove, and we refer your pet there when one is needed.

The Macquarie Veterinary Hospital team

Macquarie Park