We've seen it often enough here. Discharge out of one nostril. Treatment with antibiotics helps, but the infection returns in a week or two. Hello, Dentist?
According to the abstract of this paper on Sinus Surgery in the Horse, "the most common cause of sinus infection is extension of infection from a diseased tooth or as an aftermath to tooth repulsion."
Long story very short........if your horse has a persistent or recurring nasal discharge, think "teeth." To see just how little barrier there is between tooth root and sinus, visit http://www.hanne.com/teeth-photos.htm and click on the fourth photo from the top. Its easy to see how an infection in a tooth root can move into the sinus right next to it.
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