Standing left recurrent laryngeal neurectomy for prospective evaluation of laryngeal hemiplegia evaluated by a high-speed treadmill test.

OBJECTIVE: To describe left recurrent laryngeal neurectomy (LRLn) performed under standing sedation and evaluate the effect of LRLn on upper respiratory tract function using a high-speed treadmill test (HST). We hypothesized that (1) unilateral LRLn could be performed in standing horses, resulting in ipsilateral arytenoid cartilage collapse (ACC); and (2) HST after LRLn would be associated with alterations in upper respiratory function consistent with dynamic ACC. ANIMALS: 6 Thoroughbred horses. METHODS: The horses were trained and underwent a baseline HST up to 14 m/s at 5% incline until fatigue. Evaluation included; airflow, pharyngeal and tracheal pressures, and dynamic upper respiratory tract endoscopy. Trans-laryngeal impedance (TLI) and left-to-right quotient angle ratio (LRQ) were calculated after testing. The following day, standing LRLn was performed in the mid-cervical region. A HST was repeated within 4 days after surgery. RESULTS: Standing LRLn was performed without complication resulting in Havemayer grade 4 ACC at rest (complete paralysis) and Rakestraw grade C or D ACC (collapse up to or beyond rima glottis midline) during exercise. Increasing treadmill speed from 11 to 14 m/s increased TLI (P < .001) and reduced LRQ (P < .001). Neurectomy resulted in an increase in TLI (P = .021) and a reduction in LRQ (P < .001). CLINICAL RELEVANCE: Standing LRLn induces laryngeal hemiplegia that can be evaluated using a HST closely after neurectomy. Standing LRLn may be useful for future prospective evaluations of surgical interventions for laryngeal hemiplegia.

A model of transient laryngeal hemiplegia in dogs through conduction blockade of the recurrent laryngeal nerve.

OBJECTIVE: To create a model of transient unilateral laryngeal paralysis (LP) that will allow the study of cricoarytenoideus dorsalis dysfunction and a method for quantification of varying degrees of LP in dogs. ANIMALS: 5 castrated male research Beagles. PROCEDURES: Between January and February 2018, dogs were anesthetized and instrumented with a laryngeal mask airway and a flexible endoscope to record the rima glottidis. The left or right recurrent laryngeal nerve (RLn) was localized using ultrasonography and electrical stimulation, then conduction blockade was induced with perineural lidocaine. The normalized glottal gap area (NGGA) was measured before and every 15 minutes after the block. Inspired 10% carbon dioxide (CO2) was administered for 1 minute at each sampling time. The inspiratory increase in NGGA (total and each side) was measured at peak inspiration. The change in hemi-NGGA for the control side versus the anesthetized side was evaluated with a mixed-effect model. RESULTS: During CO2 stimulation, the increase in inspiratory hemi-NGGA was consistently less (P < .001) for the treated side (-8% to 13%) versus the control side (49% to 82%). A compensatory increase (larger than at baseline) in the control hemi-NGGA was observed. The total NGGA remained unaffected. CLINICAL RELEVANCE: Unilateral local anesthesia of the RLn produced transient unilateral LP with a compensatory increase in the hemi-NGGA for the contralateral side. This model could facilitate the evaluation of respiratory dynamics, establishment of a grading system, and collection of other important information that is otherwise difficult to obtain in dogs with LP.

Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy.

OBJECTIVES: To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure. SAMPLE: 10 cadaveric horse larynges. PROCEDURES: While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model. RESULTS: Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model. CLINICAL RELEVANCE: Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.

Implications of different degrees of arytenoid cartilage abduction on equine upper airway characteristics.

REASON FOR PERFORMING STUDY: The necessary degree of arytenoid cartilage abduction (ACA) to restore airway patency at maximal exercise has not been determined. OBJECTIVES: Use computational fluid dynamics modelling to measure the effects of different degrees of ACA on upper airway characteristics of horses during exercise. HYPOTHESIS: Maximal ACA by laryngoplasty is necessary to restore normal peak airflow and pressure in Thoroughbred racehorses with laryngeal hemiplegia. METHODS: The upper airway was modeled with the left arytenoid in 3 different positions: maximal abduction; 88% cross-sectional area of the rima glottis; and 75% cross-sectional area of the rima glottis. The right arytenoid cartilage was maximally abducted. Two models were assumed: Model 1: no compensation of airway pressures; and Model 2: airway pressure compensation occurs to maintain peak airflow. The cross-sectional pressure and velocity distributions for turbulent flow were studied at peak flow and at different positions along the airway. RESULTS: Model 1: In the absence of a change in driving pressure, 12 and 25% reductions in cross-sectional area of the larynx resulted in 4.11 and 5.65% reductions in peak airflow and 3.68 and 5.64% in tidal volume, respectively, with mild changes in wall pressure. Model 2: To maintain peak flow, a 6.27% increase in driving tracheal pressure was required to compensate for a cross-sectional reduction of 12% and a 13.63% increase in driving tracheal pressure was needed for a cross-sectional area reduction of 25%. This increase in negative driving pressure resulted in regions with low intraluminal and wall pressures, depending on the degree of airway diameter reduction. CONCLUSION: Assuming no increase in driving pressure, the decrease in left ACA reduced airflow and tidal volume. With increasing driving pressure, a decrease in left ACA changed the wall pressure profile, subjecting the submaximally abducted arytenoid cartilage and adjacent areas to airway collapse. CLINICAL RELEVANCE: The surgical target of ACA resulting in 88 % of maximal cross-sectional area seems to be appropriate.

In vitro model for testing novel implants for equine laryngoplasty.

OBJECTIVE: To develop an in vitro laryngeal model to mimic airflow and pressures experienced by horses at maximal exercise with which to test laryngoplasty techniques. STUDY DESIGN: Randomized complete block. SAMPLE POPULATION: Cadaveric equine larynges (n=10). METHODS: Equine larynges were collected at necropsy and a bilateral prosthetic laryngoplasty suture was placed with #5 Fiberwire suture to achieve bilateral maximal arytenoid abduction. Each larynx was positioned in a flow chamber and subjected to static flow and dynamic flow cycling at 2 Hz. Tracheal pressure and flow, and pressure within the flow chamber were recorded at a sampling frequency of 500 Hz. Data obtained were compared with the published physiologic values for horses exercising at maximal exercise. RESULTS: Under static flow conditions, the testing system produced inspiratory tracheal pressures (mean+/-SEM) of -33.0+/-0.98 mm Hg at a flow of 54.48+/-1.8 L/s. Pressure in the flow chamber was -8.1+/-2.2 mm Hg producing a translaryngeal impedance of 0.56+/-0.15 mm Hg/L/s. Under dynamic conditions, cycling flow and pressure were reproduced at a frequency of 2 Hz, the peak inspiratory (mean+/-SEM) pharyngeal and tracheal pressures across all larynges were -8.85+/-2.5 and -35.54+/-1.6 mm Hg, respectively. Peak inspiratory flow was 51.65+/-2.3 L/s and impedance was 0.57+/-0.06 mm Hg/L/s. CONCLUSIONS: The model produced inspiratory pressures similar to those in horses at maximal exercise when airflows experienced at exercise were used. CLINICAL RELEVANCE: This model will allow testing of multiple novel techniques and may facilitate development of improved techniques for prosthetic laryngoplasty.

Transendoscopic, laser-assisted ventriculocordectomy for treatment of left laryngeal hemiplegia in horses: 22 cases (1999-2005).

OBJECTIVE: To determine long-term effects of transendoscopic, laser-assisted ventriculocordectomy (LAVC) on airway noise and performance in horses with naturally occurring left laryngeal hemiplegia. DESIGN: Retrospective case series. ANIMALS: 22 horses with left laryngeal hemiplegia treated by means of LAVC. PROCEDURES: Medical records were reviewed and initial complaint, intended use of the horse, duration of abnormal airway noise, preoperative performance level, endoscopic findings, surgical procedure, postoperative treatment, and complications were recorded. Follow-up telephone interviews with owners and trainers were conducted to determine time for return to intended use, level of postoperative performance, and percentage reduction in airway noise. RESULTS: All horses were examined because of excessive airway noise; 10 (45%) had concurrent exercise intolerance. Left ventriculocordectomy was performed in all 22 horses; bilateral ventriculocordectomy (right ventriculocordectomy was done 1 year later) was performed in 1 horse (5%). Complications occurred in 3 (14%) horses. Twenty (91%) horses returned to their intended use. Excessive airway noise was eliminated after surgery in 18 (82%) horses; exercise intolerance improved postoperatively in 8 of 10 horses. Three racing Thoroughbreds returned to racing; 1 additional racehorse returned to racing but required a laryngoplasty 1 year later to continue racing. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that LAVC was an effective procedure for elimination of excessive airway noise and improvement of performance in horses with left laryngeal hemiplegia.

Evidence-based equine upper respiratory surgery.

The purpose of this article is to review the veterinary literature for various surgical procedures of the equine upper respiratory tract in an effort to evaluate the evidence supporting various therapies. This article focuses on the therapeutic benefit from more widely occurring conditions, such as laryngeal hemiplegia, dorsal displacement of the soft palate, arytenoid chondritis, and epiglottic entrapment.

Histological evaluation of the equine larynx after unilateral laser-assisted ventriculocordectomy.

REASONS FOR PERFORMING STUDY: Trans-endoscopic laser surgery, such as unilateral laser-assisted ventriculocordectomy (LVC), has gained popularity in the treatment of RLN because a laryngotomy incision or general anaesthesia are not required. However, removal of the vocal fold and ventricle takes considerable laser energy and could cause collateral tissue damage, including injury to the adjacent laryngeal cartilages. OBJECTIVES: To document the histological effects of laser surgery on laryngeal tissues in horses that have undergone LVC for the treatment of laryngeal hemiplegia (LH). METHODS: Six horses were used: 4 with experimentally induced LH that had subsequently undergone LVC 6 months prior to euthanasia; and, 2 horses were used as controls. One of the control horses with naturally occurring LH was used to study the effect of neuropathy alone, whereas the other was subjected to euthanasia immediately following LVC to evaluate the acute effect of laser surgery. Using a band saw, each larynx was sectioned transversely at 5 mm intervals and evaluated histologically. RESULTS: Acutely, LVC caused thermal damage to adjacent soft tissues but did not affect the histology of the laryngeal cartilages. Six months after LVC, laryngeal cartilages were histologically normal and there was squamous metaplasia of the repaired laryngeal mucosa, resulting in restitution of the mucosal integrity. CONCLUSIONS: Using a diode laser in contact fashion at 20 W, LVC can be used to remove the laryngeal vocal fold and ventricle without causing laryngeal cartilage damage. POTENTIAL RELEVANCE: Laryngeal chondritis is an unlikely consequence of LVC.

[Clinical and laryngoscopic findings in a Swiss Alpine goat with left grade 4 laryngeal hemiplegia]. / Klinische und laryngoskopische Befunde bei einer gemsfarbigen Gebirgsziege mit Hemiplegia laryngis sinistra Grad 4.

This case report describes the diagnostic trial of an inspiratory wheeze in a 1.5-year-old Swiss Alpine goat. Left grade 4 laryngeal hemiplegia was diagnosed via laryngoscopy, whereas the severity of the hemiplegia was assessed according to the grading system used in horses. The results of clinical, radiographic, sonographic and endoscopic examinations as well as haematological, biochemical and serological analyses did not reveal the cause of the hemiplegia. Treatment with an antibiotic and vitamin B complex resulted in only slight improvement. A postmortem examination four months later revealed no gross lesions in the left laryngeal nerve, larynx and intrinsic laryngeal musculature. Histological examination of the nerve, arytenoid cartilage and intrinsic laryngeal musculature also showed no lesions. Therefore, the cause of the disease in this goat is suspected to be on the cellular or molecular level of the intrinsic laryngeal musculature.

Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Recent studies have evaluated surgical techniques aimed at reducing noise and improving airway function in horses with recurrent laryngeal neuropathy (RLN). These techniques require general anaesthesia and are invasive. A minimally invasive transnasal surgical technique for treatment of RLN that may be employed in the standing, sedated horse would be advantageous. OBJECTIVE: To determine whether unilateral laser-assisted ventriculocordectomy (LVC) improves upper airway function and reduces noise during inhalation in exercising horses with laryngeal hemiplegia (LH). METHODS: Six Standardbred horses were used; respiratory sound and inspiratory transupper airway pressure (Pui) measured before and after induction of LH, and 60, 90 and 120 days after LVC. Inspiratory sound level (SL) and the sound intensities of formants 1, 2 and 3 (Fl, F2 and F3, respectively), were measured using computer-based sound analysis programmes. In addition, upper airway endoscopy was performed at each time interval, at rest and during treadmill exercise. RESULTS: In LH-affected horses, Pui, SL and the sound intensity of F2 and F3 were increased significantly from baseline values. At 60 days after LVC, Pui and SL had returned to baseline, and F2 and F3 values had improved partially compared to LH values. At 90 and 120 days, however, SL increased again to LH levels. CONCLUSIONS: LVC decreases LH-associated airway obstruction by 60 days after surgery, and reduces inspiratory noise but not as effectively as bilateral ventriculocordectomy. POTENTIAL RELEVANCE: LVC may be recommended as a treatment of LH, where reduction of upper airway obstruction and respiratory noise is desired and the owner wishes to avoid risks associated with a laryngotomy incision or general anaesthesia.

A comparison of laryngoplasty and modified partial arytenoidectomy as treatments for laryngeal hemiplegia in exercising horses.

OBJECTIVE: To compare upper airway mechanics, arterial blood gases, and tracheal contamination in horses with induced left laryngeal hemiplegia (recurrent laryngeal neuropathy [RLN]) treated by laryngoplasty/vocal cordectomy (LPVC) or modified partial arytenoidectomy (MPA). STUDY DESIGN: Repeated measures under the following conditions: Control, RLN, LPVC, and MPA. ANIMALS: Six horses. METHODS: Two trials were conducted under all conditions at 80% and 100% of maximal heart rate (HR(max)). In Trial 1, arterial blood gases, tracheal and pharyngeal pressures, and laryngeal videoendoscopy were recorded. In Trial 2, upper airway pressure and airflow were determined. Tracheobronchial aspirates were performed after exercise to quantify airway contamination. RESULTS: Compared with control, RLN significantly increased inspiratory impedance and worsened exercise-induced hypoxemia. At 80% HR(max), LPVC restored most variables to control values. At 100% HR(max), LPVC improved all variables, but did not restore minute volume, arterial pH, and PaCO(2). At 80% HR(max), MPA restored all variables except bicarbonate to control values. At 100% HR(max), MPA improved all variables, but did not statistically restore minute ventilation or bicarbonate level. Only minor differences were noted between LPVC and MPA. Both resulted in equivalent tracheal contamination. CONCLUSIONS: Airway mechanics and arterial blood gas values were not restored to normal after either LPVC or MPA in horses exercising at HR(max). This does not affect ventilation at sub-maximal exercise, but has clinical implications at HR(max). Both procedures diminish normal laryngeal protective mechanisms. CLINICAL RELEVANCE: At sub-maximal exercise intensities both LPVC and MPA restore airway ventilation to normal. At maximal exercise the superiority of LPVC over MPA is slight.

Ventriculocordectomy as the sole treatment for recurrent laryngeal neuropathy: long-term results from ninety-two horses.

OBJECTIVE: To evaluate the effect ventriculocordectomy (VC) for treatment of recurrent laryngeal neuropathy (RLN) on exercise performance and owner satisfaction in a mixed-breed population of horses. STUDY DESIGN: Retrospective study. ANIMALS: Adult horses (n=92) with a history of abnormal respiratory noise and RLN. METHODS: Retrospective analysis of horse that had unilateral VC (and contralateral ventriculectomy in 63 horses) for treatment of idiopathic RLN. Owners/trainers completed a questionnaire about complications and outcome at least 1 year after surgery. Performance index was determined using race records for previously raced Thoroughbreds to evaluate outcome. RESULTS: Clinical signs included abnormal exercise-induced respiratory noises (noises; 52%), poor performance (11%), and noises and poor performance (37%). The median preoperative resting endoscopic grade of laryngeal function was Havemeyer grade III.1 (mild asymmetry). No discharge from the laryngotomy 1 week postoperatively occurred in 62% horses, 22% coughed after surgery, 66% made no noises, 9% continued to make noises at the canter, 21% made noise at the gallop, and 4% of owners were unsure whether noises were present. Ninety-three percent of horses returned to full work after surgery. Overall, 86% of owners considered the surgery worthwhile, 3% did not consider it worthwhile, and 11% were unsure. Surgery had a significantly beneficial effect on the racing performance index in Thoroughbreds (P=.004). CONCLUSIONS: VC is a useful alternative to laryngoplasty for selected cases of RLN and is associated with a positive effect on exercise performance, a low postoperative complication rate, and a high rate of owner satisfaction. CLINICAL RELEVANCE: Unilateral VC should be considered as a sole treatment in horses with low grades of RLN.

Placement of a long term tracheal cannula in a Thoroughbred racehorse with bilateral laryngeal dysfunction.

A Thoroughbred horse with bilateral laryngeal dysfunction was treated by placement of a long term tracheal cannula in order to restore full athletic function. The horse initially presented with right-sided arytenoid dysfunction that was considered to be due to a congenital malformation of the laryngeal cartilage. This was corrected by a right-sided laryngoplasty and ventriculectomy. The horse re-presented 1 year later with idiopathic left laryngeal hemiplegia. The decision was made to place a long-term tracheal cannula due to the low success rate and high complication rate associated with other surgeries used to correct bilateral arytenoid dysfunction. A three-piece tracheotomy cannula and stopper were positioned under general anaesthesia. The horse rapidly adjusted to the tracheal cannula and no post-surgical complications were encountered. The horse resumed training 4 weeks postoperatively. Due to the rules governing racing in Australia the horse was exported to New Zealand where he continued his racing career. It was concluded that tracheotomy is a straightforward technique associated with minimal complications and can provide an excellent prognosis for return of full airway function in racing horses. It is recognised that many issues need to be considered prior to more general acceptance of this technique, including assessment of animal welfare issues and public perception. In appropriate cases consideration should be given to using long term placement of a tracheotomy cannula as a treatment option to restore maximal airflow in horses with upper airway obstruction.

Evaluation of a canine cranial cruciate ligament repair system for use in equine laryngoplasty.

OBJECTIVE: To report the use of a nylon suture system (Canine Cranial Cruciate Ligament Repair System; Securos Inc Veterinary Orthopedics) as a prosthesis for equine laryngoplasty. STUDY DESIGN: Experimental and prospective clinical study. ANIMALS: Cadaver specimens (n = 5) and 7 horses with left laryngeal hemiplegia. METHODS: A commercially available monofilament nylon suture system was implanted as a laryngeal prosthesis. Arytenoid cartilage abduction was achieved with a tensioning device applied to the suture prosthesis during transnasal endoscopic observation. Suture fixation was achieved with crimping clamps and a crimping device. RESULTS: The nylon suture system was suitable as a laryngeal prosthesis for arytenoid cartilage abduction. The ratchet mechanism of the tensioning device facilitated abduction of the arytenoid cartilage and suture fixation was achieved by the crimped clamp without any loss of tension. Postoperatively, there was a slight loss of tension in 4 horses and complete loss of tension in 1 horse because of cartilage failure. After convalescence, none of the horses had abnormal respiratory noise, exercise intolerance or cough. CONCLUSIONS: A nylon suture system designed for canine cranial cruciate ligament repair was used successfully as a laryngeal prosthesis and facilitated control of the degree of arytenoid cartilage abduction during laryngoplasty. CLINICAL RELEVANCE: For improved control of the degree of arytenoid cartilage abduction during laryngoplasty, use of a nylon suture system with metal crimps should be considered.

Effect of laryngoplasty on respiratory noise reduction in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Laryngoplasty is the technique of choice for treatment of laryngeal hemiplegia, with the aim of improving airway function and/or eliminating respiratory noise. However, there are no quantitative data in the literature describing the effect of laryngoplasty on upper airway noise or its relationship to upper airway mechanics in horses with laryngeal hemiplegia. OBJECTIVES: To determine whether laryngoplasty reduces respiratory noise in exercising horses with laryngeal hemiplegia; and to establish whether the degree of upper airway obstruction can be predicted by upper airway noise, or the degree of arytenoid abduction correlated with airway obstruction and noise production. METHODS: Six Standardbred horses with normal upper airways during maximal exercise were used. Respiratory sounds and inspiratory transupper airway pressure (Pui) were measured in all horses before and after induction of laryngeal hemiplegia and 30, 60 and 90 days after laryngoplasty. Inspiratory sound level (SL) and the sound intensity of the 3 inspiratory formants (F1, F2 and F3, respectively) were measured using a computer-based sound analysis programme. The degree of abduction was graded by endoscopic visualisation 1, 30, 60 and 90 days post operatively. Linear regression analysis was used to determine correlations between Pui, sound indices and grades of arytenoid abduction. RESULTS: In laryngeal hemiplegia-affected horses, Pui, inspiratory SL and the sound intensity of F1, F2 and F3 were significantly increased. At 30 days following laryngoplasty, the sound intensity of F1 and Pui returned to baseline values. The sound intensities of F2, F3 and SL were significantly improved from laryngeal hemiplegia values at 30 days post operatively, but did not return to baseline at any measurement period. Sound level, F2 and F3 were significantly correlated with Pui (P<0.05), but the correlations were weak (r2 = 0.26, 035 and 0.40, respectively). Grade of abduction and F2 were positively and significantly correlated (P<0.006, r2 = 0.76). Grade of arytenoid abduction and Pui were not correlated (P = 0.12). CONCLUSIONS: Laryngoplasty reduced inspiratory noise in laryngeal hemiplegia-affected horses by 30 days following surgery, but did not return it to baseline values. While upper airway noise and Pui were correlated, this relationship was insufficiently strong to predict Pui from noise in individual animals. The degree of arytenoid abduction was not correlated with Pui, but was positively correlated with noise production. POTENTIAL RELEVANCE: Laryngoplasty reduces upper airway noise in horses with laryngeal hemiplegia, but is not as effective as bilateral ventriculocordectomy in this regard, although respiratory noise reduction occurs more rapidly than with bilateral ventriculocordectomy. Residual noise during exercise cannot be used as a predictor of improvement in upper airway function in individual horses following laryngoplasty. The degree of arytenoid abduction obtained following surgery does not affect upper airway flow mechanics. Interestingly, we found that the greater the arytenoid abduction, the louder the respiratory noise.

Laryngoplasty with ventriculectomy or ventriculocordectomy in 104 draft horses (1992-2000).

OBJECTIVE: To evaluate efficacy and safety of laryngoplasty with vetriculectomy (VE) or ventriculocordectomy (VCE) for treatment of laryngeal hemiplegia (LH) in draft horses. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred four draft horses used for competitive hitch competitions. METHODS: Medical records and postoperative endoscopy for competitive hitch draft horses diagnosed with left LH and treated with laryngoplasty and VE or VCE between January 1992 and December 2000 were reviewed. Follow-up information was obtained from telephone interviews with owners and trainers, and performance scores of 1 to 3 were assigned in which 1 was defined as a horse that was unable to perform (abnormal respiratory noise with or without exercise intolerance), 2 was able to perform but not for its intended use (exercise tolerant but abnormal respiratory noise), and 3 was performing as expected for its intended use (exercise tolerant, no abnormal respiratory noise). RESULTS: One hundred four horses that had 111 laryngoplasty procedures were included. All horses had preoperative performance scores of 1. Follow-up information was available for 79 horses. Improvement in postoperative performance (exercise tolerant, with or without abnormal respiratory noise) was reported in 92% of horses. Respiratory noise was eliminated in 72% (57 horses) of horses. Postoperative performance scores were the following: 3 in 57 (72%) horses, 2 in 16 (20%) horses, and 1 in 6 (8%) horses. There was no significant difference in postoperative performance based on preoperative grade of LH. There was a trend for horses with >/=70% of possible maximal abduction postoperatively to have a performance score of 3. Postanesthetic complications included prolonged recovery (4 horses, 4%) and myopathy or neuropathy (7 horses, 7%). One of these horses was killed because it did stand; triceps myopathy and encephalopathy were confirmed on necropsy. CONCLUSIONS: Laryngoplasty with VE or VCE is an effective and safe procedure for the treatment of LH in the draft horse. Repeat laryngoplasty can be performed successfully, with good performance outcome after laryngoplasty failure. Complications associated with general anesthesia and laryngoplasty in draft horses are higher than reported for light breed horses under similar conditions. CLINICAL RELEVANCE: For LH, laryngoplasty with VCE or VE under general anesthesia is recommended to eliminate abnormal respiratory noise and improve performance in most competitive hitch draft horses.

Ventriculocordectomy reduces respiratory noise in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Show and performance horse with laryngeal hemiplegia (LH) often present for excessive respiratory noise rather than significant exercise intolerance. Therefore, the goal of surgery in these horses is to reduce respiratory noise but there are no quantitative studies evaluating the effect of any upper-airway surgery in LH-affected horses. OBJECTIVE: To determine whether bilateral ventriculocordectomy (VC) reduces respiratory noise in exercising horses with laryngeal hemiplegia. METHODS: Six Standardbred horses with normal upper airways were used in this study. Respiratory sounds and inspiratory trans-upper airway pressure (Pui) were measured in all horses before and after induction of LH, and 30, 90 and 120 days after VC. In horses with LH, spectrogram analysis revealed 3 inspiratory sound formants centred at approximately 400, 1700 and 3700 Hz. Inspiratory sound levels (SL) and the sound intensity of the 3 inspiratory formants (F1, F2, F3 respectively) were measured using a computer-based sound analysis programme. RESULTS: In LH-affected horses, Pui, inspiratory SL and the sound intensity of F2 and F3 were significantly increased compared to baseline values. At 90 and 120 days after VC the sound intensities of F2 and F3 returned to baseline values. The Pui and SL, were significantly decreased compared to LH values, but remained different from baseline. CONCLUSIONS: VC effectively reduces inspiratory noise in LH-affected horses by 90 days following surgery. Inspiratory trans-upper airway pressures are improved 30 days following VC, but do not return to baseline values. POTENTIAL RELEVANCE: VC can be recommended as a surgical treatment of LH-affected horses if reduction of respiratory noise is the primary objective of surgery. Further studies are required to determine if variations of the surgical technique used in this study will have similar results.

Sound signature for identification and quantification of upper airway disease in horses.

OBJECTIVE: To investigate whether upper airway sounds of horses exercising with laryngeal hemiplegia and alar fold paralysis have distinct sound characteristics, compared with unaffected horses. ANIMALS: 6 mature horses. PROCEDURE: Upper airway sounds were recorded in horses exercising on a high-speed treadmill at maximum heart rate (HR(MAX)) under 3 treatment conditions (ie, normal upper airway function [control condition], and after induction of left laryngeal hemiplegia or bilateral alar fold paralysis) in a randomized crossover design. Fundamental frequency, spectrograms using Gabor transform, and intensity characteristics of acquired sounds (peak sound level [sound(peak] and highest frequency of at least -25 dB sound intensity [F(25max)]) were evaluated. RESULTS: Evaluation of the fundamental frequency of the time domain signal was not useful. Sensitivity and specificity (83 and 75%, respectively) of spectrograms were greatest at maximal exercise, but the exact abnormal condition was identified in evaluation of only 12 of 18 spectrograms. Increased accuracy was obtained using sound(peak) and F(25max) as discriminating variables. The use of sound(peak) discriminated between control and laryngeal hemiplegia conditions and F(25max) between laryngeal hemiplegia and alar fold paralysis conditions. This increased the specificity of sound analysis to 92% (sensitivity 83%) and accurately classified the abnormal state in 92% of affected horses. CONCLUSIONS AND CLINICAL RELEVANCE: Sound analysis might be a useful adjunct to the diagnosis and evaluation of treatment of horses with upper airway obstruction, but would appear to require close attention to exercise intensity. Multiple measurements of recorded sounds might be needed to obtain sufficient accuracy for clinical use.

Spectrum analysis of respiratory sounds in exercising horses with experimentally induced laryngeal hemiplegia or dorsal displacement of the soft palate.

OBJECTIVE: To record respiratory sounds in exercising horses and determine whether spectrum analysis could be use to identify sounds specific for laryngeal hemiplegia (LH) and dorsal displacement of the soft palate (DDSP). ANIMALS: 5 Standardbred horses. PROCEDURE: Respiratory sounds were recorded and pharyngeal pressure and stride frequency were measured while horses exercised at speeds corresponding to maximum heart rate, before and after induction of LH and DDSP. RESULTS: When airway function was normal, expiratory sounds predominated and lasted throughout exhalation. After induction of LH, expiratory sounds were unaffected; however, all horses produced inspiratory sounds characterized by 3 frequency bands centered at approximately 0.3, 1.6, and 3.8 kHz. After induction of DDSP, inspiratory sounds were unaffected, but a broad-frequency expiratory sound, characterized by rapid periodicity (rattling) was heard throughout expiration. This sound was not consistently detected in all horses. CONCLUSIONS AND CLINICAL RELEVANCE: The technique used to record respiratory sounds was well tolerated by the horses, easy, and inexpensive. Spectrum analysis of respiratory sounds from exercising horses after experimental induction of LH or DDSP revealed unique sound patterns. If other conditions causing airway obstruction are also associated with unique sound patterns, spectrum analysis of respiratory sounds may prove to be useful in the diagnosis of airway abnormalities in horses.