Effect of a tongue-tie on upper airway mechanics during exercise following sternothyrohyoid myectomy in clinically normal horses

OBJECTIVE: To determine the effect of a tongue-tie on upper airway mechanics in clinically normal horses exercising on a treadmill following sternothyrohyoid myectomy. ANIMALS: 6 Standardbreds. PROCEDURE: Upper airway mechanics were measured with horses exercising on a treadmill at 5, 8, and 10 m/s 4 weeks after a sternothyrohyoid myectomy was performed. Pharyngeal and tracheal inspiratory and expiratory pressures were measured by use of transnasal pharyngeal and tracheal catheters connected to differential pressure transducers. Horses were fitted with a facemask and airflow was measured by use of a pneumotachograph. Horses underwent a standardized exercise protocol on a treadmill at 5, 8, and 10 m/s with and without a tongue-tie in a randomized cross-over design. Inspiratory and expiratory airflow, tracheal pressure, and pharyngeal pressure were measured, and inspiratory and expiratory resistances were calculated. RESULTS: We were unable to detect an effect of a tongue-tie on any of the respiratory variables measured. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that a tongue-tie does not alter upper airway mechanics following sternothyrohyoid myectomy in clinically normal horses during exercise.     

Effect of topical anesthesia of the laryngeal mucosa on upper airway mechanics in exercising horses.

OBJECTIVE: To determine the effect of desensitization of the laryngeal mucosal mechanoreceptors on upper airway mechanics in exercising horses. ANIMALS: 6 Standardbreds. PROCEDURE: In study 1, videoendoscopic examinations were performed while horses ran on a treadmill with and without topical anesthesia of the laryngeal mucosa. In study 2, peak tracheal and nasopharyngeal pressures and airflows were obtained from horses during incremental treadmill exercise tests, with and without topical anesthesia of the laryngeal mucosa. A nasal occlusion test was performed on each horse while standing during an endoscopic examination for both trials. RESULTS: In study 1, horses had nasopharyngeal collapse while running on the treadmill when the laryngeal mucosa was anesthetized. In study 2, inspiratory upper airway and nasopharyngeal impedance were significantly higher, and peak tracheal inspiratory pressure, respiratory frequency, and minute ventilation were significantly lower in horses when the laryngeal mucosa was anesthetized, compared with values obtained when horses exercised without topical anesthesia. Peak inspiratory and expiratory airflows were lower in horses when the laryngeal mucosa was anesthetized, although differences did not quite reach significance (P = 0.06 and 0.09, respectively). During a nasal occlusion test, horses had episodes of nasopharyngeal collapse and dorsal displacement of the soft palate when the laryngeal mucosa was anesthetized. Upper airway function was normal in these horses without laryngeal mucosal anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE: Receptors within the laryngeal mucosa may be important in maintaining upper airway patency in exercising horses.     

Effect of commercially available nasal strips on airway resistance in exercising horses

OBJECTIVE: To determine the effect of a commercially available nasal strip on airway mechanics in exercising horses. ANIMALS: 6 horses (5 Standardbreds and 1 Thoroughbred). PROCEDURE: Horses exercised on a treadmill at speeds corresponding to 100 and 120% of maximal heart rate with and without application of a commercially available nasal strip. Concurrently, tracheal pressures, airflow, and heart rate were measured. Peak inspiratory and expiratory tracheal pressures, airflow, respiratory frequency, and tidal volume were recorded. Inspiratory and expiratory airway resistances were calculated by dividing peak pressures by peak flows. Endoscopic examination of the narrowest point of the nasal cavity (ie, nasal valve) was performed in 1 resting horse before, during, and after application of a nasal strip. RESULTS: During exercise on a treadmill, peak tracheal inspiratory pressure and inspiratory airway resistance were significantly less when nasal strips were applied to horses exercising at speeds corresponding to 100 and 120% of maximal heart rate. Application of the nasal strip pulled the dorsal conchal fold laterally, expanding the dorsal meatus. CONCLUSIONS AND CLINICAL RELEVANCE: The commercially available nasal strip tented the skin over the nasal valve and dilated that section of the nasal passage, resulting in decreased airway resistance during inspiration. The nasal strip probably decreases the amount of work required for respiratory muscles in horses during intense exercise and may reduce the energy required for breathing in these horses.     

Incidence of swallowing during exercise in horses with dorsal displacement of the soft palate

Reasons for performing study: The relationship between dorsal displacement of the soft palate (DDSP) and swallowing is unclear. Objective: To quantify the relationship between DDSP and swallowing in horses at exercise. Hypotheses: The frequency of swallowing increases immediately prior to DDSP in horses at exercise. Methods: Videoendoscopic and upper airway pressure data were collated from horses with a definitive diagnosis of DDSP at exercise. Horses with no upper airway abnormalities were matched by age, breed and sex and used as controls. Sixty‐nine horses were identified with a definitive diagnosis of DDSP during the study interval. Airway pressure data were available for 42 horses. Results: The majority of horses displaced at high exercising speeds while accelerating; a smaller number displaced during deceleration after peak speed had been reached. Horses swallowed significantly more frequently in the 1 min immediately preceding DDSP than in the control horses at equivalent speeds. DDSP at exercise results in a significant increase in tracheal expiratory pressure, a significant decrease in pharyngeal expiratory pressure and a significantly less negative pharyngeal inspiratory pressure compared to matched controls and compared to the pressures during the 1 min interval prior to DDSP. There was no significant difference between any measure of airway pressure before or after a swallow when examined at each time interval in the DDSP population. Conclusions: The frequency of swallowing decreases with increasing speed in normal horses. In contrast, the frequency of swallowing increases immediately prior to onset of DDSP. This is not a result of pharyngeal and tracheal pressure changes. Potential relevance: The increased frequency of swallowing observed prior to DDSP may be related to the aetiology of the disease.     

Treatment of left laryngeal hemiplegia in standardbreds, using a nerve muscle pedicle graft

The efficacy of a nerve muscle pedicle (NMP) graft in restoring upper airway function was evaluated in exercising horses with induced left laryngeal hemiplegia. The NMP graft was created from the first cervical nerve and the omohyoideus muscle and transplanted into the left cricoarytenoideus dorsalis muscle. Seven adult Standardbreds were trained to exercise on a treadmill inclined at 6.38 degrees. With the horses at rest and exercising at 4.2 and 7.0 m/s, the following variables were recorded: peak inspiratory and expiratory transupper airway pressures (defined as the pressure difference between a lateral tracheal catheter and a mask catheter), peak inspiratory and expiratory air flow, inspiratory and expiratory impedance, tidal volume, minute ventilation, heart rate, and respiratory frequency. Measurements were made before left recurrent laryngeal neurectomy (LRLN), 28 days after LRLN, and 12, 24, and 52 weeks after the NMP graft (n = 5) or sham operation (n = 2). Before LRLN, exercise increased inspiratory and expiratory air flow and transupper airway pressure, whereas the impedance was unchanged. After LRLN, transupper airway inspiratory pressure and impedance were significantly greater and inspiratory air flow was significantly less than baseline values at 7.0 m/s. The sham operation did not improve airway function. Twelve weeks after insertion of the NMP graft, inspiratory impedance and inspiratory air flow were significantly different (improved) from LRLN values. Twenty-four weeks after insertion of the NMP graft, inspiratory impedance was not significantly different from LRLN values.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Effect of laryngeal hemiplegia and laryngoplasty on airway flow mechanics in exercising horses

The effect of left laryngeal hemiplegia on airway flow mechanics in 5 exercising horses was examined, and the efficacy of surgical repair by prosthetic laryngoplasty was evaluated. Measurements of the upper airway flow mechanics were made with horses on a treadmill (incline 6.38 degrees) while standing (period A); walking at 1.3 m/s (period B); trotting at 2.6 m/s (period C); trotting at 4.3 m/s (period D); and standing after exercise (period E). Experiments were done on healthy horses before any surgical manipulation (control), at 10 days after left recurrent laryngeal neurectomy, and at least 14 days after prosthetic larynogoplasty. Increasing treadmill speed from period A to period D progressively increased heart rate, respiratory frequency, peak inspiratory flow, and peak expiratory flow, but inspiratory resistance and expiratory resistance remained unchanged. Neither left recurrent laryngeal neutrectomy nor prosthetic laryngoplasty affected heart rate, respiratory frequency, peak expiratory flow, or expiratory resistance when compared with those values at the control measurement periods. Left recurrent laryngeal neurectomy resulted in inspiratory flow limitation at peak inspiratory flow of approximately 25 L/s, and increased inspiratory resistance at periods D and E. Subsequent prosthetic laryngoplasty alleviated the flow limitation and reduced inspiratory resistance at measurement periods D and E.     

Effects of ventriculectomy, prosthetic laryngoplasty, and exercise on upper airway function in horses with induced left laryngeal hemiplegia

Effects of ventriculectomy and prosthetic laryngoplasty on upper airway flow mechanics and blood gas tensions in exercising horses with induced left laryngeal hemiplegia were assessed. Five adult horses were trained to stand, trot (4.5 m/s), and gallop (7.2 m/s) on a treadmill (6.38 degrees incline). Inspiratory and expiratory airflows (VImax, VEmax, respectively) were measured using a 15.2-cm diameter pneumotachograph in a face mask. Inspiratory and expiratory transupper airway pressures (PuI, PuE, respectively) were determined as pressure differences between barometric pressure and lateral tracheal pressure. Blood collected from exteriorized carotid arteries was analyzed for PaO2, PaCO2, pH, hemoglobin (Hb) content, and HCO3- values. Heart rate (HR) was determined with an HR monitor. Measurements were made with horses standing, trotting, and galloping before left recurrent laryngeal neurectomy (LRLN; base line), 14 days after LRLN, 30 days after ventriculectomy (44 days after LRLN), and 14 days after prosthetic laryngoplasty (58 days after LRLN). Before LRLN (base line), increasing treadmill speed for horses from standing to the trot and gallop progressively increased HR, respiratory frequency, VImax, VEmax, PuI, PuE, Hb, and PaCO2 values and decreased PaO2, pH, and HCO3- values; inspiratory and expiratory impedances were unchanged. After LRLN, inspiratory impedance and PuI were significantly (P less than 0.05) increased in horses at the trot and gallop, and PaCO2 was significantly increased in horses at the gallop. The VImax and respiratory frequency were significantly (P less than 0.05) decreased in horses at the gallop. Left recurrent laryngeal neurectomy had no effect on PuE, VEmax, HR, PaO2, pH, Hb, or expiratory impedance values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Failure of subtotal arytenoidectomy to improve upper airway flow mechanics in exercising standardbreds with induced laryngeal hemiplegia

Upper airway flow mechanics and arterial blood gas measurements were used to assess the efficacy of subtotal arytenoidectomy for treatment of induced left laryngeal hemiplegia in horses. Measurements were collected with the horses at rest, and trotting or pacing on a treadmill (6.38 degrees incline) at speeds of 4.2 and 7.0 m/s. Experimental protocols were performed after right common carotid artery exteriorization (baseline), after left recurrent laryngeal neurectomy (LRLN), and after left subtotal arytenoidectomy. At baseline, increasing treadmill speed progressively increased peak inspiratory and expiratory flow (VImax and VEmax, respectively), peak inspiratory and expiratory transupper airway pressure (PuI and PuE, respectively), respiratory frequency (f), tidal volume (VT), minute volume (VE), and heart rate. Inspiratory and expiratory times (TI and TE, respectively) and arterial oxygen tension (PaO2) decreased with increased treadmill speed; inspiratory and expiratory impedance (ZI and ZE, respectively) did not change. After LRLN, VImax, f, and PaO2 significantly (P less than 0.05) decreased at exercise, whereas PuI, TI, and ZI significantly increased. Minute volume decreased at exercise after LRLN, but the changes were not significant; LRLN had no effect on VEmax, PuE, ZE, heart rate, arterial carbon dioxide tension (PaCO2), or VT. Subtotal arytenoidectomy did not improve upper airway flow mechanics or blood gas measurements impaired by laryngeal hemiplegia.     

Effect of poll flexion and dynamic laryngeal collapse on tracheal pressure in Norwegian Coldblooded Trotter racehorses

Reason for performing study: Dynamic laryngeal collapse (DLC) associated with poll flexion is a newly diagnosed upper respiratory tract obstructive disorder that causes poor racing performance. Objectives: To determine if Norwegian Coldblooded Trotters (NCTs) affected with DLC associated with poll flexion differ from normal, elite NCTs based on simple airway mechanics measurements. Methods: Five normal elite NCTs and 6 NCTs diagnosed previously with DLC underwent treadmill videoendoscopy while tracheal pressures were measured continuously. Alternating head positions were used such that horses were exercised with free head carriage and induced poll flexion at heart rates >200 beats/min. Results: Peak inspiratory tracheal pressures were significantly more negative for horses with DLC compared to the elite horses. This difference was only significant during the exercise phases when the poll region was flexed, P = 0.0015. Head position significantly affected peak inspiratory pressure for both elite and affected horses, P<0.0001. Conclusions and clinical relevance: Induced poll flexion significantly affected peak inspiratory pressure (PIP) in all horses; however, PIPs were significantly more negative in those affected with DLC. Based upon the tracheal pressure measurements recorded in this study, DLC in NCTs is a severe obstructive upper respiratory tract disorder that is induced by poll flexion.     

Cricothyroid muscle function and vocal fold stability in exercising horses

OBJECTIVES: To determine (1) if the cricothyroid muscle had respiratory-related electromyographic (EMG) activity that increased with respiratory effort and (2) if bilateral cricothyroid myotomy resulted in vocal fold instability and collapse in exercising horses. STUDY DESIGN: Experimental. ANIMALS: Seven (3 EMG; 4 cricothyroid myotomy) Standardbred horses. METHODS: Three horses exercised on a treadmill at speeds corresponding to the speed that produced maximum heart rate (HR(max)), 75% of maximum heart rate (HR(75%max)), and 50% of maximum heart rate (HR(50%max)) for 60 seconds at each speed while EMG activity of the cricothyroid muscle and nasopharyngeal pressures were measured. Another 4 normal horses were exercised on the treadmill at HR(max) and HR(75%max) for 60 seconds at each speed before and after bilateral cricothyroid myotomy. Upper airway pressures were measured and videoendoscopic examinations were performed and videotaped at each speed. RESULTS: Peak phasic EMBG activity of the cricothyroid muscle was coincident with inspiration and increased with treadmill speed. Bilateral cricothyroid myotomy resulted in vocal fold collapse in all horses. Mean peak inspiratory pressures were significantly more negative compared with control values at both HR(max) and HR(75%max). CONCLUSIONS: Cricothyroid muscle dysfunction may be implicated in vocal fold collapse and likely causes inspiratory airway obstruction in exercising horses. CLINICAL RELEVANCE: Conditions compromising cricothyroid muscle function or motor innervation could result in vocal fold collapse.     

Exercising videoendoscopic evaluation of 45 horses with respiratory noise and/or poor performance after laryngoplasty

Objective: To (1) assess upper airway function by videoendoscopy in horses performing poorly after laryngoplasty and (2) establish whether dynamic collapse of the left arytenoid can be predicted by the degree of resting postsurgical abduction. Study Design: Case series. Animals: Horses that had left laryngoplasty (n=45). Methods: Medical records (June 1993–December 2007) of horses evaluated for abnormal respiratory noise and/or poor performance after laryngoplasty were reviewed. Horses with video recordings of resting and exercising upper airway endoscopy were included and postsurgical abduction categorized. Horses with immediate postoperative endoscopy recordings were also evaluated and postsurgical abduction categorized. Relationships between resting postsurgical abduction and historical information with exercising endoscopic findings were examined. Results: Dynamic collapse of the left arytenoid cartilage was probable in horses with no postsurgical abduction and could not be predicted in horses with grade 3 or 4 postsurgical abduction. Respiratory noise was associated with upper airway obstruction but was not specific for arytenoid collapse. Most horses with a left vocal fold had billowing of the fold during exercise. Other forms of dynamic collapse involved the right vocal fold, aryepiglottic folds, corniculate process of left arytenoid cartilage, dorsal displacement of soft palate, and pharyngeal collapse. Complex obstructions were observed in most examinations and in all horses with exercising collapse of the left arytenoid cartilage. Conclusions: There was no relationship between exercising collapse of the left arytenoid cartilage and grade 3 or 4 postsurgical abduction but was likely in horses with no abduction.     

Tidal breathing flow-volume loop analysis for clinical assessment of airway obstruction in conscious dogs

Using a mask, pneumotachograph, and X-Y recorder, tidal breathing flow-volume loops (TBFVL) were evaluated in 33 healthy dogs and in 18 dogs with acquired obstructive respiratory tract disease. The loops were evaluated for qualitative shape, tidal volume (VT), respiratory rate, peak and midtidal inspiratory flow (PIF and IF50, respectively), peak and midtidal expiratory flow (PEF and EF50, respectively), inspiratory and expiratory flow at end expiratory volume plus 25% VT (IF25 and EF25, respectively), inspiratory time, and expiratory time. Indices of loop shape were developed by division of flow measurements (eg, PEF/PIF and IF50/IF25). Twenty healthy dogs had the same TBFVL (type 1). Typically, PEF occurred at the beginning of expiration, and PIF occurred toward the end of inspiration. Three other TBFVL types were identified in the remaining dogs. Mean coefficients of variation for TBFVL indices ranged from 7% to 18%. Dogs with a fixed-type upper airway obstruction (pharyngeal or laryngeal mass, n = 7) had TBFVL abnormalities, indicating inspiratory and expiratory phase flattening. Concavity or late expiratory phase flattening was detected in TBFVL from dogs with chronic bronchitis/tracheal collapse (n = 11). The TBFVL were easily evaluated in conscious dogs and were useful in the functional assessment of airway obstruction.     

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.     

Respiratory responses to exercise in the horse

Horses are elite athletes when compared with other mammalian species. In the latter, performance is limited by cardiovascular or musculoskeletal performance whereas in athletic horses it is the respiratory system that appears to be rate limiting and virtually all horses exercising at high intensities become hypoxaemic and hypercapnoeic. This is due to both diffusion limitation and a level of ventilation inadequate for the metabolic level that enables horses to exercise at these intensities. In conjunction with these blood gas changes, total pulmonary resistance increases and the work of breathing rises exponentially and airflow eventually plateaus despite increases in inspiratory and expiratory intrapleural pressures. Horses breathe at comparatively high frequencies when galloping due to the tight 1:1 coupling of strides to breathing. Whether this effects gas exchange and, if so, to what extent, has not been fully elucidated.     

Characterization of normal tidal breathing flow-volume loops for Thoroughbred horses

The purpose of this study was to characterize the normal equine tidal breathing flow-volume loop (TBFVL). The study was performed using 18 healthy Thoroughbred horses. TBFVLs constructed from data collected from resting horses had a typical biphasic inspiratory and expiratory phase. The interindividual variability of the indices used to describe TBFVLs was in the range 16–32%, which is comparable to the variability of other measures of equine pulmonary mechanics. The large variability of these data probably limits the value of resting TBFVL indices for detecting subclinical respiratory conditions in individual horses. Factor analysis of these data revealed that in excess of 90% of the variance of the initial response variables could be explained in terms of three common factors. Varimax rotation of these three common factors provided three subsequent factors that were readily identifiable as (1) a factor describing the time-volume relationships of TBFVLs, responsible for 81% of the total variance, (2) a factor explaining the expiratory portion of the TBFVL, explaining 12% of the variance, and (3) a factor describing the inspiratory portion of the loops, responsible for the remaining 7% of the variance. The analysis also provided standardized factor scoring coefficients for use in subsequent studies using similar experimental techniques.Abbreviations EF₂₅ expiratory flow at expiratory volume plus 25%V _E - EF₅₀ midtidal expiratory flow - f respiratory rate - IF₂₅ inspiratory flow at 25% of inspiratory volume - IF₅₀ midtidal inspiratory flow - MSA measure of sampling adequacy - PEF peak expiratory flow - PIF peak inspiratory flow - TBFVL tidal breathing flow-volume loop - T _E expiratory time - T _I inspiratory time - USPTM ultrasonic pneumotachometer - V _E expiratory volume - V _I inspiratory volume     

Spectral analysis of respiratory noise in horses with upper airway disorders

REASONS FOR PERFORMING STUDY: It has long been recognised that the production of abnormal respiratory sounds by horses during exercise is frequently associated with upper airway obstructions. Respiratory acoustic measurements have shown promise in investigation of upper airway disorders in man and, more recently, in horses with experimentally-induced obstructions. OBJECTIVES: To evaluate sounds from exercising horses with naturally occurring dynamic obstructions of the upper respiratory tract and to compare these with those from normal horses in order to determine whether different obstructions produce characteristic spectral patterns. METHODS: The audio signal, airflow and videoendoscopic images were recorded simultaneously during an incremental exercise test on a high-speed treadmill. RESULTS: Spectral analysis of the audio signal showed marked differences between control and clinically afflicted horses. Dorsal displacement of the soft palate was characterised by a narrow low frequency (20-80 Hz) peak during expiration. Horses with dynamic laryngeal collapse produced inspiratory sounds characterised by a broad band high frequency spectral component in the range 1.1-2.7 kHz. CONCLUSIONS AND POTENTIAL RELEVANCE: Spectral analysis of respiratory sounds in horses has potential as a diagnostic technique for field use especially when facilities for high-speed treadmill assessment are not practicable.     

Laser vocal cordectomy fails to effectively reduce respiratory noise in horses with laryngeal hemiplegia

OBJECTIVE: To report the effect of unilateral laser vocal cordectomy on respiratory noise and airway function in horses with experimentally induced laryngeal hemiplegia (LH). STUDY DESIGN: Experimental study. ANIMALS: Six Standardbred horses without upper airway abnormalities at rest or during high-speed treadmill exercise. METHODS: Respiratory sounds and inspiratory trans-upper airway pressure (P(Ui)) were measured before (baseline) and 14 days after induction of LH by left recurrent laryngeal neurectomy, and again 30, 60, 90, and 120 days after endoscopically assisted laser cordectomy of the left vocal cord. Data were collected with the horses exercising on a treadmill at a speed producing maximum heart rate (HR(max)). RESULTS: In horses exercising at HR(max), induction of LH caused a significant increase in P(Ui), sound level (SL), and the sound intensity of formant 2 (F(2)) and 3 (F(3)). The sound intensity of formant 1 (F(1)) was unaffected by induction of LH. Laser vocal cordectomy had no effect on SL, or on the sound intensity of F(1) and F(3). At 30, 60, 90, and 120 days after surgery, P(Ui) and the sound intensity of F(2) were significantly reduced, but these variables remained significantly different from baseline values. CONCLUSIONS: Unilateral laser vocal cordectomy did not effectively improve upper airway noise in horses with LH. The procedure decreased upper airway obstruction to the same degree as bilateral ventriculocordectomy. CLINICAL RELEVANCE: Currently, laser vocal cordectomy cannot be recommended for the treatment of upper airway noise in horses with LH.     

Effects of stylopharyngeus muscle dysfunction on the nasopharynx in exercising horses

REASONS FOR PERFORMING STUDY: Nasopharyngeal collapse has been observed in horses as a potential cause of exercise intolerance and upper respiratory noise. No treatment is currently available and affected horses are often retired from performance. OBJECTIVE: To determine the effect of bilateral glossopharyngeal nerve block and stylopharyngeus muscle dysfunction on nasopharyngeal function and airway pressures in exercising horses. METHODS: Endoscopic examinations were performed on horses at rest and while running on a treadmill at speeds corresponding to HRmax50, HRmax75 and HRmax, with upper airway pressures measured with and without bilateral glossopharyngeal nerve block. RESULTS: Bilateral glossopharyngeal nerve block caused stylopharyngeus muscle dysfunction and dorsal nasopharyngeal collapse in all horses. Peak inspiratory upper airway pressure was significantly (P = 0.0069) more negative at all speeds and respiratory frequency was lower (P = 0.017) in horses with bilateral glossopharyngeal nerve block and stylopharyngeus muscle dysfunction compared to control values. CONCLUSIONS: Bilateral glossopharyngeal nerve anaesthesia produced stylopharyngeus muscle dysfunction, dorsal pharyngeal collapse and airway obstruction in all horses. POTENTIAL RELEVANCE: The stylopharyngeus muscle is probably an important nasopharyngeal dilating muscle in horses and dysfunction of this muscle may be implicated in clinical cases of dorsal nasopharyngeal collapse. Before this information can be clinically useful, further research on the possible aetiology of stylopharyngeus dysfunction and dysfunction of other muscles that dilate the dorsal and lateral walls of the nasopharynx in horses is needed.     

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.