Variability of resting endoscopic grading for assessment of recurrent laryngeal neuropathy in horses

Reasons for performing study: The extent to which variability affects endoscopic grading of arytenoid cartilage movement is uncertain. Objective: To determine the observer and within horse variability of grading arytenoid cartilage movement in horses during resting endoscopic examination, using a 7‐grade system. Methods: Endoscopic recordings of the upper respiratory tract made at rest in 270 draught horses were reviewed independently by 2 veterinarians to assess interobserver variability when scoring horses' laryngeal function with a 7‐grade system. Grading was repeated by both examiners in 80 randomly selected recordings in order to assess intraobserver variability. In 120 horses, endoscopy was repeated after 24–48 h, with videos graded by both veterinarians to assess intrahorse variability. Results: The mean weighted κ statistic for concordance within examiners was 0.867, with a mean intraobserver agreement of 76.3%. The weighted κ statistic for concordance between the 2 examiners was 0.765, with an interobserver agreement of 63.1%. Of the horses receiving 2 endoscopic examinations, the same grade was assigned to 57.1% of horses at the second examination, when effects resulting from interobserver variability were removed. The mean weighted κ statistic for concordance between the grade assigned at first vs. second examinations was 0.588, indicating only moderate agreement. Conclusions and potential relevance: Intra‐ and interobserver reliability of resting endoscopic grading of arytenoid cartilage movement using a 7‐grade system was high when examinations were conducted by experienced veterinarians. However, there was moderate daily intrahorse variability, suggesting that results of resting endoscopic examinations performed on a single day should be interpreted with caution.     

Histological and ultrastructural evidence that recurrent laryngeal neuropathy is a bilateral mononeuropathy limited to recurrent laryngeal nerves

Reasons for performing study: Recurrent laryngeal neuropathy (RLN) is a common and debilitating peripheral nerve disease of horses, but it remains unclear if this disease is a mono‐ or polyneuropathy. An understanding of the distribution of the neuropathological lesions in RLN affected horses is fundamental to studying the aetiology of this very significant disease of tall horses. Objective: To determine whether RLN should be classified as a mono‐ or polyneuropathy. Methods: Multiple long peripheral nerves and their innervated muscles were examined systematically in 3 clinically affected RLN horses Results: Severe lesions were evident in the left as well as right recurrent laryngeal nerves in all horses, both distally and, in one case, also proximally. No primary axonal lesions were evident in other nerves nor were changes found in their innervated muscles. Conclusions: RLN is not a polyneuropathy but should be classified as a bilateral mononeuropathy. Potential relevance: Genetic and local factors specifically affecting the recurrent laryngeal nerves in RLN‐affected horses should now be investigated further.     

Pathological classification of equine recurrent laryngeal neuropathy

Recurrent Laryngeal Neuropathy (RLN) is a highly prevalent and predominantly left‐sided, degenerative disorder of the recurrent laryngeal nerves (RLn) of tall horses, that causes inspiratory stridor at exercise because of intrinsic laryngeal muscle paresis. The associated laryngeal dysfunction and exercise intolerance in athletic horses commonly leads to surgical intervention, retirement or euthanasia with associated financial and welfare implications. Despite speculation, there is a lack of consensus and conflicting evidence supporting the primary classification of RLN, as either a distal (“dying back”) axonopathy or as a primary myelinopathy and as either a (bilateral) mononeuropathy or a polyneuropathy; this uncertainty hinders etiological and pathophysiological research. In this review, we discuss the neuropathological changes and electrophysiological deficits reported in the RLn of affected horses, and the evidence for correct classification of the disorder. In so doing, we summarize and reveal the limitations of much historical research on RLN and propose future directions that might best help identify the etiology and pathophysiology of this enigmatic disorder.     

Fifty years of recurring struggles with recurrent laryngeal neuropathy

Recurrent laryngeal neuropathy appears to be a simple problem that should have a simple solution, yet the complexity and dynamic nature of laryngeal function is underappreciated. This review highlights the challenges and accomplishments that work towards that greater understanding of what is necessary to find a successful solution.     

Effect of ventriculectomy versus ventriculocordectomy on upper airway noise in draught horses with recurrent laryngeal neuropathy

Reasons for performing study: Little is known about the efficacy of bilateral ventriculectomy (VE) or bilateral ventriculocordectomy (VCE) in draught horses. Objectives: To compare the effect of VE and VCE on upper airway noise in draught horses with recurrent laryngeal neuropathy (RLN) by use of quantitative sound analysis techniques. Hypothesis: In competitive draught horses with grade 4 RLN, VE and VCE reduce upper airway noise during exercise, but VCE is more effective. Methods: Thirty competitive hitch or pulling draught horses with grade 4 RLN were evaluated for upper airway sound during exercise. Respiratory rate (RR), inspiratory (Ti) and expiratory time (Te), the ratio between Ti and Te (Ti/Te), inspiratory (Sli) and expiratory sound levels (Sle), the ratio between Sli and Sle (Sli/Sle), and peak sound intensity of the second formant (F2) were calculated. Eleven horses were treated with VE and 19 with VCE. After 90 days of voice and physical rest and 30 days of work, the horses returned for post operative upper airway sound evaluation and resting videoendoscopy. Results: VE significantly reduced Ti/Te, Sli, Sli/Sle and the sound intensity of F2. Respiratory rate, Ti, Te and Sle were unaffected by VE. VCE significantly reduced Ti/Te, Ti, Te, Sli, Sli/Sle and the sound intensity of F2, while RR and Sle were unaffected. The reduction in sound intensity of F2 following VCE was significantly greater than following VE. After VE and VCE, 7/11 (64%) and 15/18 (83%) owners, respectively, concluded that the surgery improved upper airway sound in their horses sufficiently for successful competition. Conclusions: VE and VCE significantly reduce upper airway noise and indices of airway obstruction in draught horses with RLN, but VCE is more effective than VE. The procedures have few post operative complications. Potential relevance: VCE is recommended as the preferred treatment for RLN in draught horses. Further studies are required to evaluate the longevity of the procedure's results.     

Surgical management of recurrent laryngeal neuropathy

Recurrent laryngeal neuropathy (RLN, laryngeal hemiplegia, laryngeal paralysis, ‘roaring’) is common in the equine industry with a prevalence ranging from 2.6–11% in light breeds ( Raphel 1982 ; Lane 1987 ; Morris and Seeherman 1990 ) up to 38% in draught breeds ( Brakenhoff et al. 2006 ; Perkins et al. 2009 ). There are a number of different surgical treatments currently available and more being developed. This article aims to discuss factors affecting choice of treatment and then provide an evidence‐based approach to describe surgical approaches, success rates and morbidity. Specific details of surgical methods are not given as they are readily available in surgical textbooks ( Stick 2006 ; McGorum et al. 2007 ).     

A review of recent developments in the clinical application of prosthetic laryngoplasty for recurrent laryngeal neuropathy: Indications,complications and outcome

Recurrent laryngeal neuropathy (RLN) has been recognised for two centuries in horses. Surveys undertaken in Europe and the United States have reported that prosthetic laryngoplasty is the most common treatment for RLN, particularly for advanced cases. Despite widespread adoption of this surgical technique for treatment of RLN, reported success rates still vary widely, particularly in horses used for high intensity exercise where outcomes are often considered moderate, at best. Studies evaluating the outcome of the procedure are complicated by the use of variable criteria for measuring success, various modifications in the procedure, differing athletic demands in horses used in different equine disciplines and horses lost to follow‐up. Furthermore, post operative complications appear to be common, in particular, the effects of the surgery on airway dynamics which are not completely understood. Proposed modifications to the technique may provide a means of improving success rates; however, standardised objective measurements taken before and after surgery are required to effectively evaluate the potential benefits and outcomes of the procedure.     

Temporary right recurrent laryngeal neuropathy in a horse associated with a left prosthetic laryngoplasty procedure

Right recurrent laryngeal neuropathy (RLN) is an uncommon, acquired disease for which the aetiology can frequently be diagnosed. Numerous aetiologies have been proposed for right‐sided RLN which comprises 2% of all cases of RLN. In this report we discuss the clinical course, treatment and outcome following right‐sided laryngeal paralysis as a complication of left‐sided prosthetic laryngoplasty in a horse. To the authors' knowledge, this is the first report of such a surgical complication.     

Diagnosis of laryngeal dysplasia in five horses using magnetic resonance imaging and ultrasonography

Reasons for performing study: Laryngeal dysplasia due to suspected maldevelopment of the fourth branchial arch has been reported previously in the horse and has been associated with rostral displacement of the palatopharyngeal arch and/or right laryngeal dysfunction. These studies all described the endoscopic and/or anatomical post mortem identification of the disease, but ultrasonography or magnetic resonance imaging (MRI) of this disease have not been described. Hypothesis: MRI and ultrasound findings accurately reflect the anatomical features of presumptive fourth branchial arch abnormality and allow accurate ante mortem diagnosis of this condition and, therefore, appropriate management. Methods: Between February 2008 and January 2009, all horses examined at Rood and Riddle Equine Hospital diagnosed with rostral displacement of the palatopharyngeal arch and/or right laryngeal dysfunction using upper airway endoscopy (n = 5) underwent ultrasonography and MRI of the laryngeal region. Results: All 5 horses that met the inclusion criteria were identified and all underwent laryngeal MRI and ultrasound examinations. Features consistent with laryngeal dysplasia, including lack of the cricothyroid articulation, dorsal extension of the thyroid cartilage lamina, and absence or hypoplasia of the cricopharyngeus muscle, were seen in all cases using both types of imaging. Conclusions and potential relevance: MRI and ultrasonography permit definitive premortem diagnosis of laryngeal dysplasia. Upper airway abnormalities identified using endoscopy can be more fully characterised using MRI and ultrasonography allowing more appropriate recommendations to be made. Preoperative imaging may also prevent inappropriate surgical intervention.     

Evaluation of laryngeal function under the influence of various head and neck positions during exercise in 58 performance horses

The objective of this study was to examine laryngeal function at rest and during ridden exercise and to further analyse the impact of different head and neck positions on the laryngeal function in ridden sport horses. Fifty‐eight Warmblood horses were examined endoscopically during ridden exercise as well as during quiet breathing at rest before and after sedation. Four different head‐neck positions (unrestrained, reference, elevation and hyperflexion) were assessed during the exercise test. Laryngeal function was graded at rest and for every combination of gait and head and neck position during exercise. There was a significant correlation between the grade of laryngeal function during exercise and at rest both before (correlation coefficient = 0.794) and after (correlation coefficient = 0.741) sedation (P<0.01). No significant association was found between the grade of laryngeal function during exercise and the different head and neck positions.     

Multiple immunofluorescence labelling enables simultaneous identification of all mature fibre types in a single equine skeletal muscle cryosection

Skeletal muscle is composed of a heterogeneous mixture of several fibre types, each with specific physiological properties. In equine muscle, identification of these individual fibres (fibre typing) is important for both exercise physiology and pathological studies. Traditionally, fibre typing has been achieved by adenosine triphosphatase (ATPase) histochemistry or by immunoperoxidase labelling with antibodies directed at myosin heavy chain isoforms. ATPase histochemistry can be temperamental and lacks specificity, and both techniques require staining of serial cryosections to reveal the entire fibre type compliment of a single sample, which is time consuming and prone to inaccuracy. Here we describe an immunofluorescence labelling technique that enables rapid, accurate and specific identification of the 3 mature equine muscle fibre types in a single cryosection.     

Changes in muscle fiber type and expression of mRNA of myosin heavy chain isoforms in porcine muscle during pre‐ and postnatal development

The purpose of this study is to elucidate developmental changes in muscle fiber type in the pig during pre‐ and postnatal development. For this purpose, we performed a histochemical analysis for myosin adenosine triphosphatase activity to assess muscle fiber type and determined abundances of messenger RNA (mRNA) of myosin heavy chain (MHC) isoforms. Samples of Longissimus dorsi (LD) muscle were taken from fetuses on day 90 of the fetal stage. Further, samples of LD, Rhomboideus and Biceps femoris (B. femoris) muscles were taken from pigs when they were 1, 12, 26, 45 or 75 days old. Expression of MHC 2b mRNA in the LD and the B. femoris muscles rapidly and considerably increased from the late fetal stage to the early postnatal stage and this increase was associated with the development of type 2b fibers at least in the LD muscle. As shown by the rapid and considerable changes in expression of MHC 2b mRNA, it seems that a certain plasticity of muscle fiber type still remains in this developmental stage.