Palatal sclerotherapy for the treatment of intermittent dorsal displacement of the soft palate in 51 standardbred racehorses

This retrospective study evaluated the efficacy and side effects of palatal sclerotherapy in standardbred racehorses suspected to have intermittent dorsal displacement of the soft palate (IDDSP). Fifty-one horses were treated with multiple endoscopically guided injections of 3% sodium tetradecyl sulfate in the soft palate. Two groups were identified: those that had respiratory noises during exercise (n = 27) and those that did not (n = 24). Treatment was well-tolerated. Furthermore, horses significantly reduced their racing times for the last 400 m compared with their times before treatment and even when their times were compared to the mean times for horses in the same race. In conclusion, palatal sclerotherapy appears to be a suitable alternative therapeutic option for horses suspected to have IDDSP.     

Histological and biomechanical effects of palatal sclerotherapy in the horse using sodium tetradecyl sulfate

Palatal sclerotherapy using sodium tetradecyl sulfate has been suggested as a treatment for dorsal displacement of the soft palate in young Standardbred horses. The present study evaluated histological and biomechanical changes in the equine soft palate following trans-endoscopic treatment with a low dose of this compound. Two horses were euthanased and examined at 2 weeks and at 1, 2, 4 and 6 months post-sclerotherapy, while two further horses served as untreated controls. The technique was easily performed in all cases without major complications. On histological examination there was no evidence of palatal necrosis, inflammation or fibrosis in any of the treated or control animals. There was no variation in the density of palatal connective tissue between individuals, and on biomechanical assessment no significant difference in the stiffness of the palatal tissue was found between treated and control horses at any time. The lower dose of sodium tetradecyl sulfate used in this study relative to previous reports, might explain the absence of tissue alterations. This method of sclerotherapy did not alter the morphology or biomechanical properties of normal equine soft palates.     

Sternothyrohyoideus myectomy in horses: 17 cases (1984-1985)

Review of medical records of 78 horses admitted to the George D. Widener Hospital for Large Animals with dorsal displacement of the soft palate revealed 94% of these horses to have evidence of an intermittent abnormal "gurgling" respiratory noise at the time of exercise. Sternothyrohyoideus myectomy was used as a primary treatment for 17 of these horses, with a success rate of 58%. Anatomic dissection of 30 horses indicated that the midcervical region is the optimal site for sternothyrohyoideus myectomy to alleviate dorsal displacement of the soft palate.     

Persistent dorsal displacement of the soft palate attributable to a frenulum of the epiglottis in a racing Thoroughbred

CASE DESCRIPTION: A 7-year-old sexually intact male Thoroughbred racehorse was evaluated because of exercise intolerance, respiratory tract noise, and coughing when eating. CLINICAL FINDINGS: A persistent dorsal displacement of the soft palate was identified during endoscopic examination of the upper portions of the respiratory tract. Radiography of the pharyngeal and laryngeal regions revealed a hypoplastic epiglottis that was ventral to, and not in contact with, the soft palate. The horse was anesthetized, and an oral endoscopic examination revealed a subepiglottic frenulum that had resulted in the dorsal displacement of the soft palate. TREATMENT AND OUTCOME: The frenulum was transected transendoscopically by use of a diode laser. Twenty-four hours following surgery, repeat endoscopic and radiographic examinations revealed that the epiglottis had returned to its correct anatomic position in relation to the soft palate. Four weeks after surgery, endoscopy of the upper portions of the airway revealed recurrence of the dorsal displacement of the soft palate. CLINICAL RELEVANCE: A subepiglottic frenulum should be considered as a cause of persistent dorsal displacement of the soft palate in horses. An endoscopic examination of the oropharyngeal region should be performed in horses prior to undertaking any surgical interventions to treat persistent dorsal displacement of the soft palate.     

Transendoscopic injection of poly-L-lactic acid into the soft palate in horses: A new therapy for dorsal displacement of the soft palate?

The purpose of this study was to establish a minimal invasive, transendoscopic technique for injection of poly-L-lactic acid into the free edge of the soft palate that can be performed on the standing sedated horse. Furthermore, whether the implant material induces an increase in fibrous tissue at the injection site, resulting in a greater rigidity of the soft palate, was determined.In 4 horses, the injection was performed bilaterally along the caudal margin of the soft palate, and the influence of the treatment on the soft palate function was determined. Clinical, radiographic and endoscopic examinations at rest were performed before and up to 168 days after injection according to a standardized examination protocol.In 6 horses, the implant material was injected unilaterally into the right half of the caudal margin of the soft palate. After clinical and endoscopic follow-up examinations, 2 horses each were killed 28, 84, and 168 days after the implantation procedure. At necropsy, macroscopic comparison of the treated and the untreated halves of the soft palate showed the influence on the size of the ostium intrapharyngeum and on the soft palate thickness. The localization of the implant material in the soft palate and the tissue response to the poly-L-lactic acid were evaluated histologically.Transendoscopic injection into the soft palate requires neither general anesthesia nor wound management, and it is noted for minimal tissue trauma. After injection, no alteration of the soft palate function was observed in horses with normal upper airway mechanics. One horse with intermittent dorsal displacement of the soft palate showed an improvement of the soft palate function for 112 days after implantation. No significant alteration in the size of the ostium intrapharyngeum was evident in any horse. Histologic assessment indicated the presence of implant material during the entire observation period of 168 days. The implant was accompanied by a granulomatous inflammation, and it was encapsulated by fibrous tissue. This may result in an increase in stiffness, and subsequent a greater rigidity of the soft palate, preventing it from displacement. The injection may therefore be considered an alternative to established therapies in horses showing dorsal displacement of the soft palate because of its unstable free edge.     

The displaced equine soft palate as a source of abnormal respiratory noise during expiration

REASONS FOR PERFORMING STUDY: To develop the technique of respiratory sound analysis for the diagnosis of dorsal displacement of the equine soft palate. OBJECTIVES: To show that 1) the displaced soft palate can spontaneously vibrate in the presence of expiratory airflow; 2) the observed frequency of vibration can be detected in respiratory sound recordings; and 3) the frequency of vibrations measured in cadaveric specimens are similar to those obtained from audio spectra in exercising horses with DDSP. METHODS: Palatal movements and respiratory sounds were recorded from artificially ventilated cadaveric heads. The fundamental mode of palate vibrations calculated from high-speed videoendoscopic recordings was compared with frequencies detected in the audio spectra and with data collected from exercising horses with DDSP. RESULTS: Palate vibrations occurred when air was blown through the trachea. The fundamental mode of vibrations was present in the audio spectra and was not significantly different from those recorded in vivo. CONCLUSIONS: Vibrations of the soft palate are the probable source of expiratory sounds recorded in horses with DDSP. POTENTIAL RELEVANCE: This study strengthens the case for the application of respiratory sound analysis in the diagnosis of DDSP in exercising horses.     

Use of transendoscopic contact neodymium:yttrium aluminum garnet laser to drain dorsal epiglottic abscesses in two horses

A submucosal abscess, located on the dorsal surface of the epiglottis, was diagnosed in 2 Thoroughbred racehorses by use of endoscopy. Both horses had exercise intolerance. One horse had intermittent dorsal displacement of the soft palate, coughed while eating and galloping, and made an abnormal respiratory noise. Both abscesses were drained transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. Eleven days after surgery, the surgical sites appeared to have healed. Clinical signs resolved permanently, and both horses returned to successful racing careers.     

ULTRASONOGRAPHIC ASSESSMENT OF LARYNGOHYOID POSITION AS A PREDICTOR OF DORSAL DISPLACEMENT OF THE SOFT PALATE IN HORSES

Dorsal displacement of the soft palate is an important cause of poor performance in racehorses, yet its etiology is not fully understood. Diagnosis requires treadmill videoendoscopy, which is not widely available. The relationship of the larynx, the hyoid apparatus, and the remainder of the skull may be important in predisposing horses to dorsal displacement of the soft palate. We hypothesized that this relationship could be accurately assessed in unsedated horses through ultrasonographic examination. Fifty-six racehorses presented for evaluation of poor performance were subjected to treadmill videoendoscopy and resting ultrasonography. Using ultrasound-assisted percutaneous measures of laryngo-hyoid position, the relationship between selected anatomic structures and the occurrence of dorsal displacement of the soft palate was evaluated. A significant relationship was found between the depth of the basihyoid bone at rest and the occurrence of dorsal displacement of the soft palate at exercise ( P =0.03). Other measures of laryngohyoid position were not found to be associated with dorsal displacement of the soft palate. Thus, there is an association between the occurrence of dorsal displacement of the soft palate at exercise and the resting position of the basihyoid bone, whereby on average a more ventral location of the basihyoid bone is present in horses with dorsal displacement of the soft palate. The pathophysiologic implications of this finding are not fully understood but, based on our findings, ultrasound examination is of value in assisting in the diagnosis of dorsal displacement of the soft palate.     

Evaluation of upper respiratory tract function during strenuous exercise in racehorses

Forty-six racehorses with a history of poor performance underwent endoscopic evaluation of laryngeal and pharyngeal function while exercising on a high-speed treadmill. This evaluation allowed the definitive diagnosis of intermittent or continual upper respiratory tract obstruction as a cause of poor performance, as well as the documentation of the dynamic functional anatomy of the obstruction. Ten of the horses (22%) were determined to have a functional abnormality of the upper respiratory tract. These abnormalities included epiglottic entrapment (1 horse), persistent dorsal displacement of the soft palate during exercise (4 horses), and left laryngeal hemiplegia (5 horses). Thirty-two horses were observed to have signs of left laryngeal hemiparesis (asynchronous arytenoid movement) at rest that did not impair full laryngeal abduction during strenuous exercise.     

Sternothyroideus Tenectomy Combination Surgery: Treatment Outcome in 95 Thoroughbred Racehorses (1996–2006)

This retrospective case series reports on the clinical experiences of a group of Thoroughbred racehorses in training that were treated surgically for intermittent dorsal displacement of the soft palate (DDSP) using sternothyroideus tenectomy in combination with soft palate surgery. The 95 horses included in the study were Thoroughbred racehorses in training referred for surgical treatment of intermittent DDSP over a 10-year period. Return to racing was 94% (89/95). Total earnings increased for up to three starts before and after surgery in 65% of horses (62/95, P= .0006). Of the 58 horses that raced in three or more races before and after surgery, 71% (41/58) improved their total earnings. Mean days to first start were 106 days. Performance index improved in 64% of these horses (37/58). Sixty of the 95 horses (63%) raced in six or more races after surgery. Sternothyroideus tenectomy combination surgery had a good prognosis for improving earnings and performance index after surgery in this group of horses that were treated for a working diagnosis of intermittent DDSP.     

Endoscopy of the upper respiratory tract during treadmill exercise: a clinical study of 100 horses

SUMMARY: Endoscopy of the upper respiratory tract was performed in 100 horses during high speed treadmill exercise. Reasons for endoscopy were a history of an abnormal noise during exercise in 75 horses, poor performance in 17 horses and to evaluate the results of upper respiratory tract surgery in 8 horses. Of the 75 horses with a history of an abnormal noise during exercise the cause was determined in 67 (89%). Endoscopic abnormalities were detected at rest in 40 of these 75 horses (53%). In these 40 horses, a similar diagnosis as to the cause of the abnormal noise was made at rest and during exercise on the treadmill in 19 cases, while in the remaining 21 the endoscopic findings during exercise varied from that seen at rest. This included 3 horses in which a diagnosis was made at rest but no abnormalities were detected during exercise. Some of the findings during treadmill endoscopy included laryngeal dysfunction, grades 3, 4 and 5 (22 cases), dorsal displacement of the soft palate (20), epiglottic entrapment (8), epiglottic flutter (4), aryepiglottic fold flutter (4), pharyngeal collapse (3), arytenoiditis (3), vocal cord flutter (3), false nostril noise (2), pharyngeal lymphoid hyperplasia (2), soft palate haemorrhage (1) and positional arytenoid collapse (1). More than one abnormality was observed during exercise in 7 horses. A complete and correct diagnosis based on the resting endoscopy findings alone was made in 19 (25%) of these 75 cases. In the 17 horses examined because of poor performance, no abnormalities were detected during treadmill endoscopy that were not evident at rest. None of these 17 horses presented with a history of an abnormal respiratory noise, although one, diagnosed as having grade 4 laryngeal function at rest and exercise, did make a characteristic inspiratory noise during treadmill exercise. Eight horses were evaluated after surgery for correction of laryngeal hemiplegia, as the post-operative performance or the amount of respiratory noise present was considered unsatisfactory. Of these, 3 were found to have a satisfactory airway during exercise and other reasons for poor performance were detected; 3 had insufficient abduction; and 2 had intermittent dorsal displacement of the soft palate. Endoscopy of the upper respiratory tract was found to be a useful technique for evaluating the cause of abnormal respiratory noise in most cases. We concluded that treadmill endoscopy in horses presented for poor performance, without a history of an abnormal respiratory noise, was of little value. The technique, in conjunction with arterial blood gas measurements, was useful in determining the efficacy of surgical treatment of laryngeal hemiplegia.     

Successful treatment of persistent dorsal displacement of the soft palate and evaluation of laryngohyoid position in 15 racehorses

Reasons for performing study: Caudal descent of the larynx has been proposed to be associated with intermittent dorsal displacement of the soft palate (DDSP) as it leads to a loss of the seal between the epiglottis and soft palate but further investigation of this theory is required. Objectives: To evaluate laryngohyoid position of horses with persistent DDSP in comparison to horses with intermittent DDSP and evaluate the outcome of treatment. Hypotheses: Horses with persistent DDSP have a different laryngohyoid position compared to those with intermittent DDSP. Horses with persistent DDSP can be returned successfully to racing with a laryngeal tie‐forward procedure. Methods: Medical records of 15 racehorses presented for persistent DDSP between 2002 and 2007 were reviewed. Age, sex and breed matched horses diagnosed with intermittent DDSP were used as a comparison group. Treatment of all horses was performed by laryngeal tie‐forward, 8/15 horses with persistent DDSP had a subsequent laser staphylectomy. Preoperative laryngohyoid position was compared between the 2 groups using a radiographic reference system. Surgical effect on position was assessed by comparing pre‐ and post operative radiographic measurements. Outcome was assessed by return to racing and comparison of pre‐ and post operative race earnings ($). Results: Thirteen of 15 horses with persistent DDSP returned to racing. Seven of 15 horses were treated with laryngeal tie‐forward alone while 8/15 horses were also treated with a laser staphylectomy. Horses with persistent DDSP had a more caudal larynx (ossification of the thyroid cartilage) (13 mm, P = 0.014), a more caudal (10 mm, P = 0.044) and dorsal (7 mm, P = 0.01) basihyoid bone, and a more dorsal thyrohyoid‐thyroid articulation (10 mm, P = 0.002) than horses with intermittent DDSP. Conclusions and potential relevance: Racehorses with persistent DDSP can be treated successfully by laryngeal tie‐forward or by laryngeal tie‐forward followed by laser staphylectomy. Horses with persistent DDSP have a more caudal larynx and more caudal and dorsal basihyoid bone than horses with intermittent DDSP.     

High-speed treadmill videoendoscopic examination of the upper respiratory tract in the horse: the results of 291 clinical cases

The purpose of the study was to describe the prevalence of upper airway abnormalities and establish if any significant associations existed between study variables and the two most frequently identified disorders; axial deviation of the aryepiglottic folds and dorsal displacement of the soft palate. The clinical records and video-recordings of all horses referred for upper respiratory tract evaluation during high-speed treadmill videoendoscopy between November 1997 and September 2003 were reviewed. Of 291 horses included in the study, 265 underwent resting endoscopy and 42% (112/265) had a recognised abnormality. More than one abnormality was identified in 49% of horses. In general, horses referred specifically for evaluation of a respiratory tract noise were more likely to have an abnormality detected during exercise than those referred for high-speed treadmill videoendoscopy for poor performance (82% versus 49%). Axial deviation of the aryepiglottic folds (105/192, 55%) was the most common abnormality identified, followed by dorsal displacement of the soft palate (74/192, 39%) and idiopathic left laryngeal hemiplegia (65/192, 34%). Other abnormalities identified included arytenoid collapse, vocal fold collapse, dynamic pharyngeal collapse, epiglottic fold entrapment, epiglottic retroversion, rostral displacement of the palatopharyngeal arch and right laryngeal hemiplegia. In horses with axial deviation of the aryepiglottic folds there was a significant association between the increasing severity of the deviation and the increasing number of abnormalities detected. There were no other associations found. High-speed treadmill videoendoscopy is an important component of the evaluation of poor performance, particularly in horses with a history of respiratory noise. The occurrence of multiple abnormalities in a large proportion of horses suggests that high-speed treadmill videoendoscopy should be recommended, where possible, to make an accurate diagnosis, advise on appropriate treatment options and provide a prognosis for affected horses.     

Transendoscopic electrosurgery for epiglottal entrapment in the horse

Monopolar electrosurgical cutting was used to correct epiglottal entrapment in 5 horses. The operations were carried out in the conscious animal, using topical anesthesia. The procedure required the use of a coagulation electrode designed specifically for electrosurgery, introduced through the instrument channel of a fiberoptic endoscope. The results were satisfactory and serious complications were not encountered. In 2 horses, excessive submucosal swelling developed at the site of the surgical wound, and the tumefaction took several weeks to subside in one of these horses. In both horses, the long-term outcome was a minor degree of reentrapment. The main advantages of this technique, compared with other corrective procedures, related to the avoidance of the need for general anesthesia and laryngotomy, allowing racehorses to be treated without any major interruption in their training schedules. The surgery was simple, rapid, and bloodless, and was not followed by any dorsal displacement of the soft palate. It was suggested that transendoscopic electrosurgery has potential for use in the treatment of a number of other diseases of the respiratory tract and other systems, both in the horse and in other species. In the equine respiratory tract, the technique might usefully be applied to the treatment of guttural pouch tympany, soft palate cysts, nasopharyngeal polyps, choanal atresia, subepiglottic cysts, and tracheal granulomata. A review of 21 cases of epiglottal entrapment in horses revealed no evidence to support the suggestion that dorsal displacement of the soft palate is a cause of epiglottal entrapment or vice-versa.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of race winnings, ratings and a performance index to assess the effect of thermocautery of the soft palate for treatment of horses with suspected intermittent dorsal displacement. A case-control study in 110 racing Thoroughbreds

REASONS FOR PERFORMING THE STUDY: There have been no reports of the efficacy of thermocautery of the soft palate (TSP) assessed objectively as a treatment of intermittent dorsal displacement of the soft palate (DDSP). OBJECTIVE: To compare: racing performance of horses that underwent thermocautery of the soft palate with matched controls; and 'Racing Post ratings' (RPR) with prize money won (RE) and a performance index (PI) for each of the horses in the study. HYPOTHESIS: Thermocautery of the soft palate has no beneficial effect on racing performance and the 3 measures of performance are significantly related. METHODS: The inclusion criteria were fulfilled by 110 horses and each was matched with 2 controls. Changes in performance were compared statistically. RPR, RE and PI were analysed using a regression model. RESULTS: The percentage of horses that improved in performance following the procedure was 28-51% for the 3 measures of performance, compared to 21-53% for the matched controls. There was no significant effect of the procedure on the changes in RPR or RE. There was a significant effect of the procedure on the change in PI (P=0.015) with more treated horses achieving an improved PI and fewer acquiring a worse PI than matched control horses. The measures of performance showed significant correlation. CONCLUSIONS: Thermocautery of the soft palate alone may not be the most efficacious treatment of DDSP. POTENTIAL RELEVANCE: Production of a reliable measure of racehorse performance may be possible.     

Epiglottic entrapment by arytenoepiglottic folds in the horse

An abnormality of the epiglottis and arytenoepiglottic folds that caused epiglottic entrapment was diagnosed in 21 horses. Until recently, this entrapment was poorly understood. Definitive diagnosis of epiglottic entrapment can be made only by endoscopic examination of the epiglottis, arytenoepiglottic folds, and soft palate to differentiate the abnormality from dorsal displacement of the soft palate. Dorsal displacement of the soft palate is often associated with entrapped epiglottis. Epiglottic deformity, especially hypoplasia, is often associated with the entrapment. The abnormality was detected in horses 1 to 16 years old. Because of the relatively large number of young animals (11 being less than or equal to 2 years old), a congenital predisposition was suggested. This suggestion was strengthened by the fact that many of the horses had deformities of the epiglottis that were considered congenital. Because some of the horses had trained and raced satisfactorily before signs of upper airway obstruction developed, it was assumed that the abnormality may be a sequel to epiglottic injury.     

Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty for treatment of dorsal displacement of the soft palate in 102 thoroughbred racehorses

Objective— To compare racing performance before and after sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty in Thoroughbred racehorses with intermittent dorsal displacement of the soft palate (DDSP).
Study Design— Retrospective study.
Animals— Thoroughbred racehorses (n=102) with DDSP.
Methods— Retrieved data included signalment, primary complaint, and upper respiratory tract endoscopic finding. Lifetime race records were compared for earnings per start before and after surgery, days to 1st start, and races won postoperatively.
Results— Comparing mean earnings per start for 3 races before ($2792) and after ($3806) surgery, racing performance improved significantly after surgery in 63% (46/73) of horses that competed in at least 1 race before and after surgery ( P =.02). Mean and median days to 1st start after surgery were 109 and 69 days, respectively. Of horses that raced postoperatively 65% (60/92) won at least 1 race, and 77% (71/92) raced in >5 races after surgery.
Conclusions— Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty significantly improved racing performance in experienced Thoroughbred racehorses with performance limiting DDSP, and overall had a similar outcome to other reported surgical techniques for treatment of DDSP.
Clinical Relevance— Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty should be considered as a surgical approach to correction of DDSP in Thoroughbred racehorses; however, it is possible that staphylectomy may not be necessary to achieve a desirable outcome.     

A novel approach for palatal cyst ablation in a horse

An 18-month-old Welsh Cob was referred to a university teaching hospital for investigation of abnormal respiratory noise at rest. Video-endoscopy revealed persistent displacement of the soft palate with bilateral 2–3 cm diameter raised areas on either side of the midline. Neither trans-nasal nor oral approaches allowed sufficient visualisation of the caudal soft palate for diagnosis or treatment. Latero-lateral radiographs showed a blunted, thickened caudal edge of the soft palate consistent with a palatal cyst. Two palatal cysts were thermally ablated with a transendoscopic diode laser via temporary tracheotomy. The horse recovered uneventfully and resolution of the displacement was evident on follow-up endoscopy 11 months later. This report documents a novel surgical approach to the caudal aspect of the soft palate.     

Electromyographic activity of the palatinus and palatopharyngeus muscles in exercising horses

REASONS FOR PERFORMING STUDY: Determining the respiratory related activity of the palatinus and palatopharyngeus muscles in exercising horses is relevant because dysfunction of these muscles has been implicated in the pathogenesis of dorsal displacement of the soft palate. OBJECTIVE: To determine if the palatinus and palatopharyngeus muscles have respiratory activity that increases with intensity in exercising horses. METHODS: Electromyographic activity was measured in the palatinus and palatopharyngeus muscles using bipolar fine-wire electrodes while the horses completed an incremental exercise treadmill protocol. RESULTS: Both muscles displayed synchronous expiratory activity that increased significantly (P < 0.05) with exercise intensity. Phasic expiratory activity of the palatinus increased 390 +/- 98%, whereas phasic expiratory activity of the palatopharyngeus increased by 198 +/- 30% as the treadmill speed increased from 6 to 12 m/s. CONCLUSIONS: The palatinus and palatopharyngeus muscles may be important respiratory muscles, functioning to stabilise the position of the soft palate during intense exercise. CLINICAL RELEVANCE: The predominant expiratory activity of these muscles may be associated with specific muscle function related to exercise or distinct upper airway phenomena of an obligate nasal breather, such as the horse.     

Exercising upper respiratory videoendoscopic evaluation of 100 nonracing performance horses with abnormal respiratory noise and/or poor performance

Reasons for performing study: Although well documented in racehorses, there is paucity in the literature regarding the prevalence of dynamic upper airway abnormalities in nonracing performance horses. Objective: To describe upper airway function of nonracing performance horses with abnormal respiratory noise and/or poor performance via exercising upper airway videoendoscopy. Methods: Medical records of nonracing performance horses admitted for exercising evaluation with a chief complaint of abnormal respiratory noise and/or poor performance were reviewed. All horses had video recordings of resting and exercising upper airway endoscopy. Relationships between horse demographics, resting endoscopic findings, treadmill intensity and implementation of head and neck flexion during exercise with exercising endoscopic findings were examined. Results: Dynamic upper airway obstructions were observed in 72% of examinations. Head and neck flexion was necessary to obtain a diagnosis in 21 horses. Pharyngeal wall collapse was the most prevalent upper airway abnormality, observed in 31% of the examinations. Complex abnormalities were noted in 27% of the examinations. Resting laryngeal dysfunction was significantly associated with dynamic arytenoid collapse and the odds of detecting intermittent dorsal displacement of the soft palate (DDSP) during exercise in horses with resting DDSP was only 7.7%. Exercising endoscopic observations were different from the resting observations in 54% of examinations. Conclusions: Dynamic upper airway obstructions were common in nonracing performance horses with respiratory noise and/or poor performance. Resting endoscopy was only helpful in determining exercising abnormalities with recurrent laryngeal neuropathy. Potential relevance: This study emphasises the importance of exercising endoscopic evaluation in nonracing performance horses with abnormal respiratory noise and/or poor performance for accurate assessment of dynamic upper airway function.