URT nosie

Question 1

what are the reasons for treating URT noise?

Answer 1

• Dyspnoea - difficulty breathing
• Cosmetics
• Poor performance
  ◦ URT causes60% of airflow resistance in resp tract
  ◦ decrease in diameter, increase resistance
  ◦ decrease O2 delivery
• Other
  ◦ Dysphagia

Question 2

what is done to diagnose URT noise

Answer 2

• History
  ◦ when is the noise made, all though exercise, only at a certain time
• Examination of the URT at rest
• Dynamic observation
  ◦ Vary exercise intensities
  ◦ Consider effect of tack
  ◦ inspiratory or expiratory noise
• Static respiratory endoscopy
• Overground dynamic endoscopy
• Also consider radiography, CT and occasionally ultrasonography

Question 3

what pathologies can occur at the level of the nostril in horses? what are the treatments for these?

Answer 3

• Epidermal inclusion cysts (atheromas)
  ◦ cosmetic
  ◦ need to take out the cyst sack if not will come back
• Redundant alar folds
• Lacerations affecting nostrils
  ◦ when heal cause a reduction in size - decreased airflow

Treatment
* Relatively straightforward
* Main aims are restoration of normal anatomy and good cosmetic effect

Question 4

what congenital condition can affect the nose of horses?

Answer 4

‘Wry nose’
* Reconstruction can be complicated and expensive depending on degree of deviation
often euthanasia

Question 5

name the paranasal sinuses?

Answer 5

Caudal group:
* Caudal maxillary
* Dorsal conchal
* Frontal
* Sphenopalatine
Rostral group:
* Rostral maxillary
* Ventral conchal

Septum between caudal and rostral maxillary sinuses (variable location usually 5cm from rostral aspect of facial crest).
Both maxillary sinuses open into caudal middle meatus via nasomaxillary aperture

Question 6

what is the connection fo the teeth and the sinuses in horses?

Answer 6

• Tooth roots of 4th, 5th and 6th cheek teeth lie within the maxillary sinuses
  ◦ infection causes sinusitis
• Roots of 3rd cheek tooth forms rostral wall of rostral maxillary sinus
  ◦ infection may cause sinusitis

Question 7

what are the conditions that affect the nasal passages in horses and what is the treatement?

Answer 7

Masses
* Fungal granuloma
* Neoplasia
* Ethmoid haematoma

Treatment
Attempt transendoscopic removal

Question 8

when is sinus surgery indicated in horses?

Answer 8

• Expansive lesions in paranasal sinus e.g. sinus cyst, neoplasia, ethmoid haematoma, tooth root abscess
• Primary sinusitis
• Severe trauma of facial bones

Question 9

what condition causes a rattleing noise on exhalation in horses? when is it normally heard? what is the treatment for it?

Answer 9

Intermittent Dorsal Displacement of the Soft Palate, often at the end of exercise
treatment - * Tie forward (prosthesis to replace thyrohyoid muscle) – currently most popular and best success rate (80%)

Question 10

what condition occurs to the pharynx in horses and may be associated with gutterap pouch tympany and dorsal displacement of the soft palate?

Answer 10

dynamic pharyngeal collapse
* Collapse of pharyngeal wall when negative pressure highest

Question 11

what congenital condition affects the pharynx in horses?

Answer 11

cleft palate
* Nasal reflux of milk / food material and aspiration pneumonia
* Uncommon
* Diagnosed on endoscopy
* Poor prognosis - recurrent infections and poor athletic function - typically euthanised
* Surgery - poor success rate - not really justified ethicaly

Question 12

what are the complications from recurent laryngeal neuropathy surgery?

Answer 12

• Dysphagia – arytenoid cartilages come together when swallowing, and the epiglottis flips up, if the cartilage is tied back they can’t come together)
• Aspiration pneumonia (temporary or permanent)
• Avoid excessive abduction
• Implant failure with laryngoplasty

Question 13

what laryngeal condition is assocciated with high pitched noise on inspiration? what is the treatment?

Answer 13

Recurrent laryngeal neuropathy
* Typically idiopathic condition
* Grading system:
* At rest/exercise 1 to 4 (seven overall grades)

Treatment options:
* Laryngoplasty (tie back)
* Ventriculectomy (Hobday)
* Ventriculocordectomy
* Arytenoidectomy
* Neuromuscular pedicle graft

Question 14

what is arytenoid chondropathy? how is it diagnosed?

Answer 14

A pathologic enlargement of one or both bilateral arytenoid cartilages resulting in poor performance, respiratory noise, and respiratory obstruction.

Diagnosis
* Endoscopy (resting)
◦ Size—compare to other side (tricky if bilateral)
◦ Mucosa—loss of “bumps”, breaks in surface
◦ Drainage, granulation tissue
* Palpation—rounded muscular process

Question 15

how is arytenoid chondropathy treated?

Answer 15

Medical
* Antimicrobial
* Anti-inflammatories
◦ systemic and local
◦ Very important acutely
* Often improves significantly

Surgical
* Local excision (via endoscope or laryngotomy)
* Arytenoidectomy—failure of medical management
* Permanent tracheostomy
◦ esp if bilateral

Question 16

what is Medial deviation of the aryepiglottic folds ? what is the treatment?

Answer 16

A condition in which the aryepiglottic folds collapse during strenuous exercise, partially obstructing the upper respiratory tract.
* Laser surgery to remove excess tissue (Can be done surgically under GA if no laser available)

Question 17

what congenital and developemtal conditon affects the epiglotis in horses? what is the treatment?

Answer 17

Subepiglottic cysts or granulomas
Treatment by removal
- surgical excision through laryngotomy
- oral removal using or snare wire

Good prognosis

Question 18

what are the 4 treatment options for epiglotic entrapment?

Answer 18

1. Axial division per os
2. Resection of aryepiglottic folds
3. Axial division per nasum
4. Transendoscopic laser division

All have complications – make sure you cut the right structure!
2, 3 and 4: no requirement for general anaesthesia

Question 19

what are the surgeries that are done to the trachea?

Answer 19

Most tracheal surgeries performed to bypass nasal passages, pharynx or larynx
◦ Tracheotomy (temporary)
◦ Tracheostomy (permanent)
* Intra-tracheal lesions ie foreign bodies, granulomas, neoplasia
* Tracheal collapse

Question 20

how is a tracheostomy performed?

Answer 20

• Creation of a permanent stoma
• Normally performed under anaesthesia
• Partial resection of cartilage rings then mucosa sutured to skin
• Wound care and aftercare is significant, and the owner should be advised of this beforehand
• Potential complications include pulmonary infection and drowning

Question 21

how is a teacheotomy performed?

Answer 21

• Performed in the cranial or mid third of neck - midline dissection to trachea (avoiding neurovascular structures)
• Incision made between and parallel to cartilage rings (DO NOT CUT RINGS)
• Tracheotomy tube (self-retaining silicone or metal J tubes) placed and secured with sutures or bandage
• Aftercare - basic wound management and removing excess discharge

Question 22

what are three conditions that affect the gutteral pouch, what is the treatments for each of them?

Answer 22

Tympany – airflow in and out is not working properly, air goes in and can’t get out
* Fenestration of median septum (unilateral)
* Resection of plica salpingopharangeus
* Salpingopharangeal fistula

Empyema - puss
* Lavage via a Foley catheter

Chondroids – lumps of consolidated puss (eg after strangles)
* Basket removal
* Lavage
* Surgery