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Module 9 > Upper Resp. Tract Noise In Companion Animals > Flashcards

Upper Resp. Tract Noise In Companion Animals Flashcards

1
Q

what does athletic function in equines require

A
  1. low resistance
  2. high capacity
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2
Q

where does most airway resistance occur

A

80-90% is from upper airways

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3
Q

what occurs to airway resistance during exercise

A

increases by 80%

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4
Q

what occurs if diameter of airway reduces

A

if diameter reduces by 20% airway resistance doubles

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5
Q

what are the clinical signs of upper respiratory tract disease

A
  1. asymptomatic
  2. resp noise with or without exercise intolerance
  3. at gallop, stride rate and resp rate are coupled
  4. at trot, breathing and stride are independent
  5. dysphagia, nasal reflux of food material and/or cough
  6. resp. distress –> loud abnormal resp noise, nasal flaring, reduced nasal airflow, extended and low head position, increased resp rate and effort, severe cases may have cyanotic mucous membranes
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6
Q

what is the difference between stridor and stertor in dogs

A
  1. stridor –> harsh inspiratory noise at exercise, laryngeal paralysis, quiet at rest, profound dyspnoea at light exercise
  2. stertor –> snore at sleep and at exercise, brachycephalic breeds (fore-shortened noses and squashed pharynx, profound dyspnoea at sleep and exercise)
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7
Q

how is URT disease diagnostically evaluated

A
  1. history
    - presenting complaint
    - clinical signs (when do they occur –> rest or exercise)
    - use or intended use
    - effect of tack and head carriage
    - prior surgery disease, or trauma of head and neck
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8
Q

how is respiratory disease investigated in horses

A
  1. full clinical exam (rule out lameness, cardiac disease, etc)
  2. lunge (both directions)
  3. exercise test (listen for upper resp noise and determine if its inspiratory, expiratory or both)
  4. rebreathing exam
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9
Q

what does a physical exam for URT disease entail (5)

A
  1. auscultate heart and lungs
  2. palpate jugular furrow and assess jugular fill (evidence of surgery, trauma, thrombosis of vein)
  3. palpate larynx (evidence of prior surgery, prominence of muscular process, laryngeal dysplasia)
  4. assess airflow from nostrils
  5. character of nasal discharge if any
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10
Q

how is a resting endoscopy performed and what does it evaluate (3)

A

unsedated

  1. nasal cavity, pharynx, larynx, trachea
  2. arytenoids –> function, thickness, mucosal lesions
  3. epiglottis –> position, thickness, ulceration, entrapping membrane
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11
Q

what does sedated endoscopy evaluate

A
  1. suepiglottic region –> may require topical anaesthesia
  2. guttural pouches
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12
Q

what is occuring here

A

larygneal paralysis

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13
Q

what are the differences in endoscopy with horses and dogs

A

horses: through the nasal cavity
dogs: through the oral cavity, soft palate is dorsal

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14
Q

what is occuring here

A

elongated soft palate

brachycephalics: stertor, dyspnea, death

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15
Q

what is the best diagnostic tool for diagnosing dynamic upper resp disorders

A

exercising upper airway endoscopy

approx 50% of horses presented for evaluation with normal resting endoscopy will have dynamic obstruction diagnosed on exercise exam and 19% to 56% of horses will have multiple abnormalities

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16
Q

what are the two methods of exercising upper airway endoscopy

A
  1. high speed treadmill
  2. overground endoscopy
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17
Q

what are the pros of highspeed treadmill exercise endoscopy (3)

A
  1. dynamic exam
  2. speed and incline can be altered
  3. training conditions are repeatable
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18
Q

what are the cons of highspeed treadmill exercise endoscopy (4)

A
  1. not ridden
  2. abnormal environment
  3. training required
  4. potentially dangerous
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19
Q

what are the pros of overground endoscopy

A
  1. dynamic exam
  2. more accurately recreates ridden conditions (environment, rider, tack, head carriage)
  3. inexpensive and more readily available
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20
Q

what are the cons of overground endoscopy

A
  1. same ridden conditions cannot be reproduced every time
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21
Q

what is recurrent laryngeal neuropathy

A

inspiratory disorder characterized by inability to fully abduct the corniculate process of an arytenoid cartilage (usually the left side)

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22
Q

what is recurrent laryngeal neuropathy caused by

A

neurogenic atrophy of muscles of abduction, especially the cricoarytenoideus dorsalis (CAD) muscle due to progressive loss of large myelinated fibres of recurrent laryngeal nerve (RLN) (damage/dysfunction)

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23
Q

what is occuring here

A

post mortem depiciting atrophy of the left CAD muscle

recurrent laryngeal neuropathy

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24
Q

what is the pathogenesis of recurrent laryngeal neuropathy caused by progressive loss of myelinated axons of RLN (5)

A
  1. paralysis of CAD muscle
  2. inability to achieve maximum abduction of left arytenoid during exercise
  3. rima glottis progressively reduces in size
  4. hypoxemia, hypercarbia and metabolic acidosis
  5. early fatigue and poor performance
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25
Q

what is the pathogenesis of recurrent laryngeal neuropathy

A

most cases are idiopathic and involve large-breed horses

genetic

other causes: trauma to nerve (perivascular injection), toxicity/organophosphates, hepatic encephalopathy (bilateral)

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26
Q

what is occuring here

A

bilateral laryngeal neuropathy due to hepatic encephalopathy

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27
Q

how is recurrent laryngeal neuropathy diagnosed (3)

A
  1. history: inspiratory roaring/whistling noise during exercise, variable degree of exercise intolerance, usually dependent on level of activity
  2. clinical examination: palpable laryngeal muscle atrophy (not reliable)
  3. resting and dynamic endoscopy
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28
Q

what is the grading systems for RLN in resting endoscopy

A

stage I: synchronous and full abduction of arytenoid cartilages

stage II: asynchronous movement, but full abduction is achieved with swallowing, nasal occlusion or use of resp stimulants

stage III: asynchronous movement, full abduction cannot be induced either by swallowing, nasal occlusion or use of resp stimulants

stage IV: complete immobility of arytenoid cartilage and vocal fold

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29
Q

what is the laryngeal grade for RLN in resting endoscopy

A

stage I

30
Q

what is the laryngeal grade for RLN in resting endoscopy

A

stage II

31
Q

what is the laryngeal grade for RLN in resting endoscopy

A

stage III

32
Q

what is the laryngeal grade for RLN in resting endoscopy

A

stage IV

33
Q

what are the grading systems for RLN using dynamic endoscopy

A

A: full abduction of arytenoid cartilages during inspiration

B: partial abduction of the left arytenoid cartilages between full abduction and the resting position

C: abduction less than resting position including collapse into the right half of the rima glottidis

34
Q

how is RLN managed

A

based on presenting complaint (abnormal upper resp noise, poor performance, or both), age and use of horse, degree of arytenoid collapse during dynamic endoscopy

some horses can tolerate and work to capacity despite upper airway obstruction, esp when high speed is not expected

35
Q

what are the treatment options for RLN

A
  1. prosthetic laryngoplasty (tie back)
  2. ventriculectomy or ventriculocordectomy
  3. reinnervation of the CAD muscle
  4. partial arytenoidectomy
36
Q

what is prosthetic laryngoplasty

A

placement of suture prosthesis betwen cricoid cartilage and muscular process of affected arytenoid cartilage

mimics CAD muscle contraction –> allowing permanent abduction of corniculate process of the arytenoid cartilage

ideally –> sufficient arytenoid cartilage abduction to allow adeqate airflow during exercise, not allow entry of saliva, food or water into the laryngeal or tracheal lumen during swallowing

37
Q

when would prosthetic laryngoplasty be appropriate

A

reserved for horses in which arytenoid collapse is confirmed with dynamic endoscopy and its having a negative impact on performance

38
Q

how is the prognosis of prosthetic laryngoplasty

A

50-70% of racehorses will improve

75-90% of horses involved in non-racing will improve

39
Q

what is occuring here

A

the right image shows a post op following tie back and left sided ventriculocordectomy

40
Q

what is ventriculectomy

A

removal of mucosal lining of laryngeal ventricle (laryngeal saccule)

41
Q

what is ventriculocordectomy (hobday)

A

more common than ventriculectomy

removal or ablation of vocal cord and ventricle

reduces inspiratory noise in horses but doesn’t return upper resp flow mechanics to baseline values

42
Q

what is occuring here

A

unilateral (left sided) ventriculocordectomy performed via endoscopy using a diode laser

43
Q

when is ventriculectomy and ventriculocordectomy appropriate (4)

A
  1. at same time as tie back in horses with grade 4 laryngeal movement where primary complaints are resp noise and exercise intolerance
  2. sport horses with grade 4 laryngeal movement where primary complaint is resp noise and exercise intolerance is not a concern
  3. racehorses with grade 3 laryngeal movement that don’t experience complete arytenoid collapse during high-speed exercise, but don’t experience vocal fold collapse identified during exercise videoendoscopy
  4. horses that have had a tide back and still experience vocal fold collapse
44
Q

what is reinnervation of CAD muscle

A

first and second cervical nerve branches (C1/C2) which innervate the omohyoideus muscle are isolated and implanted into the CAD muscle to promote reinnervation

clinically evident approx 4-5 months post-surgery but can take up 12 months –> if no arytenoid abduction is observed 9 months after surgery, the chance of reinnervation is small

may not be suitable when immediate return to performance is necessary

45
Q

when is reinnervation of CAD muscle done

A

younger horses and those with grade 3 laryngeal movements

80% success rate in a population of racehorses

46
Q

which horses are not suitable for reinnervation of CAD muscle

A

horses that have had previous tie back aren’t candiates –> disruption of C1/C2 nerve branches during surgery or trauma and resultant fibrosis of CAD muscle

47
Q

what is partial arytenoidectomy

A

removal of corniculate process and body of arytenoid cartilage via a laryngotomy –> leaving only the muscular process of the arytenoid cartilage intact

48
Q

what is the goal of arytenoidectomy

A

improve airway geometry by increasing cross-sectional area of rima glottidis and prevent dynamic collapse of unsupported structures

49
Q

what is a laryngotomy

A

surgical incision which provides access to interior of the larynx made ventrally at the level of larynx

50
Q

when is a partial arytenoidectomy done

A

to treat RLN when there is congenital malformation of cartilages or when tie back has failed because of fracture of the laryngeal cartilages

51
Q

what is the prognosis of partial arytenoidectomy

A

60-78% of horses return to racing

75% of non-racehorses return to their previous level of use

52
Q

what do dogs with laryngeal paralysis present with

A

profound exercise induced dyspnoea

huge quality of life implications

53
Q

what is treatment of laryngeal paralysis in dogs

A

tieback surgery to improve quality of life

but will never return to athletic function

54
Q

what is dorsal displacement of soft palate

A

displacement of caudal free border of the soft palate dorsal to the epiglottis

55
Q

what are the two types of dorsal displacement of the soft palate in dogs

A
  1. intermittent (most common)
  2. persistent
56
Q

what is intermittent dorsal displacement of soft palate

A

dynamic condition

57
Q

what is persistent dorsal displacement of soft palate

A

observed in resting horses

secondary to neurological damage –> ex. guttural pouch disease, neoplasia, peripheral neuropathies

causes major exercise intolerance and dysphagia

poor prognosis

58
Q

what does dorsal displacement of the soft palate result in

A

expiratory airway obstruction

59
Q

what is the prevalence of dorsal displacement of soft palate

A

10-20% of 2-3 year old thoroughbred and standardbred racehorses

sport horses exercised with head and neck in a flexed position (collected)

horses that have previously undergone a prosthetic laryngoplasty may be more susceptible to developing DDSP

60
Q

what is the impact of collection on dorsal displacement of soft palate

A
  1. head and neck flexion
  2. alteration in upper airway dimensions
  3. increased airway resistance and negative inspiratory pressure
  4. instability of soft palate
  5. increased susceptibility to dorsal displacement of the soft palate
61
Q

what does dorsal displacement of the soft palate lead to

A
  1. flow limiting expiratory obstruction
  2. increased tracheal expiratory pressure and impedance
  3. reduced minute ventilation
  4. hypoxia, hypercarbia, impaired athletic performance
62
Q

what is the pathogenesis of dorsal displacement of soft palate

A

still unclear

50% of cases have concurrent lower airway disease

some horses will show signs of DDSP while unfit with resolution as their fitness increases

can occur with other disease (epiglottic entrapment)

research has identified several muscles or nerves where dysfunction could lead to DDSP

63
Q

how is DDSP diagnosed

A

young performance horses

  1. character history: sudden impairement in performance, often at maximal exercise (towards the end of a race when fatigue may be a factor), gurgling, choking expiratory noise in approx 50% of cases, open mouth breathing
  2. endoscopy: resting and overground endoscopy
64
Q

how is DDSP managed conservatively

A
  1. rest from exercise
  2. improve physical condition
  3. tack changes
  4. medical management of upper airway inflammation (systemic corticosteroids, systemic anti-inflammatory medications, topical throat sprays)
65
Q

how is DDSP managed surgically

A
  1. tension, thermal and laser palatoplasty
  2. staphylectomy
  3. standard meyctomy
  4. minimally invasive myectomy
  5. laryngeal tie-forward
66
Q

what is palatoplasty

A

reduced flaccidity of soft palate through fibrosis

tension palatoplasty (palatine mucosa and submucosa to level of palatine aponeurosis surgically removed, remaining mucosa sutured together)

thermal and laser palatoplasty: soft palate cauterized with heated steel rods or diode laser

67
Q

what is laryngeal tie forward

A

replace action of thyrohyoideus muscles bilaterally –> larynx advances approx 4cm rostrally post-procedure as well dorsally –> increased soft palate-epiglottis contact

sutures placed between thyroid cartilage and basihyoid bone

bilateral sternothyroidectomy performed concurrently

68
Q

what is the recent work of larygneal tie forward success

A

55-65%

69
Q

what is dorsal displacement of soft palate

A

dorsal displacement of caudal free border of soft palate dorsal to epiglottis

70
Q

what is occuring here

A

DDSP

71
Q
A

Module 9 (43 decks)

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