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Upper Airway Examination and Ultrasound

April 2018 - Amputations & Neurological Conditions

Join us this month as our expert, Dr. Barrie Grant, joins the forum to answer your questions concerning neurological conditions in the horse. Dr. Grant will also be available to answer any questions related to amputations.

Click here to read this month's questions and answers.

Upper Airway Examination and Ultrasound

  1. My horse has a large sarcoid on her neck. Have you heard of Balanced Eco Solutions salve that claims to kill the bovine papiloma virus that causes the sarcoid? They claim to have a 85% success rate in curing sarcoids with their salve and immune booster supplement, but won't give me any references in the Los Angeles region where I am located. They claim it does not leave a scar and that the hair will grow back. If you have any information on this company or their product, I would greatly appreciate it. It would be good for veterinarians to know about this product if it really works because my vet said she only knows of surgery and the blood root salve, both of which leave scars on a large sarcoid, which mine is rather large.

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    In general, sarcoids are subtyped according to their clinical appearance, and biologic behavior, and therapies and success of treatment depend on the type of the sarcoid. Therefore it is always advised to have your veterinarian examine your horse before starting any therapy.

    I do not have any experience with the Balanced Eco Solution salve, and to my knowledge, there are no published studies using this product. In our hospital we treat the ulcerative fibroblastic form of equine sarcoids with a combination of surgical excision and cisplatin beats or 5-fluorouracil injections. Cisplatin and 5-fluorouracil are chemotherapeutics which can prevent tumor regrowth. The best result is achieved in cases where the tumor can be removed with a margin of healthy skin and the skin incision closed afterwards. It is then possible to include a few cisplatin beats in the area where the tumor has been previously growing and therefore prevent regrowth. In cases where the skin can be closed after removal the scaring is minimal and reduced to the incision site. In some cases where skin closure is not possible, a combination of surgical removal, cisplatin or 5-fluorouracil injections and/or cryotherapy can be used. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  2. From August through the first frost, my Tennessee Walking horse suffers from asthma. The vet puts him on Dexamethsone, Clenbuterol, and dark beer. I had an allergy test done and was giving him allergy shots for a year and when his asthma season hit, the allergy shots showed no difference. The "dex" and everything else I give him along with soaking his timothy hay for 30 minutes (year round) helps and when he gets a severe coughing spell, I call the vet out. Is there any current findings on ways to relieve the onset or at the very least, ease the attacks?

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    Keeping a horse with the symptoms you are describing in a dust reduced or dust free environment is a very important step and therefore it is excellent to feed wet hay instead of dry hay. To further evaluate the type of lower airway inflammation your horse is experiencing an examination called BAL (bronchoalveolar lavage) would be very helpful. During this examination, a small amount of sterile saline will be flushed into his bronchi/lungs via an endoscope, and retrieved. This fluid can then be examined. Depending on the results, it might be possible to use a combination between oral and inhaled medications to relieve your horse’s symptoms. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  3. What would you do with a horse that suffers from palatal instability at exercise but also has crico-tracheal membrane collapse - the whole circumference collapses inwards on dynamic endoscopy giving the appearance of a sphincter behind the larynx?

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    The symptom you are describing is seen very rarely and only during high speed exercise. Therefore, it is very important to perform an endoscopy during exercise in some horses as your veterinarian has done. Most likely the sphincter-like prolapse of the crico-tracheal membrane is caused by strong negative pressures within the upper airway due to the palatal (soft palate) instability you are describing. If your horse is a two year old, we normally suggest waiting with racing for one more year. A lot of horses can improve during this extra year of additional training.

    Other underlying problems can be muscle tissue disorders, and I would suggest to test the horse for Equine Protozoal Myeloencephalitis (EPM), Vitamin E deficiency, and in the case your horse is a Quarter Horse for the possibility of Hyperkalemic Periodic Paralysis (HYPP).

    In case your horse is in good training condition, and the pharyngeal instability is causing dorsal displacement of the soft palate without strong signs of pharyngeal collapse, I would treat it with a tie-forward procedure. If the crico-tracheal membrane continues to prolapse, a surgical imbrication (shortening) of this membrane has been described.

    More often a syndrome called axial deviation of the aryepiglottic folds is noted on dynamic endoscopy. These collapsing folds can cause a sphincter like appearance just before (rostral) the larynx. The treatment would be excision of the collapsing tissue with a laser. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  4. Has there been any advancement in the cause, treatment, and prevention of upper airway cicatrix of horses?

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    Nasopharyngeal cicatrix syndrome is mostly seen in horses in the south of the United States. During the acute phase, signs of severe inflammation of the upper respiratory tract are seen on endoscopy. In more chronic cases, web-like scar tissue and deformation of the upper airway structures can occur and lead to different grades of respiratory tract obstruction. In patients with strong respiratory distress, permanent tracheostomy (a permanent opening into the wind pipe) is at this time the treatment of choice.

    To date, the cause for nasopharyngeal cicatrix syndrome is unknown. Due to the clinical signs and endoscopic findings, inhalation of a direct irritant, allergen or bacteria/virus is thought to be the cause for this disease, but this theory could not be confirmed to this date. A study published in 2013 by a group at Texas A&M, found that horses presented with this disease were turned out on pasture and the disease was found in a higher rate within summer months. They concluded that the possible irritant agent is most likely not airborne and most likely on pasture. Further research will be needed to further investigate the cause for this disease. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  5. My horse's right nasal passage does not have an opening. It does tears a lot. Would this affect her breathing?

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    From your description, it sounds that your horse is missing the naso-lacrimal duct opening. If this is the case, tearing of the eye occurs since the tears can only be removed by overflowing at the eye lid and cannot be removed via a small duct that connects the eye socket with the nasal passage. This duct has a bony (upper) and a soft tissue (lower) part. In some horses, swelling of the soft tissue aspect might occur from time to time, which could possibly cause mild obstruction of one nostril and could be relevant during high speed exercise. In most riding horses, this should not cause any major shortness of breath.

    Depending on the location of the occlusion of the naso-lacrimal duct, surgery might be possible to establish an opening and therefore adequate drainage of the tear fluid.

    If your horse’s complete right nasal passage is occluded, the situation is very different. This can cause shortness of breath during trotting or cantering, but during rest enough air is flowing through the one nasal passage to provide the horse with adequate oxygen. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  6. My horse makes a loud noise when her head is tucked, when riding. Also, I can hear breathing when she is eating out of a bucket. I have not had her scoped since I'm not even sure if the veterinarians here in my area scope. Should I try to get it done?

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    My suggestion is to have your horse examined by a veterinarian. Ideal would be endoscopy to evaluate the nasal passages, the larynx and the pharynx as well as her guttural pouches. In case your veterinarian has no endoscope available, a clinical examination during rest and during exercise can give your veterinarian several clues to differentiate between different causes for the respiratory noise, and he or she can than decide if further examination via endoscopy would be necessary. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  7. Other than layoff and the use of lasix, is there any other way to reduce or eliminate Epistaxis?

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    Epistaxis is a nose bleed. It can have several causes. It is most commonly seen in race horses during high speeds and the underlying cause is bleeding into the lung tissue due to high blood pressures in small lung blood vessels (Exercise Induced Pulmonary Hemorrhage). In these horses, it is important to evaluate the upper and lower airway tract for any signs of malfunction, which should be treated (like lower airway disease or instability of the upper airway). In some horses, none of the above mentioned can be found and these horses are commonly treated with furosemide before the race or a resting period. There is at the moment no other medication for treatment of this symptom available, but some horses seem to respond favorably to wearing a nose strip to open the nostrils during racing and therefore decreasing upper airway resistance.

    Other causes for epistaxis can be ethmoid hematomas or guttural pouch mycosis; therefore it is important to examine a horse showing epistaxis with endoscopy by your veterinarian so the right treatment can be initiated. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  8. I think my 8-year-old mare may have allergies. Her eyes run and there is swelling under them. What should I do?

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    There is certainly a possibility that the swelling and runny eyes are caused by allergies that let the tissue in the nasolacrimal duct swell, and therefore cause the tearing of your mares eyes. But there can be a lot of other causes for this type of clinical signs you are describing. The best way to help your mare is to have her examined by your veterinarian to make sure that she does not have any corneal ulcers, congested nasolacrimal ducts, which might need to be flushed, conjunctivitis or even a little foreign body like a small piece of hay or a seed embedded in her conjunctivas. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine

  9. My recently claimed filly has been diagnosed with and had laser surgery for a laryngeal chondroma. I understand chondroma's often grow back. Are they chronic or with vigilant attention and care can they be cured? Thank you for considering my query.

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    A laryngeal chondroma is granulation tissue on the surface of the arytenoid cartilage (laryngeal flapper). The underlying cause for this growing tissue is an inflammation/local infection and deformation of the arytenoid cartilage, also called arytenoiditis. In some cases, the arytenoiditis can be treated medically with antibiotics and anti-inflammatory drugs, and the remaining protruding granulation tissues removed by laser surgery. If the function of the larynx is normal and the wound after the laser therapy has healed well before re-introducing to racing, the chances are the best not to have re-occurrence of the granulation tissue and interference with the airway. That said, it is important to give your horse enough rest (several weeks) and possibly perform an endoscopic re-evaluation before starting strenuous training. In some cases, the surgical removal of the inflamed arytenoid cartilage (a procedure called partial arytenoidectomy) might be necessary to resolve recurrent inflammation, growing granulation tissue and obstruction of the airway. If both sides of the larynx (both arytenoid cartilages) are affected the prognosis is much worse. Kirstin Bubeck, DVM, Tufts University Cummings School of Veterinary Medicine