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Diagnosis and Treatment Alternatives for Various Causes of Upper Airway Obstruction (in the Horse)
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Diagnosis of upper airway obstruction
History: : Abnormality of the patency of the upper airway can be manifested by abnormal upper respiratory noise and/or a decrease in performance. The history is often different for sport horses than for racehorses. In racehorses, a sudden drop in performance in the last half of the race with and without an abnormal respiratory noise is reported. Sport horse riders report a respiratory noise more marked with collection, either without a decrease in performance or with a progressive decrease in performance.
Physical exam: Although endoscopic examination is the most helpful diagnostic aid, an external physical exam should focus on ruling out other causes of airway obstruction or the presence of infection in the upper airways. First, external symmetry of the nasal cavity and sinus would help identify or indicate possible obstruction of the nasal passage. Functional deficits caused by vasodilation of the nasal submucosal vasculature (e.g., Horner syndrome) should be identified. Finally, the presence of nasal discharges and the size of intermandibular lymph nodes should be determined; significant inflammation of the upper airway would dictate guttural pouch endoscopy.
Sound analysis: An objective means to identify and characterize abnormal sounds is spectral analysis. The band of abnormal intensity for horses with DDSP is 18-77 Hz. RLN leads to higher intensity frequencies in three bands centered at 0.3, 1.6, and 3.8 kHz. This technique is quite helpful, yet limited by the absence of criteria for identification of other upper respiratory diseases or for concomitant obstructions.
Endoscopic exam: Videoendoscopic examination during exercise is the gold standard. Until recently, the most controlled evaluation method for was high-speed treadmill videoendoscopy. The advent of wireless videoendoscopy will greatly increase the availability of this diagnostic modality. This is critical for dynamic disease such as some grades of RLN, midline collapse of AE fold, and DDSP. Remember that 80% of horses with intermittent DDSP on the treadmill do not manifest abnormality during resting endoscopy.
Imaging: Chalmers et al. introduced laryngeal ultrasound. The mid-ventral window is promising for the diagnosis of DDSP, while the lateral window is most helpful in identifying the status of the cricoarytenoid lateralis muscle and lateral surface of the arytenoid cartilage to confirm the presence or absence of chondritis or abscessation. [...]
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