Laryngeal whistle syndrome, also known as hemiplegia laryngis or recurrent laryngeal neuropathy (RLN), describes the paralysis of one side of the laryngeal muscles caused by a disorder of the nerve responsible for controlling them. The disease manifests itself through a typical sound during inhalation, which is why riders often say that the horse has a "tone." Large horses are particularly affected, with geldings and stallions more commonly affected than mares.
The recurrent laryngeal nerve (the name of the affected nerve) is located on both sides of the head. Due to its special location (it wraps around the aorta), the left recurrent nerve is exposed to greater pressure and tension than the nerve on the right side. It supplies almost all of the muscles of the larynx, and damage to this nerve results in paralysis of the vocal folds (the voice-producing apparatus of the larynx) on the left side and the inability to open the larynx.
The paralyzed vocal fold on the left side begins to flutter when breathing in, producing the typical whistling sound of the larynx, especially when strained. Depending on the severity of the condition, the sound may also be heard at rest and intensify with exertion.the negative pressure in the larynx can also lead to complete laryngeal closure.
The first symptom noticed by owners is usually the typical roaring, whistling, or snoring sound that only occurs during exertion when inhaling. As the disease progresses, significant breathing difficulties and thus reduced exercise capacity may occur. In the event of complete obstruction of the larynx and subsequent respiratory distress, affected horses may panic, refuse to exert themselves completely, or bolt.
In many cases, however, affected horses can continue to work largely normally despite the sound. Regular veterinary check-ups are strongly recommended to monitor the progression of the disease and prevent permanent oxygen deprivation and associated performance impairment.
It is extremely important for the veterinarian to receive a detailed report from the owner regarding the onset, duration, and intensity of the noises under stress and any loss of performance, as this provides valuable information about the disease. As part of the general examination, the veterinarian will first examine the horse thoroughly at rest to identify any potential findings and rule out other possible causes. The vet may occasionally be able to feel existing muscle wasting in the larynx from the outside. The oxygen content of the blood can be determined using a blood gas analysis. To do this, the vet must take a sample of arterial blood from the horse and examine it immediately. The horse is then examined under stress. This can be done either by riding, lunging, or on a treadmill.
The veterinarian will attempt to reproduce the situation in which the owner claims to have heard the breathing noise. Another supplementary and very informative examination is endoscopy of the respiratory tract, which can now also be performed under stress (on a treadmill) and is essential for a reliable diagnosis of laryngeal paralysis.
In rare cases, if the nerve is only slightly bruised or inflamed, healing may occur after a few days to several months with cortisone therapy.
In all other cases of chronic nerve paralysis, the original functionality can only be restored with the help of surgery to tighten the left vocal cord (through scarring or certain plastic surgery techniques). Various surgical techniques have therefore been developed, some of which are used in combination. All methods aim to restore the normal opening of the larynx. Most of these techniques require the affected horses to be placed under general anesthesia; only a few veterinary specialists perform laryngeal surgery on a standing horse. This completely avoids the risk of general anesthesia. Another advantage of performing the operation on a standing horse is the ability to check the opening of the larynx endoscopically during the operation. After vocal cord surgery, the horse may resume training after 4 to 6 weeks at the earliest.
The modified nerve transplant surgery, which has been developed over the last few years, has brought about further progress in the treatment of laryngeal stridor. Using a completely different, natural approach, the paralyzed muscle is no longer replaced by a prosthesis, but a new nerve is inserted into the muscle to rebuild it. However, the horse must remain in stable rest for at least six months until the nerve has properly grown into the muscle. The advantage of this method is that if the operation is unsuccessful, all other techniques can still be performed. After the operation, there is a risk that food may enter the windpipe and thus the lungs due to the lack of closure of the larynx during swallowing. The result is a condition known as aspiration pneumonia (pneumonia caused by swallowing).
In order not to jeopardize the success of the operation, all common surgical methods require careful and consistent follow-up care.
The prospects for a functional cure are considered favorable following the surgical methods described, and a horse that has undergone laryngeal surgery can certainly return to sport. However, if complications arise after surgery, the prognosis may worsen.
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