ANALYTICAL CLINICAL STUDIES
Results of upper airway radiography and ultrasonography predict dynamic laryngeal collapse in affected horses
- In part presented at the 5th Annual Scientific Meeting of the European College of Veterinary Diagnostic Imaging (ECVDI), Svolvær, Norway, August 2008; and at the 4th World Equine Airways Symposium (WEAS) in Bern, Switzerland, August 2009 (Ultrasonographic findings of the equine larynx in horses affected with dynamic laryngeal collapse associated with head flexion; Fjordbakk CT, Chalmers H. Holcombe S, Risberg AI, and Strand E).
Reasons for performing study
The pathogenesis of dynamic bilateral laryngeal collapse (DLC) associated with poll flexion is unknown. Diagnosis is dependent upon exercise endoscopy while replicating the flexed head position harness racehorses experience during racing.
To describe the effects of poll flexion on rostrocaudal laryngeal positioning and laryngeal lumen width in resting horses diagnosed with DLC compared to controls, and to establish diagnostic criteria for DLC by use of diagnostic imaging.
Fifty harness racehorses were prospectively included in the study: 25 cases diagnosed with DLC by treadmill endoscopy and 25 controls in which treadmill endoscopy revealed no abnormal findings. Laryngeal radiography and ultrasonography were obtained in neutral and flexed head positions. Laryngeal positioning and laryngohyoid conformation were compared between the groups and head positions.
Poll flexion induced a greater rostral advancement of the larynx in relation to the hyoid apparatus in resting harness racehorses affected with DLC compared to controls (P = 0.007). At the level of the vocal folds, poll flexion resulted in a smaller laryngeal lumen width in horses affected with DLC compared to controls (P = 0.04). Horses were significantly more likely to be affected with DLC when the thyrohyoid bone to thyroid cartilage distance was ≥12 mm in poll flexion (odds ratio 21.3, 95% confidence interval 3.65–124.8, P = 0.004) and when laryngeal lumen width at the level of the vocal folds was less in poll flexion than in the neutral head position (odds ratio 8.4; 95% confidence interval 1.6–44.1, P = 0.012).
Conclusions and potential relevance
In DLC horses, poll flexion advanced the larynx more rostrally and resulted in a decreased airway lumen width compared to control horses. Laryngeal ultrasound and radiography may facilitate the diagnosis of DLC at rest.