Horse Throat
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Horse Throat
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Your Thoroughbred event horse has started to make an odd noise when he inhales during exercise. You mention this to your friend who has a horse in race training, and he says it’s not uncommon for horses to have some sort of blockage in the windpipe. “Paralyzed flaps or something,” he thinks. You have your veterinarian examine the horse’s throat, and it looks perfectly normal. Next time you gallop him, he sounds worse. What do you do now?
A roaring noise as the horse inhales during strenuous exercise is often caused when the arytenoid cartilage isn’t pulled far enough out of the way to open the trachea, blocking free passage of air. Horses that are severely affected become unable to perform well because they can’t take in enough air as they breathe. There are two arytenoids cartilages, left and right, and paralysis is almost always on the left. This defect is found most often in Thoroughbred and Standardbred horses, and there is some evidence that the problem is hereditary. Veterinarians examining a standing horse usually won’t see any abnormality, and for this reason diagnosis is often made with an endoscope while the horse is exercising and the blockage is easier to observe.
According to Kentucky Equine Research staff veterinarian Dr. Bryan Waldridge, this condition usually doesn’t improve on its own and often gets worse unless it is treated. Traditionally, “tie-back” surgery was performed to pull the cartilage out of the way and suture it in an open position. Initial success was sometimes followed by partial closure when the cartilage sagged or tore loose from its restraint. A slightly different procedure, the modified tie-back, seems to give good results that last longer. A quicker treatment involves snipping away part of the cartilage. Nerve grafts are also being tried as a means of restoring movement to the paralyzed flap. No technique is guaranteed to give perfect results in every horse, and complications of surgery may include infection or damage to other throat structures. However, many horses can return to previous levels of performance after some type of tie-back procedure.
Owners who notice noisy breathing and a drop in exercise tolerance should check with a veterinarian who is able to arrange an endoscopic examination as the horse is exercising. Not every case of respiratory noise is caused by paralyzed arytenoid cartilage, and treatment will depend on the specific problem and its severity.
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If your voice sounds rough or husky, you may have dysphonia – commonly called hoarseness. Maybe you talked too loud in a crowded restaurant, or maybe there’s an underlying medical condition for this symptom. Hoarseness should go away after a short time but, if it lasts for three weeks or more, you should see your healthcare provider.
Cancer Research UK. Laryngeal Cancer. (https://www.cancerresearchuk.org/about-cancer/laryngeal-cancer/symptoms) Accessed 5/16/2021.
ENT Health. Hoarseness. (https://www.enthealth.org/conditions/hoarseness/) Accessed 5/16/2021.
House SA, Fisher EL. Hoarseness in Adults. Am Fam Physician. 2017 Dec;96(11):720-728. Accessed 5/16/2021.
National Institute on Deafness and Other Communication Disorders (NIDCD). Hoarseness. (https://www.nidcd.nih.gov/health/hoarseness) Accessed 5/16/2021.
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Hoarseness (dysphonia) is when your voice sounds raspy, strained or breathy. The volume (how loud or soft you speak) may be different and so may the pitch (how high or low your voice sounds). There are many causes of hoarseness but, fortunately, most are not serious and tend to go away after a short time.
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You can speak thanks to your vocal folds (vocal cords) and larynx (voice box). Your larynx sits above your trachea (windpipe) – the airway that goes down to your lungs. The vocal cords, which are two bands of muscle, are inside your larynx, and they open and close. When you speak, air from your lungs makes the cords vibrate, creating sound waves. If you relax (shorten) your vocal folds, your voice will sound deeper. It will be higher pitched if the vocal folds tense or elongate.
Hoarseness is very common. About one-third of people will have it at some point in their lives.
Anyone at any age can experience hoarseness. This symptom is most common in people who smoke and those who use their voices professionally like teachers, singers, sales representatives and call center operators
Hoarseness can be a symptom of lung cancer. It’s more commonly associated with laryngeal cancer.
No. Your vocal cords and larynx do not affect your heart.
Yes, stress (mental/emotional) is one of the more common causes of hoarseness.
Yes. Post nasal drip is one of several possible causes of hoarseness.
Hoarseness can sometimes be a symptom of laryngeal cancer.
There are several possible causes of hoarseness. Many are harmless. Causes include:
Depending on your symptoms, your usual healthcare provider may refer you to an otolaryngologist or ENT (ears, nose and throat specialist). After getting your medical history and a list of your medications, your ENT may ask the following questions:
After that, your ENT will want to listen to your voice and examine your head and neck. They’ll check for any lumps in your neck and examine your voice box using a laryngoscope, which is a lightened instrument that will be inserted into the back of your throat through your nostrils. If there is cause for concern, your healthcare provider may order the following tests:
Treatment depends on the condition causing the hoarseness. The conditions and their treatments include:
If you experience hoarseness repeatedly because you use your voice so much every day, you might need to see a speech-language pathologist for voice therapy. There are exercises you can do and you’ll be taught how to use your voice to avoid hoarseness.
There are some easy ways to prevent a hoarse voice. You should practice them especially if you use your voice for professional reasons, particularly if that’s every day. Try the following to help prevent hoarseness:
If your voice is still hoarse after three weeks, you should see your healthcare provider. You should see a healthcare provider before then if you have any of the following:
Your voice is one of the most important tools for communication, so it’s important to keep it working well. Hoarseness can be annoying or – if you use your voice professionally – distressing. Take care of your voice by drinking enough water, avoiding caffeine and smoking and using a microphone or other amplification tool if you need to speak loudly. Remember to see your healthcare provider if the hoarseness lasts three weeks.
Last reviewed by a Cleveland Clinic medical professional on 05/18/2021.
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The nares are supported by nasal cartilages . Unlike other species the ventral and dorsal lateral nasal cartilages, which attach to the rostral end of the nasal septum, do not contact each other. In the hose, the dorsal and ventral cartilages are indistinct or absent. Instead, horses have alar cartilages to support the nostrils, but the lateral walls of the nostrils remain unsupported; allowing greater mobility. The alar cartilages divide the nostril into the dorsal ('false nostril') and ventral ('true nostril'). The dorsal nostril leads to a blind-ending diverticulum in the nasoincisive notch. The ventral nostril leads to the nasal cavity. This is important when placing a nasogastric tube, which must be inserted ventrally.
Another species difference is that the nasolacrimal duct opens at the nasal puncta on the ventral floor of the nasal vestibule close to the transition point between the nasal mucosa and the nostril.
Horses do not have a nasal philtrum.
The nasal cavity is the area between the nostrils and the cribiform plate, it is divided by a septum into right and left sides. The nasal conchae , also known as ethmoturbinate, are scroll-shaped bones covered with nasal mucosa that project into the nasal cavity. The first endoturbinate is the base of the dorsal nasal conchae. It extends the furthest into the nasal cavity. The second endoturbinate forms the middle nasal concha. Subsequent turbinates are much smaller. The ventral nasal conchus is not formed by turbinates, but by the maxilla.
The conchae divide the nasal cavity into three meatuses, which form a common meatus near the nasal septum.
The paranasal sinuses of the horse are extensive, consisting of six pairs:
The most clinically significant sinuses are the frontal and maxillary. The sinuses all communicate with the nasal cavity to allow drainage. The rostral and caudal maxillary sinuses communicate directly with the nasal cavity. The dorsal, middle & ventral conchal, frontal and sphenopalatine sinuses drain indirectly via the maxillary sinuses. The conchal sinuses lie within the fine, scroll-shaped bones known as conchae or turbinates . These conchae are attached to the lateral wall of the nasal passages.
The paranasal sinuses are lined with respiratory epithelium (pseudostratified ciliated columnar) and goblet cells.
The frontal sinus occupies the skull from a point midway between the infraorbital foramen and the medial canthus of the eye to a point midway between the caudal edges of the orbit. The frontal sinus is divided into right and left compartments by a midline septum. The conchofrontal sinus is formed by a communication between the rostromedial frontal sinus and the dorsal conchal sinus. The frontomaxillary aperture is a large area of communication between the frontal sinus and the caudal maxillary sinus, this is important to allow drainage. Blood supply to the frontal sinus is provided by the ethmoidal artery .
The main blood supply is provided by the arterial ethmoid rete , which is an anastamosis between the internal and external ethmoid arteries . A minor suply is provided by the caudal nasal branch of the sphenopalatine artery .
The conchal sinuses include the dorsal, ventral and middle. Each conchus is divided into two compartments, rostral and caudal, by a complete septum.
The blood supply is provided by branches of the sphenopalatine artery .
This is the largest sinus and is divided into rostral and caudal compartments by a bony septum. The position of this septum is variable, but it usually lies obliquely across the roots of the 4th and 5th cheeck teeth (Tridan 109, 110, 209, 210). In horses less than 5 years of age, the reserve crown of the 3rd-6th cheek teeth (Tridan 108, 208, 109-111, 209-211) almost fills the maxillary sinus.
The rostral maxillary sinus opens via the nasomaxillary opening into the middle nasal meatus . There is also a communication between the rostral maxillary sinus and the ventral conchal sinus, via the conchomaxillary opening ; located just medial to the infraorbital canal. Dorsally, there is communication with the frontal/conchofrontal sinus through the frontomaxillary opening. Between the rostral margin of the frontomaxillary opening and the conchal bulla, there is a passageway which connects the rostral and caudal compartments. This allows the caudal maxillary sinus to drain via the rostral maxillary sinus via the nasomaxillary opening into the middle nasal meatus.
In the horse, the sphenoid and palatine sinus compartments communicate and are hence known as the sphenopalatine sinus. The sphenopalatine sinus drains via the caudal maxillary sinus, with which is communicates freely over the infraorbital canal. This sinus lies under the ethmoidal labrynth.
Also known as: Auditory Tube Diverticulum
The guttural pouches are paired ventral diverticulae of the eustachian (auditory) tubes, formed by escape of mucosal lining of the tube through a relatively long ventral slit in the supporting cartilages. The auditory tube connect the nasal cavity and middle ear and the diverticulum dilates to form pouches which can have a capacity of 300-500ml in the domestic horse. The pouches are normally air filled.
The Guttural Pouch is located below the cranial cavity, towards the caudal end of the skull /wing of atlas. It is covered laterally by the Pterygoid muscles, parotid and mandibular glands. The floor lies mainly on the pharynx and beginning of the Oesophagus . The medial retropharyngeal lymph node lies between the pharynx and ventral wall of the pouches.
Right and left pouches are separated dorsomedially by rectus capitis ventralis and longus capitis muscles. Below this, by fused walls of the two pouches, the median septum is formed.
Each pouch is moulded to the stylohyoid muscle which divides the medial and lateral compartments, the medial compartment being approximately double the size of the lateral one and extends further caudally and ventrally.
The guttural pouch has close association with many major structures including several cranial nerves (glossopharyngeal, vagus, accessory, hypoglossal), the sympathetic trunk and the external and internal carotid arteries. The pouch directly covers the temporohyoid joint. The pouch has an extremely thin wall which is lined by respiratory epithelium which secretes mucus. This normally drains into the pharynx when the horse is grazing.
Several cranial nerves and arteries lie directly against the pouch as they pass to and from foramina in the caudal part of the skull (vessels within mucosal folds that indent the pouches):
Natural drainage of the pouch is throught the slit-like (pharyngeal) openings of the eustachian tube in the lateral wall of the nasopharynx. The connection opens when the horse swallows and grazing normally provides drainage. However, most of the pouch is ventral to his slit, and therefore drainage may be rather ineffective. If blocked, secretions accumulate and the pouch distends producing a palpable swelling.
The function of guttural pouches is largely unknown, however hypotheses have been put forward:
The larynx is situated below where the pharynx divides into the trachea and the oesophagus . It is contained partly within the rami of the mandible and extends caudally into the neck. It is important during breathing, vocalisation and deglutition (swallowing). The cartilagenous larynx can be manually palpated in the living animal and is commonly implicated in respiratory conditions such as roaring .
The pharynx is located rostrally to the larynx, whilst the trachea is located caudally. The larynx is suspended from the hyoid apparatus . It is bilaterally symmetrical and 'tube-shaped' and can be described as a musculocartilagenous organ .
Synovial joints can be found between the thyrohyoid bone and the dorsorostral aspect of the thyroid cartilage . Synovial joints include the dorsal joint of thyroid cartilage ; between the lateral aspect of the cricoid cartilage and the dorsocaudal aspect of the thyroid cartilage and between the cricoid and arytenoid cartilage . This allows abduction and adduction of the arytenoid cartilages . Movement of the cricoid-arytenoid joint controls the size of the glottic opening, the lumen and the larynx.
Membranes and elastic ligaments attach the laryngeal cartilages, allowing attachment of the epiglottis to the thyroid and cricoid cartilage . The first tracheal ring has attachment with the cricoid cartilage by the cricotracheal ligament .
The thyroid cartilage is a hyaline cartilage and forms most of the floor of the larynx. The fusion of the two lateral plates varies in different species. The rostral part forms the 'Adam's apple'. The thyroid cartilage articulates with the thyrohyoid bone and the cricoid cartilage . It becomes brittle as the animal ages.
The arytenoid cartilages are paired, triangular shaped hyaline cartilages . They lie either side of the cricoid cartilage and articulate with the rostral part of it. A vocal process is present on the caudal surface where the vocal folds attach; a muscular process extends laterally and is the origin of attachment for the cricoarytenoideus dorsalis muscle. A corniculate process extends dorsomedially.
The epiglottic cartilage is an elastic cartilage , which is the most flexible and most rostral type of cartilage. The thinner stalk-like part, is attached to the root of the tongue , the body of the thyroid cartilage and the basihyoid bone . The larger blade-like part lies behind the soft palate and points dorso-rostrally. During deglutition , the large blade part of the epiglottic cartilage partially covers the entrance to the trachea.
The vocal folds are made of (slightly stiffer) elastic ligaments and pass between the arytenoid cartilages and the laryngeal floor . They run caudodorsally, with the ligament positioned medially and the vocalis muscle laterally. Fat surrounds the vocalis muscle. The vocal folds form part of the glottis and secrete mucous. They are used for vocalisation.
The vestibular folds are made of (slightly stiffer) elastic ligaments. The vestibular ligaments are rostral to the vocal ligament . The vestibular folds run caudodorsally, rostral to the vocal folds with the ligament positioned medially and the vocalis muscle laterally.
The vestibule extends from the entrance of the larynx to the arytenoid cartilages and vocal folds . The vestibular folds run parallel, but rostral to, the vocal folds .
The glottic cleft (rima glottidis) is surrounded by the arytenoid cartilages dorsally and vocal cords ventrolaterally. It varies in size and is diamond shaped. The glottic cleft disappears when the glottis is closed. Vocal folds run caudodorsally. The infraglottic cavity extends from the caudal section of the arytenoid cartilages into the lumen of the trachea. It is fixed in size.
The epiglottis is the rostral margin of the larynx. It is a flap of elastic ca
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