This patient was brought to us for exercise intolerance, breathing difficulty and loud airway sounds.
The patient has laryngeal paralysis. This is where the muscles controlling the arytenoids cartilages do not work and leads to failure of opening of the arytenoids during inspiration.
Most commonly seen in middle-aged large breed dogs, it can occur acutely, but more often it is a chronic problem exacerbated by heat or stress. The cause is often unknown, but it can be caused by trauma or lesion to the cervical region or some kind of neuropathy, such as myasthenia gravis or tick paralysis. Diagnosis is based on visualisation of the arytenoid cartilages failing to abduct during inspiration under light anaesthesia.
Treatment
The management of the acute presentations include oxygen and sedation (butorphanol) to improve airway dynamics – with or without active cooling triggered by heat and with or without anti-inflammatories (dexamethasone) to reduce swelling secondary to airway turbulence.
Patients in severe respiratory distress, anaesthesia and intubation may be required for a short period. Long-term management involves either surgery, such as laryngeal tieback, or conservative management strategies that involve weight loss, avoiding exercise and being kept in a cool environment.
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