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Massie SL, Léguillette R. Upper airway endoscopy in exercising horses: Findings in 164 barrel racing horses with respiratory clinical signs and/or poor performance. Vet J 2023; 300-302:106038. [PMID: 37865154 DOI: 10.1016/j.tvjl.2023.106038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
Barrel racing involves sprinting through a cloverleaf pattern in under 20 s. The prevalence of upper airway obstructions (UAO) in barrel racers is unknown, thus a retrospective analysis of 164 client-owned horses referred for overground endoscopy (OGE) between 2014 and 2022 was performed. Referring complaints included respiratory noise, cough, epistaxis, behaviour (owner reported stress/anxiety, refusal to enter arena, excessive head shaking), and/or poor performance. Horses performed a standardized exercise test with low and high-speed components. Videoendoscopic recordings were systematically scored by one experienced clinician. Exercising abnormalities included palatal instability (PI), intermittent dorsal displacement of the soft palate (iDDSP), nasopharyngeal collapse (NPC), recurrent laryngeal neuropathy (RLN), ventro-medial luxation of the apex of the corniculate process of the arytenoid (VLAC), medial deviation of the aryepiglottic fold (MDAF), vocal fold collapse (VFC), and cricotracheal ligament collapse. Associations between co-existing UAOs, age and sex were examined (McNemar's test; logistic regression; P < 0.05). During exercise, 24/164 (15%) horses had no UAO. In the remaining 140 horses, 56% had two or more. NPC was observed in 68/140 (49%), PI in 59/140 (42%), iDDSP in 55/140 (39%), VFC in 38/140 (27%), RLN in 27/140 (19%), VLAC in 14/140 (10%), MDAF in 8/140 (6%) and cricotracheal ligament collapse in 8/140 (6%). Nasopharyngeal collapse and RLN were primarily Grade 3 and Grade B, respectively. Associations exist between several co-existing UAOs, but not age or sex. Abnormalities were more frequent at low-speed (55%) than high-speed (22%), highlighting the importance of OGEs at different exercise intensities. Multiple UAOs appear common in barrel racers with clinical presentations.
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Affiliation(s)
- S L Massie
- Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4Z6, Canada
| | - R Léguillette
- Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4Z6, Canada.
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Watkins AR, Ford M, van Eps AW, Stefanovski D, Parente EJ. The effect of cyanoacrylate on knot elongation in three sutures used for prosthetic laryngoplasty in the horse. Vet Surg 2023; 52:428-434. [PMID: 36691965 DOI: 10.1111/vsu.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study investigated the elongation following cyclic loading on square knots of 5 USP multifilament long-chain ultra-high molecular weight polyethylene core (UHMWPE), 2 mm woven UHMWPE tape, and 5 USP braided polyester, with and without cyanoacrylate glue. STUDY DESIGN Experimental study. SAMPLE POPULATION n = 4. METHODS Three conditions (suture without knot, suture with knot, suture with knot + cyanoacrylate) were evaluated for each suture material on a mechanical test stand by measuring the increased length of the construct after cycling from 25 to 50N for 1000 repetitions at 20 mm/second. Knot elongation was determined by subtracting the length of the control suture from the suture with knot or suture with knot + cyanoacrylate. The data were analyzed with a linear regression model with robust estimation of variance. Post-hoc analysis determined the model adjusted differences (square knot vs. cyanoacrylate) as a difference from control. t-tests were conducted to identify the significant findings. RESULTS Total elongation of polyester (6.2-7.8 mm) was greater than multifilament UHMWPE (3.4-6.4 mm) and UHMWPE tape (2-3.7 mm) for all conditions. Polyester had the lowest knot elongation (1.6 mm) and the addition of cyanoacrylate decreased knot elongation for polyester by 1 mm. CONCLUSIONS Polyester had the most total construct elongation followed by multifilament UHMWPE and UHMWPE tape. Polyester showed the least knot elongation and cyanoacrylate decreased this knot elongation. CLINICAL SIGNIFICANCE Total construct and knot elongation should be considered as contributing factors to loss of arytenoid abduction following prosthetic laryngoplasty when using polyester, multifilament UHMWPE, or UHMWPE tape. Addition of cyanoacrylate to polyester knots should be explored to limit elongation.
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Affiliation(s)
- Amanda R Watkins
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Matt Ford
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Andrew W van Eps
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Eric J Parente
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
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Katz LM. Clinical insights: Upper respiratory tract obstruction. Equine Vet J 2020; 52:339-341. [DOI: 10.1111/evj.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- L. M. Katz
- University College Dublin School of Veterinary Medicine Belfield Dublin Ireland
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Vermedal H, Strand E. Dynamic laryngeal collapse associated with poll flexion as a complication of laryngeal tie‐forward surgery in three harness racehorses. Vet Surg 2020; 49:600-606. [DOI: 10.1111/vsu.13351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/30/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hanna Vermedal
- Faculty of Veterinary MedicineNorwegian University of Life Sciences Oslo Norway
| | - Eric Strand
- Faculty of Veterinary MedicineNorwegian University of Life Sciences Oslo Norway
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Grzeskowiak RM, Schumacher J, Mulon PY, Steiner RC, Cassone L, Anderson DE. Ex-vivo Mechanical Testing of Novel Laryngeal Clamps Used for Laryngeal Advancement Constructs. Front Vet Sci 2020; 7:139. [PMID: 32226795 PMCID: PMC7081719 DOI: 10.3389/fvets.2020.00139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/24/2020] [Indexed: 12/03/2022] Open
Abstract
Rostral laryngeal advancement, also known as laryngeal tie-forward, is used to treat horses for intermittent dorsal displacement of the soft palate and has a morbidity rate of about 6%. We hypothesized that a novel laryngeal clamp would prevent morbidity associated with the sutures tearing through the thyroid cartilage. Larynges (n = 35 horses) were used for ex vivo testing. For uniaxial testing, 15 equine larynges were tested in one of three laryngeal tie-forward constructs [standard laryngeal tie-forward; modified laryngeal tie-forward using a suture-button; and modified laryngeal tie-forward using a laryngeal clamp]. For biaxial testing, 20 larynges were tested in one of two treatment groups: laryngeal tie-forward and laryngeal tie-forward using a laryngeal clamp. Constructs were tested in single cycle-to-failure. Statistical analyses were performed using ANOVA for uniaxial testing and t-tests for biaxial testing. The laryngeal tie-forward using a laryngeal clamp construct was superior to laryngeal tie-forward and laryngeal tie-forward using a suture-button constructs in resistance to pullout in uniaxial testing. The laryngeal tie-forward using a laryngeal clamp presented a significantly different method of failure than the standard laryngeal tie-forward in the biaxial testing. Failure modes for each construct were primarily by suture failure at the clamp (laryngeal tie-forward using a laryngeal clamp), suture pullout through the thyroid cartilage, or, less commonly, tearing of the cricothyroid ligament (laryngeal tie-forward). In uniaxial testing, the laryngeal tie-forward using a laryngeal clamp failed most commonly due to tearing of the cricothyroid ligament, whereas the standard laryngeal tie-forward and the laryngeal tie-forward using a suture-button failed due to the tearing of the cartilage. The laryngeal clamps provided greater stiffness, load at yield, and tensile stress at yield than did the standard construct. Laryngeal clamps may offer an alternative to standard methods of anchoring the thyroid cartilage when performing the laryngeal tie-forward procedure. Further testing and clinical trials are needed to elucidate the utility of the laryngeal tie-forward using a laryngeal clamp.
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Affiliation(s)
- Remigiusz M Grzeskowiak
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - James Schumacher
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Richard C Steiner
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Lynne Cassone
- Veterinary Diagnostic Laboratory, College of Agriculture, Food and Environment, The University of Kentucky, Lexington, KY, United States
| | - David E Anderson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
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Famokunwa B, Walsted ES, Hull JH. Assessing laryngeal function and hypersensitivity. Pulm Pharmacol Ther 2019; 56:108-115. [PMID: 31004747 DOI: 10.1016/j.pupt.2019.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
The larynx is one of the most highly innervated organs in humans, adapted to simultaneously deliver several key respiratory functions including airway protection, swallowing and phonation. In some individuals the larynx can adopt a state that could be considered 'dysfunctional' or maladaptive; resulting in or contributing to a range of clinical disorders such as chronic refractory cough, inducible laryngeal obstruction (previously termed paradoxical vocal fold movement or vocal cord dysfunction), muscle tension dysphonia and globus pharyngeus. These disorders appear to display significant overlap in clinical symptomology and in many cases have features of concomitant or allied sensory dysfunction; often described as laryngeal hypersensitivity. The recognition and accurate assessment of both laryngeal dysfunction±hypersensitivity is important to ensure accurate diagnosis and effective delivery of targeted treatment and therapeutic monitoring. Accordingly, there is increasing in the methodologies proposed to assess laryngeal function. These range from simple questionnaires to targeted investigation(s), assessing both sensory function and the laryngeal motor response, under both resting and provoked situations. This review provides a brief overview of the current state of knowledge in the field of laryngeal dysfunction and hypersensitivity assessment.
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Affiliation(s)
- B Famokunwa
- Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - E S Walsted
- Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark; Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6HP, UK
| | - J H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6HP, UK.
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Hull JH, Walsted ES, Orton CM, Williams P, Ward S, Pavitt MJ. Feasibility of portable continuous laryngoscopy during exercise testing. ERJ Open Res 2019; 5:00219-2018. [PMID: 30740460 PMCID: PMC6360209 DOI: 10.1183/23120541.00219-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/08/2018] [Indexed: 01/19/2023] Open
Abstract
Exercise-induced laryngeal obstruction (EILO) is a prevalent and yet still under-recognised cause of exertional breathlessness [1]. The transient closure of the larynx, which develops during EILO, results in dyspnoea, cough, inspiratory wheeze (i.e. stridor) and tightness in the throat on physical exertion. It is estimated that EILO is present in 6% of adolescents and as many as one in four athletes with unexplained respiratory symptoms [1, 2]. Despite improved recognition over the past 5 years [3, 4], it remains frequently misdiagnosed and mistreated as asthma [2, 5]. Exercise-induced laryngeal obstruction (EILO) is a prevalent problem causing exertional breathlessness and wheeze. This report demonstrates the feasibility and safety of a diagnostic approach to EILO, using a portable laryngoscope during exercise.http://ow.ly/eM6L30njDst
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Affiliation(s)
- James H Hull
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Emil S Walsted
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Parris Williams
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Simon Ward
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Mathew J Pavitt
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
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