CURRENT CONCEPTS IN THE ENDOSCOPIC EVALUATION OF THE UPPER AIRWAY
such as those held in England, Ireland, Francea, Australia, and New Zealandb have seen varying ac- ceptance of the use of repository video-endoscopy exams. None of the auction companies in these countries have mandated that video-endoscopy stud- ies be provided for buyers to view.
the sales consignor’s veterinarians has become more and more commonplace. Many of these have been placed in the sales repository for viewing yet, at the time of this writing, there are very few protocols established as far as requirements or minimum standards for these videos. Also, the major US auc- tion companies have not currently altered their con- ditions of sale warranties on airways to reflect any relationship to the video-endoscopy exam provided. Other Thoroughbred sales throughout the world,
4. American Association of Equine Practitioners Guidelines
In 2016 a working group of the American Associa- tion of Equine Practitioners (AAEP) was established to develop standards and protocols for video endos- copy at sales due to continued interest and discus- sion by the industry stakeholders. This working group produced the following: Protocol for Pre-Sale Video-endoscopic Examina- tion of the Upper Airway at Public Auction (2016)c
● Equipment must be capable of producing a digital video image of excellent quality.
● Horse must be identified appropriately, and that identification must be in digital format with character generation on the screen, and/or video of the catalog page, followed by unbroken video of the face prior to introduction of the scope into the nares (right or left) and up to the larynx. This is a single-stream video with no editing. The veterinarian performing the video, or the consignor will submit each upper-airway video on an individual flash drive or CD. Upper airway videos should be stored in a file separate from the radiographs in the repository in case of client request for one or the other.
● Standard technique must include maximum abduction of the arytenoids induced by swallow- ing (multiple times) and nasal occlusion. The duration of the video must be sufficient to iden- tify all laryngeal and pharyngeal structures as well as observing their maximal function within the context of a resting exam.
● The interval between the pre-sale video-endo- scopic exam and the selling session will not exceed 10 days.
5. Equipment
As mentioned before, recent developments in video- endoscopy equipment has allowed more portability and thus ease of use to make production of quality endoscopy studies more common. It is no longer required to transport large-tower video-endoscopy
units to the horse or to transport the horse to a facility with such equipment to create a good study. There are currently several portable units on the market. These units vary from video camera– equipped fiberoptic endoscopes to digital scopes with video viewing attached or with Wi-Fi or Bluetooth wireless connectivity. Several of these units have simple character generation capability and some even have the capability to read the sub- ject horse’s identifying microchip and add that in- formation to the video produced.
6. Procedure
Producing the video requires one to approach the procedure in a standardized fashion so that each video created is similar in basic format. Although it may be required from time to time, tranquilization should not be a standard procedure as it may affect function of the airway to some degree. Most horses tolerate the procedure well under traditional meth- ods of restraint and will not need tranquilization. As discussed in the AAEP-approved protocol
above, the exam requires either character genera- tion that identifies the horse embedded in the video produced and/or the visualization of the horse’s cat- alog page and the horse’s face in one continuous video stream as one introduces the scope into the nares. The author suggests doing both so that there is little question as to the identity of the horse being examined. It is important that when doing the exam, that
one is conscious to not only visualize all important pharyngeal and laryngeal structures but to also be aware that frequent movement of the scope within the upper airway can make the video hard to watch. Nearly all exams will be done visualizing only one
nasal passage as it is somewhat rare in horses at a sale to be concerned about issues with the structures within that part of the airway. Once in the phar- ynx, it is important to view the guttural pouch open- ings and the pharyngeal recess as well as directing downward to visualize the larynx and soft palate. Fields of view among video endoscopes vary and although many scopes will have a large enough field of view to see the entire pharynx/larynx without moving, others will have to be repositioned to see all structures. The examination of upper airways at sales is
mostly concerned with laryngeal structure and func- tion, epiglottis structure and soft palate dynamics. These structures and functions must be viewed on the video in sufficient fashion as to give the viewer an adequate idea that they would feel as comfortable viewing the video as they would if they performed the examination themselves. This requires the vet- erinarian creating the video to take appropriate time to adequately view all structures, make the horse swallow multiple times and also to occlude the horse’s nares to make the horse take several deep breaths to exhibit its maximal arytenoid movement.
AAEP PROCEEDINGS Vol. 66 2020 441
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