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EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2020) 32 (1) 30-32 doi: 10.1111/eve.12945
Clinical Commentary Deciphering and treating dysphagia in young horses
E. J. Parente University of Pennsylvania, Kennett Square, Pennysylvania, USA Corresponding author email:
ejp@vet.upenn.edu
Keywords: horse
The authors of ‘A novel approach for palatal cyst ablation in a horse’ in this issue of Equine Veterinary Education (Sinovich et al. 2020) should be commended for bringing this thoughtful approach to a palatal problem to the readership. There are several components of this report that are worthy of further discussion. An epiglottic and/or palatal problem should be near the
top of the differential diagnosis list whenever a horse has a clinical history of abnormal respiratory noise and coughing, particularly if associated with eating. If the animal is very young or not active, an abnormal respiratory noise may not be that evident, and too often only lower respiratory disease is considered when an animal coughs. Yet, coughing should not be overlooked as a clinical sign associated with upper respiratory abnormalities (Aitken and Parente 2011). Fortunately, the functional compromise that precipitates the coughing is most often secondary to structural abnormalities that can be seen on upper airway endoscopy. In the neonate, the most common palate problem would be a cleft palate that would result in dysphagia and evidence of aspiration with milk at the nares. Depending on the size of the cleft and the scrutiny by the owners, these horses may not be recognised as having a problem until they are older. Similarly, it is somewhat surprising in this case report that this horse was not evaluated until it was 18 months of age. It is likely that these palatal cysts were congenital and this animal would have had difficulty from the time it was born. Palatal cysts are very uncommon, but large cysts or other soft tissue masses associated with the subepiglottic region can cause dysphagia and persistent displacement of the soft palate resulting in subclinical aspiration and coughing (Fig 1). Fortunately, because there is no underlying neuromuscular dysfunction, resolving the structural problem (as was achieved in this case report) should yield complete resolution. That situation is very different from the horse that has an
underlying neuromuscular problem that is causing a primary functional inability of the oropharynx resulting in the dysphagia and possibly persistent palate displacement. Dysphagia, presumably secondary to pharyngeal dysfunction, associated with hypoxic ischaemic encephalopathy or neuropathy has been documented in neonates (Holcombe et al. 2012). Most foals will resolve the pharyngeal dysfunction over time with just supportive therapy and prevention of aspiration. Yet,
Fig 1: a) Endoscopic view of a neonate with dysphagia. A large subepiglottic cyst is evident. A naso-oesophageal feeding tube is in place. b) Endoscopic view of the oropharynx with the foal under anaesthesia in dorsal recumbency. A transendoscopic diathermic loop is being employed to transect the cyst. c) The 1- day post-operative endoscopic view showing minimal swelling. The naso-oesophageal tube that is still present was removed several hours later.
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