Ultrasonography of the Larynx for the Diagnosis of Recurrent Laryngeal Neuropathy

Chalmers, Heather

doi:10.1002/9781118834183.ch3

Cited by 4 publications

(13 citation statements)

References 9 publications

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“…The measures of agreement between the resting and exercising laryngeal endoscopy grades in our population reflect the findings of others, namely that the resting laryngeal endoscopy grade does not perfectly predict the exercising function of the larynx. This discrepancy is most likely to occur in some resting larygneal grade II and III horses For horses in these resting laryngeal endoscopy grades, ultrasound offers an additional assessment tool that more accurately predicts the exercising laryngeal endoscopy grade, as reported previously . The current study is the first to describe quantitative assessment of cricoarytenoideus lateralis echogenicity in horses with RLN.…”

Section: Discussionsupporting

confidence: 61%

“…1,11 Recent studies have concluded that ultrasonographic evaluation of horses with suspected RLN is of diagnostic value. 12,13 The detection of increased echogenicity of the cricoarytenoideus lateralis muscle has been shown to be a sensitive and specific test for RLN and has excellent agreement with the reference standard of exercising upper airway endoscopy. 12,13 These findings are consistent with reports in human medicine, in which ultrasound has been used to detect myopathy due to neurogenic atrophy and differentiate it from myopathy of nonneurogenic origin.…”

Section: Introductionmentioning

confidence: 97%

“…Recent studies have concluded that ultrasonographic evaluation of horses with suspected RLN is of diagnostic value . The detection of increased echogenicity of the cricoarytenoideus lateralis muscle has been shown to be a sensitive and specific test for RLN and has excellent agreement with the reference standard of exercising upper airway endoscopy .…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Sensitivity of Subjective and Quantitative Laryngeal Ultrasonography for Recurrent Laryngeal Neuropathy in Horses

Chalmers

Yeager

Cheetham

et al. 2012

Vet Radiology Ultrasound

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Recurrent laryngeal neuropathy (RLN) is the most common cause of laryngeal hemiplegia in horses and causes neurogenic atrophy of the intrinsic laryngeal muscles, including the cricoarytenoideus lateralis muscle. Recurrent laryngeal neuropathy results in paresis to paralysis of the vocal fold and arytenoid cartilage, which limits performance through respiratory compromise. Ultrasound has previously been reported to be a useful diagnostic technique in horses with RLN. In this report, the diagnostic sensitivity of subjective and quantitative laryngeal ultrasonography was evaluated in 154 horses presented for poor performance due to suspected upper airway disease. Ultrasonographic parameters recorded were: cricoarytenoideus lateralis echogenicity (subjective and quantitative), cricoarytenoideus lateralis thickness, vocal fold movement, and arytenoid cartilage movement. Ultrasonographic parameters were then compared with laryngeal grades based on resting and exercising upper airway endoscopy. Subjectively increased left cricoarytenoideus lateralis echogenicity yielded a sensitivity of 94.59% and specificity of 94.54% for detecting RLN, based on the reference standard of exercising laryngeal endoscopy. Quantitative left cricoarytenoideus lateralis echogenicity values differed among resting laryngeal grades I-IV. Findings from this study support previously published findings and the utility of subjective and quantitative laryngeal ultrasound as diagnostic tools for horses with poor performance.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Sensitivity of Subjective and Quantitative Laryngeal Ultrasonography for Recurrent Laryngeal Neuropathy in Horses

Chalmers

Yeager

Cheetham

et al. 2012

Vet Radiology Ultrasound

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“…In affected animals, primary axonopathy of the recurrent laryngeal nerve leads to secondary neurogenic atrophy and dysfunction of the intrinsic laryngeal muscles. The use of ultrasound to assess the laryngeal muscles in horses has emerged as a more accurate technique than resting functional assessment using upper airway endoscopy for diagnosis . Furthermore, the use of quantitative ultrasonography appears to allow stratification of disease severity.…”

mentioning

confidence: 99%

“…The use of ultrasound to assess the laryngeal muscles in horses has emerged as a more accurate technique than resting functional assessment using upper airway endoscopy for diagnosis. [10][11][12] Furthermore, the use of quantitative ultrasonography appears to allow stratification of disease severity. Developing this technology as a screening test for roaring in horses, or neuropathic disease in humans, requires expanded understanding of the corresponding histologic alterations that correlate with change in muscle ultrasonographic appearance.…”

mentioning

confidence: 99%

Ultrasonography detects early laryngeal muscle atrophy in an equine neurectomy model

et al. 2016

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Introduction: A unilateral neurectomy model was used to study the relationship between histologic and ultrasonographic tissue characteristics during muscle atrophy over time. Methods:In vivo experimental study in equine model (n=28). Mean pixel intensity of ultrasonographic images was measured, a muscle appearance grade was assigned weekly, and muscles were harvested from 4-32 weeks. Minimum fiber diameter, fiber density per unit area, percent collagen, percent fat, and fiber type profile were measured from muscle cryosections and correlated with the ultrasonographic parameters.Results: A significant relationship was identified between collagen content, minimum fiber diameter, and ultrasonographic muscle appearance as early as 8 weeks. There was no apparent association between fat content of muscle and the ultrasonographic appearance of atrophy prior to 28 weeks in this model. Discussion:Early muscle atrophy prior to fatty infiltration is detectable with ultrasound.The effect of muscle collagen content on echointensity may be mediated by reduced fiber diameter.Keywords: muscle, atrophy, ultrasound, larynx, histology Muscle & NerveThis article is protected by copyright. All rights reserved. Introduction:Diagnostic imaging modalities are at the forefront of the emerging field of non-invasive tissue characterization and offer expanding potential as a non-invasive way to assess muscle. There is need for detailed study of the relationship between the histologic and ultrasonographic findings of muscle tissue in health and disease. In neuropathic conditions, the ultrasonographic appearance of muscle has been characterized as having increased echogenicity, while with certain myopathies no such change is observed.1 The reason(s) for altered appearance of muscle under conditions of neurogenic atrophy are understood incompletely. Several authors have hypothesized that the increase in echogenicity is the result of fat and fibrous tissue infiltration. 2-5Isolated attempts have been made to correlate muscle echogenicity and histologic parameters with mixed results; the relative effects of fat and collagen content have been inconsistent in the models studied.Muscle biopsy, together with functional assessment tests, genetic testing, and/or electrodiagnosis, is the gold standard diagnostic test for many neuromuscular conditions. However, there are certain clinical situations in which biopsy, direct functional assessment, and electrodiagnosis can be neither practical nor desirable.These include situations where: 1) muscles have limited anatomic access, such as ocular muscles; 2) muscles are very small and make biopsy difficult or excessively invasive; 3) muscles could become unduly scarred by the procedure, thereby influencing muscle function; 4) muscles have already been biopsied and require noninvasive monitoring over time; 5) situations in which electrodiagnostics are undesirable for technical, anatomical, or patient-related reasons. Therefore, the use of non-invasive Muscle & NerveThis article is protected by copyright. All...

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Respiratory diseases and their effects on respiratory function and exercise capacity

Erck-Westergren¹,

Franklin

Bayly

2013

Equine Veterinary Journal

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Given that aerobic metabolism is the predominant energy pathway for most sports, the respiratory system can be a rate-limiting factor in the exercise capacity of fit and healthy horses. Consequently, respiratory diseases, even in mild forms, are potentially deleterious to any athletic performance. The functional impairment associated with a respiratory condition depends on the degree of severity of the disease and the equestrian discipline involved. Respiratory abnormalities generally result in an increase in respiratory impedance and work of breathing and a reduced level of ventilation that can be detected objectively by deterioration in breathing mechanics and arterial blood gas tensions and/or lactataemia. The overall prevalence of airway diseases is comparatively high in equine athletes and may affect the upper airways, lower airways or both. Diseases of the airways have been associated with a wide variety of anatomical and/or inflammatory conditions. In some instances, the diagnosis is challenging because conditions can be subclinical in horses at rest and become clinically relevant only during exercise. In such cases, an exercise test may be warranted in the evaluation of the patient. The design of the exercise test is critical to inducing the clinical signs of the problem and establishing an accurate diagnosis. Additional diagnostic techniques, such as airway sampling, can be valuable in the diagnosis of subclinical lower airway problems that have the capacity to impair performance. As all these techniques become more widely used in practice, they should inevitably enhance veterinarians' diagnostic capabilities and improve their assessment of treatment effectiveness and the long-term management of equine athletes.

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Ultrasonography of the Larynx for the Diagnosis of Recurrent Laryngeal Neuropathy

Cited by 4 publications

References 9 publications

Diagnostic Sensitivity of Subjective and Quantitative Laryngeal Ultrasonography for Recurrent Laryngeal Neuropathy in Horses

Diagnostic Sensitivity of Subjective and Quantitative Laryngeal Ultrasonography for Recurrent Laryngeal Neuropathy in Horses

Ultrasonography detects early laryngeal muscle atrophy in an equine neurectomy model

Respiratory diseases and their effects on respiratory function and exercise capacity

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