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T Nose-Ear-Throat
DISEASES OF THE THROAT (PHARYNX AND LARYNX)
Anjop J. Venker-van Haagen,
DVM, PhD, Dipl. ECVS.
University Utrecht,
Companion Animal Sciences,
Stationsstraat 142,
Utrecht, 3511 EJ,
The Netherlands
aj.venkervanhaagen@wanadoo.nl
History
The medical history in diseases of the pharynx
usually reveals specic problems caused either
by dysfunction of the airway through the
oropharynx or nasopharynx or by difculty
in swallowing (dysphagia). In some cases
the appearance of the pharyngeal mucosa may
suggest a systemic disorder, but in all cases
additional questions are asked about any changes
in the animals general condition, appetite,
eating, drinking, physical activity, and habits.
The answers to these questions together with a
general physical examination will provide an
impression of the patients condition.
Clinical signs
Dyspnea in pharyngeal disease. Signs of dyspnea
in pharyngeal disease are caused by obstruction of
the nasopharynx or the oropharynx. Obstruction
of the laryngopharynx primarily hinders the
passage of air through the nasopharynx and
hence it also results in signs of nasopharyngeal
obstruction. Severe obstruction of the oropharynx
or laryngopharynx hinders the passage of food as
well as air and thus causes dysphagia as well as
dyspnea. Large masses in the nasopharynx can
also obstruct the oropharynx and thus also result
in dysphagia.
When dyspnea is caused by pharyngeal obstruction
the signs are those of more forceful inspiration,
which usually produces a snoring stridor. In cats
the sounds may be soft and sometimes difcult
to distinguish from the wheezing stridor caused
by nasal obstruction. Dysphagia in pharyngeal
disease. The signs of dysphagia involving the
pharyngeal phase are gagging, choking, and
repeated swallowing of one bolus. The food may
be regurgitated and will be seen to be covered
with thick mucus, and the dog may eat it again.
When there is severe dysphagia and part of
THE PHARYNX
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Laryngoscopy
When laryngoscopy is performed for diagnosis
of laryngeal disease, the dog or cat is usually
in a certain state of dyspnea. The laryngoscope
is tted with a blade suitable for the size of the
animal and lubricated endotracheal tubes of
several sizes are prepared. The anesthetic is then
administered to effect, preferably by intravenous
injection. Propofol is satisfactory and may be
used after premedication with medetomidine.
Medetomidine premedication is given to cats
intramuscularly and to dogs intravenously. When
the laryngeal movements are absent and the
depth of anesthesia may be the cause, the short
half-life of propofol is advantageous because
after a short pause there is sufcient recovery for
the inspection to proceed.
Diagnostic imaging
Radiographs, CT, and MRI. Radiographs of
laryngeal structures are not easy to interpret.
In the lateral projection the overlapping of
structures and the presence of air pockets are
unpredictable, particularly in the dyspneic patient.
The extension of neoplastic or cystic masses and
the presence of calcication of the laryngeal
cartilages can be recognized. When surgery
is being considered for removal of a laryngeal
tumor, CT or MRI will be found indispensable
for estimating the involvement of laryngeal and
surrounding structures by the tumor. CT is less
expensive than MRI and almost always answers
the question. MRI is added in only a few cases.
In human patients these techniques do not always
require anesthesia and endotracheal tubes are
avoided. In dogs and cats the use of anesthesia
and endotracheal intubation cannot be avoided
and this will inuence the aspect of processes in
the lumen of the larynx.
Electromyography
Laryngeal dysfunction is often an indication
for electromyography (EMG) of the intrinsic
laryngeal muscles. EMG can be performed
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