Norman – equine tracheotomy to alleviate respiratory problems

Norman is a 29-year-old Shire horse with a history of equine asthma, dust allergy, a lower airway obstructive disease. He had received treatment, which was usually effective for his equine asthma, when he started wheezing and coughing in early autumn, but this time he did not improve.

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Meet Norman, a 29-year-old Shire horse with a history of equine asthma, dust allergy, a lower airway obstructive disease. Norman had received treatment, which was usually effective for his equine asthma, when he started wheezing and coughing in early autumn but this time he did not improve.

Over the next few days, he deteriorated, developing an audible respiratory noise. On Sunday afternoon, he was struggling to eat because he couldn’t breath and became distressed. When the vet Kate assessed him, he made a loud rasping noise at inspiration and expiration, his chest was quiet as there was minimal air movement, but very noisy over the larynx. His signs were exacerbated by any movement, stressor or attempts to eat. She diagnosed an upper airway obstruction – part of the airway (nasal passaged, pharynx or larynx) was blocked or malfunctioning, stopping air from entering the lungs when Norman tried to breath in. Without treatment he was likely to asphyxiate and die.

Surgery

After discussion, despite Norman’s great age, the owner agreed to an emergency surgical procedure called a trachaeotomy – bypassing the affected part of the airway and allowing air to enter the trachea directly through a hole in Norman’s neck. The procedure was performed immediately, under local anaesthetic and light sedation, which was difficult of Norman nearly collapsed. Once the airway had been secured a 3-ring metal trachaeotomy tube was placed to keep the newly created hole open

In a few minutes, Norman improved dramatically and in the following days, gained weight and was feeling much livelier. He underwent blood biochemical analysis and endoscopy to assess the cause of his obstruction. A diagnosis of idiopathic bilateral laryngeal paralysis was made, meaning his larynx (which opens when a normal horse breathes in) had collapsed, significantly narrowing his airway. This condition may be temporary or permanent, the trachaeotomy alleviates the negative pressure that occurs during inspiration, allowing inflammation to settle and function to return.

Recovery

Norman’s surgery site has healed around the tube allowing him to return to his normal life. We don’t know if his laryngeal function will improve, making it possible to remove the trachaeotomy, or if it will need to stay in place indefinitely, but we can test this by plugging the tube for short periods and monitoring his breathing. Once the tube is removed, the hole closes in 2-3 weeks, with minimal scarring. In the meantime, Norman and his owner are enjoying some additional quality time together.

Out of hours emergency

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