What is Laryngeal Paralysis in Dogs?

Laryngeal paralysis is an upper airway disease that causes difficulty breathing, most commonly in older, large breed dogs. This condition occurs when there is a loss of nerve function and the cartilages of the larynx (windpipe) do not open and close normally during respiration. The larynx has two cartilage folds that normally stay open during breathing to let air into the trachea and closed during swallowing to prevent food or water from going down the trachea. When dogs have laryngeal paralysis, the cartilage folds are “paralyzed” and stay in the closed position, thereby blocking or narrowing the opening of the trachea and decreasing airflow into the trachea and lungs and leading to difficulty breathing.

What causes Laryngeal Paralysis?

Laryngeal paralysis is caused by a generalized nerve and muscle weakness of the larynx, usually acquired as the dogs get older. The underlying cause is not entirely known, but genetics are thought to play a major role. Laryngeal paralysis can also be caused by trauma or tumors in and around the neck. There is also a rare congenital form (dogs born with the disease) that can cause laryngeal paralysis in young dogs.

What Breeds are most commonly affected by laryngeal paralysis?

Laryngeal paralysis is most commonly seen in older, large-breed dogs, but not limited to:

• Labrador Retrievers
• Golden Retrievers
• Irish Setters
• Rottweilers
• Great Danes

A congenital (from birth) form of laryngeal paralysis is less common but has been seen in Bouvier des Flandres, Dalmatians, Siberian Huskies, American Staffordshire Terriers and Bulldogs.

Clinical signs

The most common clinical signs of laryngeal paralysis are:

• Noisy or raspy breathing, especially on inspiration
• Difficulty breathing / excessive panting
• Coughing, especially after exercise
• Changes to the sound of their bark
• Anxiety
• Gagging
• Regurgitating
• Tongue or gums turning blue
• Collapse

Diagnosis

Laryngeal paralysis is diagnosed by directly examining the larynx while the dog is under sedation. Your veterinarian will visualize to see if the arytenoid cartilages are opening and closing properly during respiration.

Treatment

Unfortunately there is no cure for laryngeal paralysis, but there are some treatment options that will help improve your dog's quality of life. For mild cases, conservative medical management may be tried, whereas in moderate to severe cases, surgery is usually the best option.

Mild cases: Conservative medical management

The goal is to limit the sudden need for rapid and increased air intake. Thus we want to limit exposure to hot/ humid environments, limit strenuous exercise, manage their weight, and use a chest harness instead of a neck collar. Occasionally anti-anxiety medications and anti-inflammatories may be helpful in reducing stress.

Moderate to Severe cases: Surgery

The most common surgery for laryngeal paralysis is called a “tie-back” procedure. This procedure aims to pull back and tack the arytenoid cartilage open for “normal” breathing. While the surgery does restore the larynx's nerve and muscle function, it prevents it from blocking the opening of the trachea. This helps reduce respiratory emergencies and often improves their overall quality of life.

Unfortunately, there can be some complications after surgery, most notably aspiration pneumonia. This occurs when food or water enters down the trachea and into the lower respiratory tract causing pneumonia. Dogs with the “tie-back” procedures have an increased risk of aspiration pneumonia because the arytenoid cartilage are surgically forced to remain “opened” for improved breathing, but can’t “close” to cover and protect the trachea.

To limit the chances of aspiration pneumonia, it is recommended to avoid letting your dogs swim, feeding smaller meals, and using special feeding bowls to limit how quickly they can consume food and water.

Your dog should be seen by your veterinarian if you notice any of these signs of aspiration pneumonia:

• Poor or no appetite.
• Lethargy
• Fever
• Cough
• Nasal discharge

Respiratory emergency: Take your veterinarian or ER immediately

In the event of a respiratory emergency, you will need to take your dog to a veterinarian immediately. Treatment usually involves oxygen therapy, cooling the dog down if overheated, intravenous fluids, medications to reduce stress, and antibiotics if aspiration pneumonia is present.

Prognosis

While a diagnosis of laryngeal paralysis can be devastating, with proper medical or surgical management, your dog can still have a good quality of life. Oftentimes dogs can live for several years after diagnosis. It does however, require lifelong monitoring and management for respiratory distress and aspiration pneumonia. Most dogs respond well to treatment, especially if diagnosed early.