Headshaking associated with a unique presentation of guttural pouches infection and otitis media in a Quarter Horse stallion: diagnosis, medical treatment and outcome.
Authors: Forni G, Ellero N, Mannini A, Scacco L, Freccero F
Journal: Journal of equine veterinary science
Summary
# Headshaking, Guttural Pouch Infection and Otitis Media: A Case Study with Important Diagnostic Implications Headshaking syndrome presents a diagnostic challenge for equine practitioners, with multiple potential aetiologies ranging from neuropathic pain to upper respiratory disease. This case report documents a 3-year-old Quarter Horse stallion presenting with vertical head movement and nasal snorting during exercise, prompting investigation of an unusual concurrent pathology: bilateral guttural pouch inflammation with characteristic microbullous and bullous mucosal lesions harbouring Serratia marcescens, alongside bilateral otitis media identified on computed tomography. Initial antimicrobial therapy based on bacterial sensitivities, combined with NSAIDs and enforced rest, produced partial clinical improvement within one month, though endoscopic re-examination revealed persistent infection now involving Streptococcus equi zooepidemicus, necessitating a second treatment course with identical protocols. Complete resolution of headshaking and radiographic evidence of infection clearance was achieved by two months, with sustained remission at one-year follow-up, supporting the causative link between guttural pouch pathology and this presentation. For equine professionals managing headshaking cases, this report emphasises the importance of thorough upper respiratory endoscopy with sampling protocols (flushing, brushing, biopsy) combined with cross-sectional imaging, as guttural pouch and middle ear infections represent a potentially treatable cause that may otherwise be overlooked; additionally, it highlights the possibility of sequential or mixed bacterial infections during treatment, warranting repeat culture-directed antimicrobial selection.
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Practical Takeaways
- •Headshaking with bilateral guttural pouch involvement should prompt full upper respiratory endoscopy and CT imaging, as this presentation may indicate concurrent otitis media requiring systemic treatment.
- •Sequential bacterial cultures during treatment for guttural pouch infection can reveal secondary infections; antimicrobial selection should be guided by sensitivity testing rather than empirical therapy.
- •Combination therapy including antimicrobials, systemic NSAIDs, and adequate rest can resolve guttural pouch infection-associated headshaking, but treatment duration may extend beyond the initial response period.
Key Findings
- •Bilateral guttural pouch inflammation with microbullous lesions was identified as the underlying cause of headshaking in a 3-year-old Quarter Horse stallion.
- •Initial bacterial culture identified Serratia marcescens; follow-up culture after one month revealed Streptococcus equi zooepidemicus, requiring sequential antimicrobial treatments.
- •Combined CT imaging revealed bilateral otitis media concurrent with guttural pouch infection, contributing to the clinical presentation.
- •Complete resolution of headshaking was achieved by two months with appropriate antimicrobial therapy guided by sensitivity testing, NSAIDs, and rest, with no relapse at one-year follow-up.