Equine epiglottitis: Diagnosis, treatment and outcome.
Authors: Jimenez, Hogan, Belaghi, Curtiss
Journal: Equine veterinary journal
Summary
Epiglottitis remains a poorly characterised upper airway condition in horses, often initially misdiagnosed as other pathologies such as epiglottic entrapment or dysphagia when horses present with respiratory stridor or related clinical signs. This retrospective case series examined 24 Thoroughbred and Standardbred racehorses treated for epiglottitis at a single centre between 2009 and 2023, with the primary aim of documenting diagnostic findings, treatment approaches and clinical outcomes, alongside evaluating the efficacy of inhaled and topical anti-inflammatory medications. Treatment typically involved multimodal therapy combining systemic, topical and inhaled anti-inflammatories alongside antimicrobials, resulting in 91.6% of horses (22/24) returning to racing post-discharge, though one-third required re-admission—six with recurrent epiglottitis and two with alternative airway conditions. The substantial recurrence rate and the authors' inability to isolate the specific contribution of inhaled medications due to insufficient case numbers limit definitive recommendations on optimal treatment protocols. Clinicians should maintain epiglottitis within the differential diagnosis when examining horses with apparent epiglottic entrapment or upper airway obstruction, as accurate endoscopic identification (characterised by mucosal oedema, reddening and thickening) coupled with appropriate anti-inflammatory management offers a favourable prognosis for return to athletic work, though practitioners should counsel clients regarding the meaningful recurrence risk.
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Practical Takeaways
- •Epiglottitis is easily misdiagnosed as epiglottic entrapment—endoscopic examination is essential to differentiate between conditions and avoid unnecessary surgical intervention
- •Multi-modal anti-inflammatory therapy (systemic, topical, and inhaled) appears effective for managing epiglottitis in racehorses, with 91.6% successfully returning to racing
- •Watch for recurrence (33.3% re-admission rate, mostly recurrent epiglottitis)—this condition may require long-term monitoring or preventive strategies post-treatment
Key Findings
- •Of 18 horses initially diagnosed with epiglottic entrapment, accurate endoscopic examination revealed epiglottitis as the correct diagnosis
- •91.6% (22/24) of treated horses returned to racing after discharge
- •33.3% (8/24) of horses were re-admitted, with 6 cases of recurrent epiglottitis and 2 for other airway pathologies
- •Systemic, topical, and inhaled anti-inflammatories combined with antimicrobials resulted in successful treatment and good prognosis for return to athletic function