Dysphagia: What the Research Says
Evidence from 20 peer-reviewed studies
What Professionals Should Know
- •Dysphagia carries a generally good prognosis for most causes (>80% resolution), but horses with neurogenic causes require more guarded expectations (46% recovery)
- •Monitor all dysphagia cases closely for aspiration pneumonia development as a serious complication
- •Early diagnosis of the underlying aetiology (oral, pharyngeal, oesophageal, or neurogenic) is essential for appropriate treatment planning and client communication about prognosis
- •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
- •Guttural pouch cysts are rare but should be included in the differential diagnosis for foals presenting with dysphagia; perform complete endoscopic examination of upper airways including guttural pouches
- •Transendoscopic laser fenestration is an effective minimally invasive surgical option for guttural pouch cysts with good long-term outcomes
- •Early diagnosis and treatment of upper airway cysts in foals can prevent complications and allow normal feeding and development
- •Partial parotidectomy combined with cisplatin beads may be a viable treatment option for equine parotid carcinoma, though expect significant postoperative complications including facial nerve involvement
- •Plan for prolonged wound healing and postoperative management; this horse experienced dehiscence requiring second-intention healing but eventually returned to function
- •Detailed anatomical knowledge of the parotid region and careful surgical planning are essential to minimize complications during parotid mass removal
- •Inspect hay carefully for unwanted plant species and sharp plant parts; poor quality hay should be replaced immediately if horses show signs of oral irritation, drooling, or inappetence
- •When a horse develops dysphagia or feeding difficulties, assess whether hay quality or management is the underlying cause before pursuing invasive diagnostics
- •If a stabled horse develops free fecal water syndrome, evaluate and potentially change hay source and quality as a first-line management strategy
- •Leiomyosarcomas are extremely rare oral tumors in horses; persistent ptyalism, dysphagia, and halitosis warrant investigation including CT imaging and biopsy for definitive diagnosis
- •Combined histopathology and immunohistochemistry (Calponin/Desmin staining) is essential for confirming leiomyosarcoma diagnosis and distinguishing it from other mesenchymal tumors
- •Oral masses in horses causing dysphagia and dysmastication require imaging to assess extent of invasion and involvement of surrounding structures before treatment planning
- •TOT is a safe, non-invasive adjunctive therapy for guttural pouch mycosis that can be performed easily in standing horses and shows promise for resolving inflammatory lesions and associated neurological complications
- •Consider TOT as a complementary treatment option alongside or after conventional therapies like transarterial coil embolization, particularly when managing refractory inflammatory lesions or neurological signs
- •The technique requires minimal equipment (oxygen source, delivery tubing) and takes 30-60 minutes per session, making it practical for field or hospital use in equine practice
- •If a horse develops persistent coughing or swallowing difficulties after laryngoplasty, prosthesis removal is a viable treatment option with good success rates (66-75%)
- •Arytenoid abduction grade does not predict which horses will respond positively to prosthesis removal, so clinical response rather than endoscopic findings should guide management decisions
- •Expect about 1 in 30 laryngoplasty cases to require prosthesis removal, so counsel clients appropriately about potential post-operative complications
- •Horses presenting with persistent dysphagia, ptyalism, and weight loss warrant oral examination and biopsy to rule out lingual neoplasia, as lingual SCC is underreported and may be more common than recognized
- •Radiation therapy may be a viable treatment option to consider before euthanasia in some cases of equine lingual SCC
- •Radiographs and endoscopic evaluation are useful diagnostic tools to complement physical examination when evaluating suspected oral malignancy in horses
- •Salpingopharyngostomy is an effective surgical alternative for GPM that provides rapid resolution of nasal discharge (10-30 days) and allows outpatient treatment with lower costs
- •This technique should not be used in horses with active or recent epistaxis due to safety concerns
- •Complete fungal plaque resolution takes 1-6 months; clients should be counseled on the extended timeline despite rapid improvement in clinical signs
- •Stridor and dysphagia in foals warrant thorough imaging and endoscopic investigation, as congenital cysts and laryngeal malformations may coexist and require surgical intervention
- •Pathological examination is essential in cases of congenital laryngeal disease to identify the tissue origin and extent of malformation, guiding surgical planning
- •This rare case highlights the importance of recognizing unusual combinations of foregut-derived anomalies in neonatal foals presenting with upper airway and swallowing dysfunction
- •Branchial remnant cysts should be considered in the differential diagnosis for mature horses presenting with throat latch masses, dysphagia, or retropharyngeal swelling—not just in foals as previously reported
- •Ultrasonography is a useful diagnostic tool showing characteristic thick-walled cysts with fluid and clots; definitive diagnosis requires squamous epithelium identification via cytology or histopathology
- •Surgeons should counsel owners that right laryngeal hemiplegia is a frequent complication of BRC excision due to proximity to the recurrent laryngeal nerve, with potential impacts on athletic performance
- •European adder bites in horses can cause severe systemic effects beyond local tissue damage, requiring urgent veterinary attention and monitoring for cardiac and respiratory complications
- •Zagreb antiserum appears beneficial for treating European adder envenomation in horses when administered
- •Early recognition of severe signs (tissue necrosis, dysphagia, arrhythmias) is critical as untreated cases may warrant euthanasia consideration
- •Suspect metallic foreign body in any horse presenting with acute tongue swelling, excessive salivation, and anorexia; use radiography and ultrasonography for diagnosis if oral examination fails
- •Review feeding management with clients using hay feeders and cable-framed tractor tyres, as these are common sources of wire contamination
- •Prompt removal of accessible foreign bodies plus standard antimicrobial and anti-inflammatory therapy yields good outcomes; even conservative management without extraction can succeed
- •Guttural pouch chondroids can be safely removed in standing sedated horses using a modified Whitehouse approach, avoiding general anesthesia risks and costs
- •Most horses (80%) return to full athletic function post-operatively, making this a viable treatment option for cases refractory to medical management
- •Pre-operative evaluation should include endoscopy and radiography to confirm diagnosis and assess for concurrent conditions like dysphagia or laryngeal neuropathy that may affect prognosis
- •Masseter myodegeneration should be considered in horses presenting with trismus, dysphagia, or difficulty eating combined with visible jaw muscle atrophy
- •Serum muscle enzyme panels and selenium/vitamin E status should be evaluated in suspected cases, as deficiencies of these nutrients may be contributing factors
- •Histopathology of affected muscle may be necessary for definitive diagnosis and staging of disease, and systemic involvement should be ruled out
- •Normal swallowing function cannot be used as a diagnostic test for glossopharyngeal nerve integrity in horses
- •Dysphagia in horses should not be automatically attributed to glossopharyngeal nerve dysfunction without further investigation
- •When evaluating dysphagic horses, consider other causes of swallowing dysfunction as the glossopharyngeal nerve may have redundant or compensatory function
- •Rhinitis sicca may serve as a clinical indicator of autonomic dysfunction in horses with suspected grass sickness
- •Recognition of nasal mucosal changes alongside other clinical signs (dysphagia, constipation, sweating) should heighten suspicion for grass sickness diagnosis
- •Understanding the neurological basis of rhinitis sicca in grass sickness may inform management strategies for mucosal protection and moisture
- •Prognosis in guttural pouch mycosis is guarded with 50% survival regardless of treatment approach; dysphagia severity should guide euthanasia decisions
- •Nasal discharge, epistaxis, and cough warrant investigation for guttural pouch mycosis, but dysphagia indicates a poorer prognosis
- •Medical and surgical treatments appear equally effective, so choice should be based on individual case factors and horse owner preferences rather than expected outcome differences
- •TCE is an effective first-line treatment for guttural pouch mycosis with excellent long-term outcomes and no recurrence during extended follow-up
- •Epistaxis related to GPM responds well to TCE alone without requiring additional medical or surgical intervention in most cases
- •Horses with severe neurological complications (particularly dysphagia) may have a guarded prognosis despite intervention
Key Research Findings
Dysphagia accounted for 1.1% of all referral hospital cases over a 12-year period
Resolution of clinical signs exceeded 80% for oral, pharyngeal, and oesophageal aetiologies
Neurogenic dysphagia had significantly lower recovery rate of 46%
Aspiration pneumonia was a common sequela of dysphagia across aetiological categories
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
A 16-day-old foal presented with dysphagia caused by a guttural pouch cyst protruding into the pharyngeal vault
Transendoscopic fenestration using diode laser successfully drained the cyst and resolved clinical signs
No recurrence was observed at 12-month follow-up following minimally invasive endoscopic treatment
Thorough endoscopic examination of the guttural pouches should be performed in foals with persistent dysphagia
Partial parotid sialoadenectomy with cisplatin bead implantation achieved tumor-free status at 12 months postoperatively in a horse with parotid carcinoma
Postoperative complications included right-sided facial nerve paralysis and surgical site dehiscence, with partial nerve function recovery within 6 months
The horse returned to work 12 months after surgery with no evidence of tumor recurrence or metastatic disease
Evidence Base
Dysphagia in an equine referral hospital, 182 cases.
Connolly, Estell (2025) — Equine veterinary journal
Equine epiglottitis: Diagnosis, treatment and outcome.
Jimenez, Hogan, Belaghi et al. (2025) — Equine veterinary journal
Cyst of the Guttural Pouch in a Foal: A Case Report.
Bandera Lorenza, Celani Gianluca, Straticò Paola et al. (2023) — Journal of equine veterinary science
Partial parotid sialoadenectomy in a horse with parotid ductal carcinoma: Surgical description and case report.
Zetterström Sandra M, Matz Brad M, Neto Rachel L A L T et al. (2022) — Veterinary surgery : VS
When Changing the Hay Makes a Difference: A Series of Case Reports.
Cavallini Damiano, Penazzi Livio, Valle Emanuela et al. (2022) — Journal of equine veterinary science
Invasive leiomyosarcoma involving the tongue of an Arabian mare.
Pinzón-Osorio César Augusto, Meneses-Martínez Henry, Botero-Espinosa Lucía et al. (2021) — Journal of equine veterinary science
The Effect of Topical Oxygen Therapy in Horses Affected with Mycosis of the Guttural Pouch: An Experimental Pilot Study and a Case Series.
Lepage Olivier M, Di Francesco Paola, Moulin Nicolas et al. (2021) — Animals : an open access journal from MDPI
Outcomes of horses treated with removal of a laryngoplasty prosthesis.
Fitzharris Laura E, Lane J Geoffrey, Allen Kate J (2019) — Veterinary surgery : VS
Lingual Squamous Cell Carcinoma in Two Horses.
Morrison M Lane, Groover Erin, Schumacher John et al. (2019) — Journal of equine veterinary science
Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses.
Watkins A R, Parente E J (2018) — Equine veterinary journal
Bronchogenic and esophageal cyst with laryngeal malformations in a thoroughbred foal.
Matsuda K, Qiu Y, Furuse T et al. (2010) — Veterinary pathology
Branchial remnant cysts of mature and juvenile horses.
Nolen-Walston R D, Parente E J, Madigan J E et al. (2009) — Equine veterinary journal
Effects of bites by the European adder (Vipera berus) in seven Swedish horses.
Anlén K G (2008) — The Veterinary record
Metallic foreign bodies in the tongues of 16 horses.
Pusterla N, Latson K M, Wilson W D et al. (2006) — The Veterinary record
Standing surgical removal of inspissated guttural pouch exudate (chondroids) in ten horses.
Perkins Justin D, Schumacher Jim, Kelly Ger et al. (2006) — Veterinary surgery : VS
Masseter myodegeneration as a cause of trismus or dysphagia in adult horses.
Pearson E G, Snyder S P, Saulez M N (2005) — The Veterinary record
The effect of bilateral glossopharyngeal nerve anaesthesia on swallowing in horses.
Klebe E A, Holcombe S J, Rosenstein D et al. (2005) — Equine veterinary journal
Changes in nasal mucosal innervation in horses with grass sickness.
Prince D, Corcoran B M, Mayhew I G (2003) — Equine veterinary journal
Guttural pouch mycosis in horses: a retrospective study of 28 cases.
Dobesova O, Schwarz B, Velde K et al. (2012) — The Veterinary record
Transarterial coil embolisation in 31 horses (1999-2002) with guttural pouch mycosis: a 2-year follow-up.
Lepage O M, Piccot-Crézollet C (2005) — Equine veterinary journal