Proceedings of a Workshop on - The Havemeyer Foundation

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Havemeyer Foundation Monograph Series No. 11 IS RLN INHERITED? NEWER TECHNIQUES TO HELP INVESTIGATE THIS QUESTION M. Binns and J. Swinburne Animal Health Trust, Centre for Preventive Medicine, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK Several papers have been published which suggest that laryngeal hemiplegia has a genetic basis. In many <strong>of</strong> these studies it has been observed that the <strong>of</strong>fspring <strong>of</strong> affected stallions are more likely to be affected than the <strong>of</strong>fspring <strong>of</strong> unaffected control stallions. For example, in one recent study examining 47 <strong>of</strong>fspring <strong>of</strong> an affected stallion, 11 were affected with laryngeal hemiplegia and another 11 were suspect whereas, in a control group <strong>of</strong> 50 <strong>of</strong>fspring, only one affected and 4 suspect individuals were seen. The difference is significant at the P
Equine Recurrent Laryngeal Neuropathy MULTICENTRE TRIALS FOR EFFICACY OF TREATMENT N. Ducharme College <strong>of</strong> Veterinary Medicine, Cornell University, Ithaca, New York, USA Over the last 30 years, there have been many surveys and reports from multiple centres describing treatment results for a large number <strong>of</strong> horses with recurrent laryngeal neuropathy (RLN) (Russel and Sloane 1994; Hawkins et al. 1997; Strand et al. 2000; Kidd et al. 2002; Dixon et al. 2003a,b). In addition, there is reasonable experimental data available for evaluating the patency <strong>of</strong> the upper airway after the current surgical options: ventriculectomy, ventriculocordectomy, laryngoplasty, subtotal arytenoidectomy, partial arytenoidectomy, and laryngeal innervation (Derksen et al. 1986; Shappel et al. 1988; Tetens et al. 1996). Recently, more knowledge has been gained about methods to objectively measure upper airway sounds after these various treatments. Is there a need for multicentre trials, and what benefits would a centrally coordinated multicentre trial provide? Before we answer these questions, consider that the success rate in various surveys for racehorses treated for laryngeal hemiplegia (LH) ranges from 50 to 70%. Also, significant complications such as tracheal aspirations, persistence <strong>of</strong> upper respiratory noise, incisional seromas, incisional infection, and chondritis are still seen. It is necessary to know the optimal way to manage these complications in addition to reducing their number and severity. It would be useful to know: 1) the odds ratio that a horse will develop chondritis or decreased abduction after an incisional seroma; 2) the desirable degree <strong>of</strong> abduction to be targeted at surgery related to a horse’s specific activity; 3) whether more horses return to work after a partial arytenoidectomy than after a laryngoplasty; whether the Netherlands’ elimination <strong>of</strong> horses with laryngeal hemiplegia and some degree <strong>of</strong> laryngeal hemiparesis from breeding considerations decreased the incidence <strong>of</strong> the disease; and 4) whether laryngeal re-innervation is useful for reducing upper respiratory noise in horses performing at submaximal exercise levels. Clearly there are many unanswered questions that remain. WHAT CORE OBJECTIVES WOULD A MULTICENTRE TRIAL ACHIEVE? 1) Accumulation <strong>of</strong> significant data for evaluating treatment results stratified by subtypes <strong>of</strong> horse and activity. 2) A group could be set up to develop recommended guidelines for treating and managing LH complications based upon review <strong>of</strong> the data evidence. This group could also help set research guidelines or priorities. HOW WOULD THIS WORK? ‘The Equine Recurrent Laryngeal Neuropathy (ERLN) group’ could oversee the study design (ie inclusion criteria). The data would be entered at the point <strong>of</strong> collection only by participating investigators using a web-based program that would allow anyone to view the data being accumulated. For example, the treatment could be stratified by breed, age at the time <strong>of</strong> treatment, and activity (jumper, hunter, racehorses [point to point, flat race, steeple chase, 3 day event, quarter horse, barrel racing, and endurance] and show horses). The type <strong>of</strong> treatment (laryngeal re-innervation, laryngoplasty, partial arytenoidectomy) and technical details such as type and number <strong>of</strong> sutures, pattern <strong>of</strong> anchorage, and experience <strong>of</strong> surgeon would also be recorded. Criteria for evaluating results consistently would be agreed upon beforehand so success would be uniformly defined. 90
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