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  Discussion on Ulcerative Epiglottitis and Pharyngeal Collapse
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Member:
indigo

Posted on Tuesday, Oct 21, 2008 - 5:48 pm:

I posted a month or so ago about a mare I bought earlier this year who had a guttural pouch infection. She was treated and seemed to be doing well, but a month or so ago started having nasal discharge again, and was also making a roaring sound when she lowered her head, exerted herself etc. I took her to the surgical clinic nearest my house, and they scoped her and determined that she did NOT have another guttural pouch infection. However, she has, as per the vet's report, "severe pharyngeal collapse with ulcerative epiglottis and aryepiglottic fold. Clinical diagnosis: Ulcerative Epiglottitis." He suggested that perhaps she had had the guttural pouch infection for a long period of time before I had her, and that it had caused the scarring.

He did also do a biopsy on her epiglottis, and here are the results:

"Moderate multifocal subacute erosive epiglottitis with surface bacterial overgrowth. One representative section each taken from two small specimens of a biopsy of epiglottis are examined. The secretions exhibit discontinuous foci of epithelial erosion and necrosis. There is mild interaepithelial spongiosis. The submucosa is edematous and contains numerous lymphocytes and plasma cells with lesser number of neutrophils and crushed unidentifiable cells. Surface detrius is composed of necrotic cells admixed with a few plant fragments, mild hemorrhage and some fibrin. Clinging to one of the epithelial fragments are colonies of coccoid bacteria. There is no evidence of neoplasia in the section. No infectious agents are observed by special stains."

End result, the vet says that the bacteria present is all normal, and that there is nothing else we can do with the mare, as the scar tissue on her pharynx is extensive. The vet suggested I just watch her and if she got worse, we'd have to consider giving her a permanent tracheotomy.

I did do some online research on epiglottitis, and everything I found says it needs to be treated with antibiotics (chloramphenical was most commonly mentioned); however, all the info I found was for humans not horses. I asked the vet about this, and he didn’t seem to think antibiotics would help and that they were unnecessary, and indicated that the bacteria found in the biopsy was normal.

Am I totally off base in disagreeing with him? It seems that if she still has a nasal discharge (generally appears white and cloudy, although I have seen a bit of thinner, yellow discharge as well) that she must still have some sort of bacterial growth going on that might benefit from antibiotic treatment. I just hate to sit here and do nothing if there is SOMETHING else I could do for her to perhaps minimize the likelihood of the mare needing a tracheotomy.
Moderator:
DrO

Posted on Wednesday, Oct 22, 2008 - 8:14 am:

Hello CC,
It sounds to me like he is not communicating well the difference between what is going on with your horse and what you have read about. You have read about the treatment of acute infections of the epiglottis and pharynx. He has said there is chronic scarring of the pharynx: it will continue to collapse.

However I do agree that other less chronic changes, like the ulceration and purulent discharge, indicate that antibiotics may be helpful in preventing things from doing worse. You should note to him that just recently things were getting worse and it seems to be caused by infection.
DrO
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