Summary: A black Lab Retriever is diagnosed with laryngeal paralysis. Dr. Buzby recounts the story, shares detailed images and video of laryngeal paralysis in dogs, and shares why seconds truly do matter in treating acute manifestations of this disease.
Laryngeal paralysis in dogs
When I think of laryngeal paralysis in dogs, I think of Charlie—a good-natured black Labrador Retriever who had been my patient for many years.
I think about a complex syndrome in senior dogs called Geriatric Onset Laryngeal Paralysis Polyneuropathy or “GOLPP.” While it had not been fully characterized nor named when Charlie was alive, in retrospect, I’m sure GOLPP most accurately described his condition.
And I still think about the night we lost Charlie because of this disease and the three boxes of tissues I went through.
If you are not familiar with laryngeal paralysis in dogs (lar par), it’s a relatively common condition in medium and large breed dogs, and one you need to understand. I can’t think of a better way to explain it than by sharing Charlie’s story.
Charlie’s classic, subtle lar par symptoms
Charlie was owned by the quintessential veterinary client. Francis was observant and conscientious, and because she owned three senior Labradors, we saw a lot of each other. She noticed changes in Charlie’s breathing and scheduled an appointment for an exam.
Francis was almost apologetic in the exam room because the symptoms she described were somewhat vague. She said that sometimes Charlie’s breathing sounded like he was roaring, but as she described this, he lay sleeping on the cold tile floor, looking like the picture of health. She also explained that Charlie’s voice had changed when he barked. She finished that sentence looking sheepish, as if I might write off her concerns to some manner of delayed doggie puberty.
However, it’s important to point out two things:
- I am a passionate believer that you, the owner, know your dog better than anyone else, and if you are concerned, then I am too.
- Changes in your dog’s behavior are always worth mentioning to your vet, no matter how strange or insignificant they may seem.
When Francis described her concerns, I believed her. It wasn’t her job to ascribe significance to what she observed and make a diagnosis. That was my job. Her job was to recognize changes as early as possible and alert me to them. And she was a superstar at that.
Although Francis didn’t realize it, she was describing two telltale signs of laryngeal paralysis in dogs: raspy breathing and a change in the dog’s bark.
Understanding lar par begins with understanding a dog’s larynx
After I’d finished listening to her observations and examining Charlie, I summarized my findings and shared them with Francis. Here’s what I explained:
Deep in the dog’s throat is a region we call the larynx. You might know it by the term “voice box.” Here we find important protective structures known as the arytenoid cartilages. These are two small ridges of tough tissue on either side of the entrance to the trachea (windpipe) that open and close with each breath. They are controlled by muscles that are in turn controlled by two nerves—the recurrent laryngeal nerves and vagus nerves.
What is laryngeal paralysis in dogs?
Laryngeal paralysis is a condition in which the cartilages that protect the upper airway fail to open and close appropriately. There is nothing wrong with the cartilages themselves, but rather the muscles that control them. Truth be told, it’s not even really the muscles themselves that are the problem. It’s the nerves that supply the muscle. With laryngeal paralysis, the nerve is not sending a strong signal to the muscle. As a result, the muscle weakens and no longer opens the larynx effectively. Sometimes, one cartilage is involved, and in other circumstances, it is both.
In a normal dog, the nerves command the muscles to move, which makes the cartilages open and close like a gate to allow air to move during breathing and control what enters into the lungs.
In a dog with laryngeal paralysis, the cartilage flaps (either one or both) do not move, causing obstruction of the airway as the dog breathes. It can be very noisy as the air rushes past these structures sitting in the path of the air flow.
While many structures are important in the function of the upper airway, only one muscle actually opens the cartilages—the cricoarytenoideus dorsalis. If nerve supply to this muscle deteriorates, the characteristic stridor (aka roaring) is heard as the dog breathes due to the cartilage causing turbulence as the air moves past. As with Charlie, voice changes (dysphonia) and difficulty taking in a deep breath (inspiratory dyspnea) may also be seen.
In the interest of making this story complete, I should tell you that dogs can either be born with this problem—called congenital, or they can develop it as they age, which is the acquired form.
Congenital laryngeal paralysis
Congenital laryngeal paralysis in dogs most often affects Huskies, Bouviers des Flanders, and Rottweilers. It’s fairly uncommon, but it should be on the differential list for any young puppy with the characteristic roaring sound when breathing.
Acquired laryngeal paralysis
The more common type—and the one relevant to Charlie—is acquired laryngeal paralysis. Certain breeds seem predisposed to this condition and Labrador Retrievers top the list. Other breeds on the list include:
- German Shepherds
- Golden Retrievers
- Brittany Spaniels
- and even mixed breeds
What causes laryngeal paralysis in dogs?
The reason dogs develop lar par is not known, which is why the condition was first called “Idiopathic Acquired Laryngeal Paralysis in Dogs.” The joke in vet school was that “idiopathic” meant that the vets were idiots and couldn’t figure out the cause of the disease. This isn’t far from the truth.
Idiopathic means “of unknown cause” and that’s still true today of this condition—we don’t fully understand it. However, GOLPP research studies are underway to learn more.
Laryngeal paralysis is often the first sign of a bigger issue
When I diagnosed Charlie many years ago, it was still believed that laryngeal paralysis in dogs was an isolated condition that only affected the laryngeal nerves. In recent years, however, research has shown that many (some would say all) dogs with lar par actually have a generalized polyneuropathy—meaning all of the nerves in the body are eventually involved, but laryngeal paralysis may be the first and most obvious manifestation of the problem.
Symptoms of GOLPP
In 2012, this led to the recognition of a condition named Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP), which I mentioned at the beginning of our story. To reiterate, the cause of GOLPP has not been discovered. Senior dogs with this condition may have:
- generalized weakness, not just in the upper airway, but in all muscle control
- trouble walking due to hind end weakness
- others issues like difficulty swallowing, often related to esophageal dysfunction
Diagnosing laryngeal paralysis in dogs
If you suspect that your dog may have laryngeal paralysis, a visit to your veterinarian is in order. Diagnosis of laryngeal paralysis in dogs is based on a combination of signalment (age and breed), as well as clinical signs, such as the characteristic stridor. To confirm the diagnosis, an upper airway examination is performed, and this is exactly what we did with Charlie.
It is very difficult, if not impossible, to look into the back of an awake dog’s throat deep enough to see the structures in question, so this exam is done under sedation, usually with an anesthetic drug called Propofol. (Probably the same short-acting anesthetic you had if you’ve had a colonoscopy.)
Examining Charlie’s larynx
After Charlie was sufficiently sedated to allow me to override his gag reflex and get a good look at his larynx, I injected into his IV catheter a drug called doxapram to stimulate breathing. During this short window of time, a lighted laryngoscope was held in Charlie’s mouth so I could observe his cartilages.
I diagnosed Charlie with bilateral laryngeal paralysis because neither of his cartilages moved.
A video of a dog with laryngeal paralysis like Charlie’s
Although the video below is not of Charlie, it represents exactly what I saw on his exam. To help you acclimate to the video, the dog’s soft tongue is in the foreground and the arytenoid cartilages are the somewhat draping structures in the back of the throat—almost like curtains hanging in a dark window.)
Sometimes lar par presents as one side moving and one side paralyzed. Sometimes there is partial paralysis—where movement is present, just not to the degree we expect. Finally, as you’ll see in this video, the cartilages look like statues. They are frozen in place. This was the situation for Charlie too.
Why warm climates are the enemy for dogs with lar par
Here’s the real problem with this disease, and why this blog post really matters—sometimes the diagnosis isn’t made before a crisis occurs. When dogs need to cool off, they pant. In warm climates, this is especially important.
In a dog with lar par, the obstruction of the airway makes cooling difficult and rapid overheating can occur. I have seen dozens of dogs in my career in this condition, and it is heart-wrenching.
When I diagnose laryngeal paralysis in one of my patients, I always ask the owners if they are willing to move to northern Alaska. I’m only half joking. Because of the cooling mechanism failure described above, the heat is brutal for these dogs, and what’s even worse is the humidity. I practice veterinary medicine on the swampy coast of South Carolina. Need I say more?
Why lar par is on my short list of conditions where seconds truly do count
If you have a senior dog who suddenly seems to be in a loud respiratory crisis on a hot, humid day, you have a true veterinary emergency on your hands. Don’t panic. Seek veterinary care immediately. Do not take a “wait and see” approach, since heat stroke can be very serious and time is of the essence.
There are not a lot of times in veterinary medicine where I truly believe seconds count for your dog. This is one of them.
Once your dog is stabilized, which can be a long and challenging task, your veterinarian will discuss treatment options for lar par and GOLPP. Neither condition is “curable,” but they can be managed.
How do you treat laryngeal paralysis in dogs?
If the laryngeal paralysis is relatively mild, supportive therapies can be tried. These include:
- minimizing excitement/stressful situations and administering sedatives as needed to facilitate this
- avoiding hot, humid weather (i.e. cranking up the AC)
- using harnesses rather than neck leads and collars
Additionally, there are anecdotal reports that doxepin, a tricyclic antidepressant, can help. No studies have thoroughly evaluated this, but some reports estimate improvement in up to 75% of patients and I have also found it to be helpful in my patients. The mechanism by which it works for lar par is unknown.
Is surgery an option for dogs with lar par?
If symptoms worsen or cannot be managed conservatively, a surgical treatment option exists. The procedure is called a tie-back, and it can be very successful but is not without risk. It is usually done by a board-certified veterinary surgeon because the neck area is full of important blood vessels and nerves. The surgeon will approach the larnynx through an incision on the dog’s neck. One of the cartilages will be “tied back” so that it is permanently open and not obstructing air flow. The other will be left alone, even if both cartilages are involved.
For dogs who have tie-back surgery, watch for aspiration pneumonia
The good news is that dogs immediately breathe better after this surgery and are able to lead more normal lives. The bad news is that about one-fifth of dogs who have this procedure will get aspiration pneumonia. Since the cartilages serve as a “gate” to protect the airway, if one is tied open, then aspiration of fluid and food into the lungs is possible. As a result, dogs with a tie-back surgery must be closely watched for signs of aspiration pneumonia. These include:
- change in appetite
- nasal discharge
How to manage aspiration pneumonia
Aspiration pneumonia can be managed with changes in feeding and antibiotics when warranted. And in all fairness, it’s important to note that esophageal dysfunction (often a fundamental component of the dog’s GOLPP) also plays a role in the development of aspiration pneumonia, not just the tie-back procedure. Many of these dogs have a dilated, flaccid esophagus (called megaesophagus) that increases the risk of regurgitation and aspiration pneumonia.
But there’s a deeper issue to consider. Most dogs with lar par probably have a polyneuropathy (GOLPP) that will worsen with time. Since the cause of GOLPP has not been discovered, treatment is aimed at supportive care. Tie-back surgery will help treat the laryngeal paralysis, but we also need to address the “whole dog.”
Ways to treat the whole dog
Affected patients may have trouble rising and may stumble easily. Our company’s signature product, Dr. Buzby’s ToeGrips, can improve traction on slippery floors for these dogs and may also provide increased proprioceptive stimulus—helping the neurons from the weak hind end make connections with the central nervous system, improving the dog’s overall gait and stability.
One study estimated that two-thirds of dogs with GOLPP also have trouble drinking and eating as the disease progresses. If your dog is struggling with swallowing issues and subsequent aspiration pneumonia, your veterinarian will likely discuss changing the consistency of your dog’s food and using a Bailey chair to prevent the pooling of food in the esophagus, regurgitation, and aspiration pneumonia.
Managing lar par begins with early diagnosis
While laryngeal paralysis can be a stressful diagnosis, it is not without hope. There are management options available, and with gentle attention to comfort and mobility, dogs can do well.
But I cannot stress enough the importance of protecting these dogs from heat and humidity. As veterinarians, we rarely make this diagnosis in the winter. When the heat and humidity get bad, these poor older dogs begin to fail and often present as emergencies.
Charlie’s legacy: spreading awareness of lar par to help other dogs stay safe
Sadly, Charlie’s story does not have a happy ending. One hot, humid summer day, Charlie left his home through a doggie door while his family was out. The combination of his weak hind end plus a respiratory crisis in the sauna-like weather caused Charlie to collapse outside.
He wasn’t able to make it back inside the doggie door to the protection of air conditioning, and he wasn’t able to pant effectively to cool himself down. His mom came home to find him flat out in the backyard. Devastated, she rushed him to us. His temperature upon arrival was 107°F. Our team tried our best, but we could not save him.
At the time, I could find no silver lining in the tragic loss, and I cried with his mom until we had no tears left to cry. But perhaps in writing his story, his legacy will live on to help another dog stay safe.
Remember, if you suspect that your dog may have symptoms of lar par:
- Make an appointment with your veterinarian
- Expect your vet to perform a laryngoscopic exam to confirm the diagnosis
- Keep your dog cool at all times
- Minimize stress/excitement
- If your dog ever demonstrates signs of respiratory distress, seek veterinary care immediately
What questions do you have about laryngeal paralysis in dogs?
Please comment below. We can all learn from each other.