Talk to Me About Roarers

[Arelle]

Because the hits just keep on coming.

Have a very nice, well bred mare who I’ve had in training all year. Recently, she’s gotten louder and louder during some moments of training and we took her in to get scoped as we thought perhaps she had developed an upper respiratory infection, etc.

Instead, we found that she has a Grade IV left-side laryngeal hemiplegia. Great.

My vet has advised that there are two options - one, tie back surgery - which is less invasive, but also comes with a higher failure rate - or two, a somekindof- ectomy (I didn’t catch the medical term) where they actually lay the horse down and remove the cartilage, essentially eliminating the problem. Both obviously come with the risk of surgery and I believe from my very slight reading, higher risks of future airway infections/inflammation/etc.

I’m concerned with having to have her go through surgery. I’m wondering - if she takes a step down from the rather intense program she’s in - is it medically necessary? We only see it pop up now when she’s being asked for a lot out of her body (i.e. a very collected canter with weight out of her shoulders), tenses up, and then loses that partial airway. It doesn’t pop up when she’s walking, trotting, or cantering with more forward movement.

Does anyone have any advice, either way?

[endlessclimb]

If the mare is young with a full career ahead of her, I’d do the tieback. Pick the best vet you possible can to haul to and get it done.

If she’s potentially going to have to step down anytime soon anyways, I’d just accelerate that and step her down now.

[Rel6]

I would have your vet (or you) consult with an airway specialist. My last horse was diagnosed with a grade III roar at 4, and having a specialist weigh in made me feel less overwhelmed.

My vet connected with an airway specialist at Cornell who gave us three options. First: removing her vocal cords (ventriculocordectomy), which would stop the noise and improve her airway, but likely only marginally. It is a standing procedure done by cauterizing the vocal cords with a quick recovery and was pretty inexpensive when I was quoted. Tieback (laryngoplasty) + ventriculocordectomy, which was more invasive with a bit longer recovery, but if successful would fix both the noise and the airway restriction (more expensive, but wasn’t a terrible quote). (Aside, I didn’t think they generally did a tieback without also removing the vocal cords?) The third option is very new, and involved basically using a nerve graft to “cure” the problem by fixing the paralysis. Its more successful in lower grades of roars (mine was a grade III), and can take time to work (I was told months). Also $$$. The surgeon said the gold standard would be to ventriculocordectomy and nerve graft if she was a good candidate, with a tie-back + ventriculocordectomy if she was not.

My horse wasn’t showing exercise intolerance, and was still fairly green so I decided to hold off until I could see how bad the noise and her endurance/wind would be at a level closer to what I wanted to do with her, and when she was fitted, before making any decisions.

How old is your mare? If she was young, I would absolutely opt for a surgery. I would probably want to go to an equine hospital that can evaluate her with a dynamic endoscope, and then make a recommendation from there based off of what they are seeing. I no longer have my last horse due to unrelated reasons, but that was my plan if her roar began to impact her performance.

[Arelle]

For those asking, this mare is 5.

She’s doing fine in training, but becomes rushed and a little panicked at the collected canter … which as of this morning, it makes sense that it’s due to the restriction in airway. The roaring is a newer phenomenon though - perhaps with the increased growth she’s had this year, it led to the failure of the nerve.

My vet has advised that she would likely consult with Dr. Honnas down in the College Station/Texas A&M area should we pursue surgery.

I’m still rehabbing a minor DDFT tear on my main horse, this is my backup horse - so I’m trying not to just emotionally lose it and make a judgement based on logic vs feel. These horses are treated like kings, so having the second one in 90 days come down with something totally out of my control that seems like it’s going to require a high amount of vet work is just… ugh.

[Rel6]

I was told a roar is/can be degenerative and that my grade III mare could become grade IV in a year or so, there was no way to know. Perhaps your mare was a grade II/III and degenerated into a grade IV, and that coupled with a more intense work program, made it noticeable for the first time?

I didn’t notice my horse making a noise until she started having a more intense workload.

I still advise not to wait until you are sure you want to do surgery to consult with the specialist. You need their expertise to make an informed decision about whether (or when) surgery is the right choice. Is it really possible to decide whether to do surgery without having a specialist/surgeon tell you about the options, risks, outcomes, etc?

I’m sorry you’re going through this double whammy, and hoping for great outcomes for both your horses.

[Lysendriel]

I had the tieback + vocal cord removal done on my girl. She was a pretty advanced case (Grade IV on one side and II on the other). She was also very exercise intolerant. She could only trot with her head extended straight forward and she wasn’t able to canter.

I took her to NC State to have the procedure done. When I had the procedure done (about 3 years ago) they weren’t really concerned about it failing. I think there used to be a higher failure rate years ago but the procedure these days is very successful.

Overall, it was a really simple surgery- NC State does it standing, so that made me feel a lot better. She stayed at the clinic for 3 days, then had a few weeks of stall rest. The biggest concern they have is that they cannot fully protect their airway- so they recommended feeding them soaked feed on the floor for the rest of their lives, just to reduce the risk of aspiration. For the first few weeks we soaked her hay, just to reduce the dust while she was healing.

She is almost a completely different horse post-surgery. I am so happy I had it done. She can actually trot and canter normally! I think I paid about $2500 for the procedure, and I would do it again in heartbeat if I had another horse that roared.

[2DogsFarm]

Friend’s older (13) Belgian had this done several months ago.
He had the procedure where the paralyzed flap is resected.
Was sent home a couple days post-surgery - done at the local vet college - surgical site was treated by owners & AFAIK (I’d have to ask) is fine for returning to normal work.
Which, in this case, is driven to a cart infrequently.

[Proffie]

I had the tieback done on my Belgian/TB cross mare years ago, and unfortunately the outcome wasn’t as good as I’d hoped. It definitely helped, but she still made some noise and never got over her panic when asked to collect. I’m not sure if that was a learned response though, because I got her when she was already 9 and had lived with her issue for years. I ended up having to stop training her for dressage and just used her to poke around on the trails – which she was amazing at and loved it, luckily.

[Arelle]

So - anyone who has responded. My follow up question - how bad is the aftercare management?

IE I’ve read that they are more sensitive to dust; they must be fed on the floor to help prevent aspiration of food and water, etc.

Still weighing my options here as I travel frequently for work and would need to rely on my training barn for the management aspect.