Dog Breathing Noisily: Could It Be Laryngeal Paralysis?
Understanding Laryngeal Paralysis and the Surgery That Can Improve It
Has your dog’s breathing become noisier? Has his bark changed, does he tolerate walks less well, or does he seem to get uncomfortable in the heat quickly? These signs, often attributed to age or a decline in energy, may also be associated with laryngeal paralysis.
Laryngeal paralysis primarily affects middle-aged or older medium- and large-breed dogs, but it can also be congenital or hereditary and manifest in younger animals.
Fortunately, a better understanding of the condition makes it possible to recognize the signs earlier, avoid certain high-risk situations, and—when indicated—significantly improve the patient’s breathing and quality of life.
Laryngeal paralysis is generally acquired and develops gradually with aging. More rarely, it can be congenital or hereditary and manifest as early as the first few months or years of life.
Juvenile forms have been reported in certain bloodlines of Bouvier des Flandres, Siberian and Alaskan Huskies, Dalmatians, Black Russian Terriers, Rottweilers, and American Staffordshire Terriers.
In these young patients, the condition may be limited to the larynx, but it is sometimes part of a polyneuropathy—a disease affecting multiple nerves. Breathing difficulties may then be accompanied by weakness in the limbs, an abnormal gait, or impaired coordination.
The larynx is located at the entrance to the trachea. You can think of it as a door that controls what enters—or does not enter—the respiratory tract.
When a dog inhales, two small cartilages called the arytenoids move apart to allow air to pass through. When the dog swallows, the larynx helps protect the respiratory tract by closing the arytenoids to prevent food and water from entering the lungs.
It therefore plays three essential roles:
allowing air to pass through;
protecting the lungs during swallowing;
helping to produce vocalizations.
In cases of laryngeal paralysis, the nerves and muscles responsible for opening the arytenoids no longer function properly. The “gate” then remains partially closed during inhalation, and air must pass through a much narrower opening. It’s a bit like trying to breathe through a straw: at rest, this may be tolerable, but as soon as the dog becomes active or excited, the situation can quickly become problematic.
What are the signs of laryngeal paralysis?
The disease generally progresses gradually. The initial changes may therefore be subtle and easily attributed to aging.
The most common signs include:
heavy, hoarse, or wheezing breathing;
a change in the sound of the bark;
loudere panting than before;
decreased exercise tolerance;
marked heat intolerance;
coughing or retching during meals;
difficulty swallowing;
regurgitation;
unusual fatigue or a general slowing down.
In some dogs, weakness in the hind limbs or a less coordinated gait may also develop over time.
This latter symptom is explained by the fact that acquired laryngeal paralysis is often one of the first manifestations of a more generalized neurological disease called GOLPP (Geriatric Onset Laryngeal Paralysis Polyneuropathy). The nerves of the larynx are often the first to show signs of involvement, but those responsible for the function of the esophagus and the limbs may also be progressively affected.
When does a situation become urgent?
Seek immediate emergency veterinary care if your dog exhibits any of the following:
very labored breathing;
bluish or purplish gums or tongue;
an inability to calm down or lie down;
sudden weakness;
loss of consciousness or collapse.
How is the diagnosis made?
The diagnosis is confirmed by directly observing the movement of the laryngeal cartilages under carefully controlled deep sedation.
The patient must be sufficiently sedated to allow for clear visualization of the back of the mouth, while maintaining spontaneous breathing. The veterinarian can then check whether the arytenoid cartilages open normally during inspiration. The depth of sedation and the choice of medications are important, since certain agents can artificially reduce laryngeal movements and complicate the interpretation of the examination.
A comprehensive evaluation may also include a physical and neurological examination, blood tests, and chest X-rays to assess for the presence of aspiration pneumonia.
Surgical treatment: unilateral arytenoid lateralization
When a patient’s breathing is significantly impaired, the most commonly recommended surgical treatment is unilateral arytenoid lateralization, also known as a “tie-back.”
During this procedure, the surgeon places a permanent suture to hold one of the two arytenoid cartilages in an open position. Only one side is operated on: this opening is generally sufficient to significantly improve airflow, while minimizing as much as possible the risk of food or water entering the airways.
The surgery therefore does not repair the laryngeal nerves or cure the underlying polyneuropathy. Rather, it creates a permanent opening that allows the dog to breathe more easily and reduces the risk of future respiratory episodes. In many patients, the improvement is rapid and marked.
What are the risks of surgery?
The most significant risk is aspiration pneumonia.
Because one side of the larynx remains permanently open, small amounts of food, water, or regurgitated fluid can accidentally enter the lungs. This risk already exists in some dogs with laryngeal paralysis, but it persists for the rest of their lives after surgery.
Signs to watch for include:
a persistent or sudden cough;
fever;
loss of appetite;
unusual lethargy;
rapid or labored breathing;
nasal discharge.
A mild, occasional cough during meals may occur after a “tie-back” procedure. However, a persistent cough, accompanied by a change in the dog’s general condition, requires prompt veterinary attention.
Other complications are possible but less common: fluid buildup under the incision, infection, permanent voice changes, or rupture of the surgical fixation.
Life After a “Tie-Back”
After surgery, certain habits must be adjusted to protect the airways and promote healing.
Based on the surgeon’s recommendations, you should, in particular:
use a harness during walks;
limit activity and barking during recovery;
offer small meals several times a day;
monitor for coughing during meals;
offer small amounts of water at a time if necessary;
maintain a healthy weight;
avoid swimming.
Swimming is no longer permitted for the rest of the patient’s life following surgery, since the larynx can no longer close normally. The risk of aspiration pneumonia is therefore heightened during swimming.
What is the prognosis?
Despite the risks associated with the procedure, most dogs breathe much more easily after surgery and regain a better tolerance for walks, activity, and warmer temperatures. This surgery therefore significantly improves their quality of life.
Long-term monitoring remains essential, since the surgery improves airway patency without halting the possible progression of GOLPP. Each patient recovers at their own pace, but generally enjoys an excellent quality of life.
Early diagnosis allows you to adjust the dog’s activities, prevent respiratory crises, and determine the best time to intervene. When surgery is indicated, the “tie-back” procedure can make a significant difference.
References
American College of Veterinary Surgeons. Laryngeal Paralysis.
Cornell University College of Veterinary Medicine. Laryngeal Paralysis.
Kitshoff AM et coll. Laryngeal paralysis in dogs: an update on recent knowledge. Journal of the South African Veterinary Association, 2013.
Stanley BJ et coll. Esophageal dysfunction in dogs with idiopathic laryngeal paralysis: a controlled cohort study. Veterinary Surgery, 2010.
Wilson D, Monnet E. Risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis: 232 cases. JAVMA, 2016.
Sample SJ et coll. Late-onset laryngeal paralysis: Owner perception of quality of life and cause of death. Veterinary Medicine and Science, 2020.
Shubert MP, Ganjei JB. Outcome following elective unilateral arytenoid lateralization performed in an outpatient manner is comparable to hospitalization for dogs with laryngeal paralysis. JAVMA, 2023
