Geriatric onset laryngeal paralysis polyneuropathy (GOLPP) is a progressive neurological disorder commonly seen in older dogs, particularly in large breeds. This condition involves the dysfunction of the larynx and peripheral nerves, leading to significant respiratory distress and other associated symptoms. Understanding the pathophysiology, clinical presentation, diagnosis, and management of GOLPP is crucial for veterinary professionals and dog owners alike.
Cause: GOLPP initially affects the nerves to the larynx and is followed by other peripheral nerves, causing a more generalized loss of motor function. The exact etiology of GOLPP remains unclear, but it is believed to involve a combination of genetic predisposition, degenerative changes in nerves, and possibly autoimmune mechanisms. In affected dogs, the nerves controlling the laryngeal muscles degenerate over time, leading to decreased muscle tone and paralysis of the larynx. This results in the inability to properly open the larynx during inspiration, leading to airway obstruction and respiratory compromise. The Laryngeal Paralysis is typically the first indication that a polyneuropathy exists.
Clinical Signs: The clinical signs of GOLPP typically manifest gradually and worsen over time. Common symptoms of laryngeal paralysis include:
- Respiratory distress: Dogs may exhibit noisy breathing, increased respiratory effort, and exercise intolerance due to airway obstruction.
- Voice changes: Bark changes or loss of bark altogether can occur due to laryngeal dysfunction.
- Heat intolerance: Dogs may have difficulty regulating their body temperature due to compromised breathing.
- Coughing: Dry, non-productive coughing may be present, particularly during exertion.
- Cyanosis: Bluish discoloration of mucous membranes due to inadequate oxygenation.
- Exercise intolerance: Dogs may tire quickly during physical activity due to respiratory compromise.
As the disorder progresses, weakness is noted in the rear limbs with difficulty in foot placement and ultimately, with mobility. Patient symptoms may vary with the laryngeal paralysis causing more distressing symptoms while others may have milder respiratory symptoms and more difficulty with the neuropathy affecting their rear limbs. Similar to Degenerative Myelopathy, this is a gradually progressive disorder.
Diagnosis: Diagnosing GOLPP involves a combination of clinical signs, physical examination findings, and diagnostic tests. Veterinarians typically perform a thorough physical examination, including laryngeal examination under sedation or anesthesia to assess laryngeal function. Additional diagnostic tests may include radiographs (X-rays) of the neck and chest to evaluate airway anatomy and rule out other respiratory conditions. Advanced imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary in some cases. Electromyography (EMG) and nerve conduction studies can help confirm peripheral neuropathy.
Treatment: The management of GOLPP aims to alleviate respiratory distress and improve quality of life for affected dogs. While there is no cure for GOLPP, various treatment options can help manage clinical signs:
- Medical management: Medications such as corticosteroids or bronchodilators may be prescribed to reduce inflammation and improve airway function but seem to provide little long-term relief for Laryngeal Paralysis.
- Weight management: Maintaining a healthy weight is crucial to reduce respiratory effort and improve overall health and mobility.
- Environmental modifications: Avoiding stressful situations and providing a cool, comfortable environment can help reduce respiratory distress.
- Surgical intervention: Laryngeal tie-back surgery (arytenoid lateralization) is a common surgical procedure performed to improve airflow by permanently opening the larynx. However, it carries risks and may not be suitable for all dogs. Not all dogs require surgery for their Laryngeal Paralysis.
- Newer treatments include acupuncture to stimulate the affected nerves, Therapeutic Laser and, in some cases, controlled exercise to help maintain muscle mass in the face of decreased limb use.
- Appropriately designed foot braces can be used to help with proper paw placement in the rear limbs.
Prognosis: Geriatric onset laryngeal paralysis polyneuropathy is a condition that mainly affects senior dogs, particularly larger breeds. It can be debilitating, but early recognition and appropriate intervention can help improve the quality of life of affected dogs. The condition progresses slowly, and the goal of treatment is to delay that progression as much as possible. To provide optimal care and support for affected animals, collaboration between veterinary professionals and pet owners is essential. With appropriate supportive care, many dogs may enjoy a good quality of life long after their initial diagnosis.
Elizabeth F. Baird, DVM, CVPP, CCRT, cVMA
Steele Pain Management & Rehabilitation Center
