Overview 

Laryngeal paralysis is a disease that causes difficulty breathing, which may be initially mild and then progressively worsen over time.  

Most common in older, large-breed dogs, this condition can become a medical emergency. Conservative management may be effective for mild cases, but many dogs benefit from surgery if their breathing is more severely affected. While surgery does not repair the function of the larynx, it often improves their overall quality of life.  

Cause 

Laryngeal paralysis is caused by a loss of function in the nerve controlling the larynx (or voice box). The larynx normally opens to bring air into the trachea (windpipe) and closes to prevent the inhalation of food or water. When the larynx is not functioning correctly due to laryngeal paralysis, the airway narrows, making breathing more difficult, akin to the feeling of breathing through a straw.  

Laryngeal paralysis is often part of a generalized nerve and muscle weakening syndrome called Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP). The underlying cause is not entirely known, but genetics are thought to play a role. While laryngeal paralysis is often the earliest sign of GOLPP, the esophagus is also often affected during early stages. Esophageal dysfunction causes difficulty swallowing food and water, thus increasing the risk of inhaling food or water, and this can cause a lung infection called aspiration pneumonia.  

Laryngeal paralysis can also be caused by trauma or tumors in the neck. Additionally, a congenital condition can cause laryngeal paralysis in dogs as young as three months. 

Breed predisposition  

Laryngeal paralysis is most commonly seen in Labrador Retrievers, but it can occur in a variety of dogs, especially in large breeds.  

Congenital laryngeal paralysis has been noted in Bouvier des Flandres, Dalmatians, Siberian Huskies, Rottweilers, American Staffordshire Terriers and Black Russian Terriers.  

Clinical signs 

The signs of laryngeal paralysis will vary depending on the progression of the disease. It can become a medical emergency if breathing suddenly worsens from excitement, stress, exercise or exposure to hot and humid temperatures. GOLPP may progress to leg weakness or uncoordinated movement over time.  

The common clinical signs of laryngeal paralysis may include: 

• Noisy or raspy breathing 

• Excess panting 

• Coughing  

• Gagging 

• Regurgitating  

• Exercise and heat intolerance 

• Changes to the sound of their bark 

• Difficulty breathing  

• Tongue or gums turning blue 

• Collapse 

Diagnosis 

Laryngeal paralysis is diagnosed by directly examining the larynx while under sedation. Your veterinarian will need to perform a thorough physical and neurological exam and may recommend chest and neck X-rays.  

DNA genetic tests are available for some breeds predisposed to congenital laryngeal paralysis. 

Treatment 

There is no cure for laryngeal paralysis, but mild cases can be initially managed conservatively with the following:   

• Stress reduction 

• Anti-anxiety medications 

• Limiting exercise 

• Limiting exposure to hot and humid weather 

• Replacing neck collars with harnesses  

• Weight loss 

• Physical therapy to help maintain muscle mass  

If aspiration pneumonia occurs, it is treated with antibiotics. During a respiratory emergency caused by laryngeal paralysis, treatment involves oxygen, cooling the dog down if overheating, intravenous fluids, medications to reduce stress and more.  

The most common surgery for laryngeal paralysis is called a “tie-back” procedure, which helps open the larynx to improve breathing. While the surgery does not cure the larynx's function, it can help avoid respiratory emergencies and improve quality of life. 

Monitoring  

Aspiration pneumonia is a common complication of laryngeal paralysis surgery, but it can also occur in dogs who have not undergone surgery. A mild cough after eating and drinking is not uncommon after a tie-back procedure. Adjusting some of your dog’s habits after surgery may help prevent aspiration pneumonia after surgery, such as avoiding swimming and offering small-but-frequent drinks of water and bites of canned food.  

Your dog should be taken to your veterinarian immediately if you notice any of the following signs of aspiration pneumonia, which may include: 

• No interest in eating 

• Lethargy 

• Fever 

• Persistent cough 

• Discharge from the nose 

Outcomes 

Laryngeal paralysis requires lifelong monitoring and management. GOLPP tends to progress slowly, and some dogs may have mild signs for years and be managed conservatively before breathing becomes significantly affected.  

Similarly, the decline in mobility from GOLPP is variable, and since the disease often occurs when the dogs are older, many dogs may live their normal lifespan before it progresses to more significant and generalized muscle weakness. Physical therapy may help improve their overall muscle strength. However, dogs with congenital laryngeal paralysis often have a worse prognosis, but this can still vary depending on the dog’s breed.  

Surgery for laryngeal paralysis management often improves their quality of life. That being said, aspiration pneumonia is a common complication of surgery, but most cases respond well to treatment, especially if caught early. If the dog develops severe, recurrent cases of aspiration pneumonia, then that may lead to a poorer overall outcome.