Equine epiglottitis: a rare condition that can affect sport horse performance

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29/12/2025

In the world of equestrian sport, respiratory noise or poor performance often leads riders and trainers to think about well-known conditions such as laryngeal hemiplegia or dorsal displacement of the soft palate. However, there is a much less familiar disorder that can significantly impact athletic ability: equine epiglottitis.

Although rare, epiglottitis is a serious inflammatory condition affecting the epiglottis, a structure essential for both breathing and swallowing in horses. When overlooked or misdiagnosed, it can compromise performance and, in severe cases, the horse’s overall well-being.

The role of the epiglottis in the horse

The equine epiglottis is a triangular cartilage positioned above the soft palate. Its anatomical role is crucial, as horses are obligate nasal breathers. During exercise, the epiglottis helps maintain a clear airway, while during swallowing it protects the lower respiratory tract.

Inflammation of this structure leads to thickening, redness and sometimes ulceration of the mucosa. These changes can alter airflow and disrupt normal respiratory mechanics, especially during intense physical effort.

Clinical signs: subtle but significant

One of the challenges with equine epiglottitis is that its clinical signs are often non-specific. Horses may show decreased stamina, abnormal respiratory sounds during exercise, or an unexplained drop in performance.

In more severe cases, coughing, inspiratory noise or even difficulty swallowing may be observed. Because these signs overlap with other upper airway disorders, epiglottitis can easily go unnoticed without a thorough examination.

Diagnostic challenges and frequent misinterpretation

Endoscopy is the key diagnostic tool for identifying epiglottitis, yet even experienced clinicians may initially confuse it with epiglottic entrapment. Both conditions can appear similar during a routine endoscopic examination.

Recent retrospective studies have shown that a significant number of horses referred for surgical correction of epiglottic entrapment were later diagnosed with epiglottitis after closer inspection. This distinction is critical, as epiglottitis requires medical rather than surgical management.

Accurate diagnosis depends on careful endoscopic evaluation and, in some cases, gentle manipulation of the tissues to distinguish inflamed epiglottic mucosa from entrapping membranes.

Possible causes and risk factors

The exact cause of equine epiglottitis often remains unknown. However, it is more commonly reported in racehorses and high-performance athletes, suggesting a link with intense training and repeated airway stress.

Dust exposure, lower respiratory infections and chronic inflammation of the upper airway are believed to play a role. The high negative pressures generated during strenuous exercise may damage the mucosa, allowing inflammation or secondary infection to develop.

Medical treatment and recent advances

Treatment of equine epiglottitis focuses on controlling inflammation and preventing secondary infection. Systemic anti-inflammatory drugs and antibiotics are commonly used, often combined with topical or inhaled corticosteroids.

Inhaled therapies have gained attention in recent years, as they deliver medication directly to the affected area while minimizing systemic side effects. Clinical data indicate that this approach can significantly improve recovery time and overall outcome.

A large retrospective study reported that more than 90% of affected horses returned to racing after appropriate medical treatment, highlighting the effectiveness of early and accurate intervention.

Prognosis and long-term management

With correct diagnosis and proper treatment, the prognosis for equine epiglottitis is generally good. Most horses can safely resume training and competition.

Nevertheless, some individuals may experience recurrence or develop other epiglottic abnormalities over time. Regular follow-up and attention to environmental factors, such as dust control and training intensity, are recommended to reduce the risk of relapse.