# Laryngeal Paralysis in Senior Dogs: GOLPP Symptoms and Tie-Back Surgery ## Key Takeaways - Laryngeal paralysis in senior dogs, most commonly Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP), is characterized by the failure of arytenoid cartilages to abduct during inspiration due to recurrent laryngeal nerve damage, leading to stridor, voice change, and exercise intolerance. - Diagnosis relies on a physical examination and laryngeal examination under light sedation to visualize the non-moving arytenoid cartilages during inspiration, with differential diagnoses including Brachycephalic Obstructive Airway Syndrome (BOAS) and tracheal collapse. - Medical management focuses on reducing laryngeal inflammation with corticosteroids, managing anxiety with sedatives, restricting activity, and maintaining optimal body weight, but does not address the underlying neuropathy. - Unilateral arytenoid lateralization ("tie-back" surgery) is the primary surgical intervention for severe cases, permanently suturing one arytenoid cartilage laterally to improve airflow, though it carries risks of aspiration pneumonia and does not cure GOLPP. - GOLPP is a systemic polyneuropathy affecting multiple nerves, potentially leading to esophageal dysfunction (megaesophagus) and hind limb weakness, which are not resolved by laryngeal surgery and require ongoing management. - Emergency signs include cyanosis (blue/purple gums), collapse, severe respiratory distress, and persistent open-mouth breathing, necessitating immediate veterinary attention. --- If your senior [dog](/knowledge/veterinary-medicine/clinical-methods/dog) has started making a harsh, raspy sound when breathing, especially after exercise or in warm weather, the cause may be laryngeal paralysis. This condition prevents the cartilage flaps in the voice box from opening properly. For older dogs, the most common form is Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP). This article explains the condition, its symptoms, the diagnostic process, and the surgical option known as tie-back surgery (arytenoid lateralization). We also cover when surgery is not appropriate and what you can do to keep your dog comfortable. **Owner Triage Summary:** If your dog is showing signs of respiratory distress, such as blue-tinged gums, severe panting, or collapse, this is an emergency. Go to the nearest veterinary clinic immediately. For less urgent signs like a changed bark or noisy breathing, schedule a veterinary examination within a few days. Do not attempt any home treatments for breathing problems. This article is educational and is not a substitute for veterinary diagnosis or treatment. ## At a Glance: Key Information for Dog Owners The table below provides a quick overview. Always confirm details with your veterinarian. | Feature | Description | | :--- | :--- | | **Condition** | Laryngeal paralysis: failure of the arytenoid cartilages to open during inspiration. | | **Common Form in Seniors** | Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP). | | **Primary Symptoms** | Noisy breathing (stridor), voice change, coughing, gagging, exercise intolerance. | | **Diagnosis** | Physical exam, history, and laryngeal examination under light sedation. | | **Medical Management** | Anti-inflammatory drugs, sedatives, activity restriction, and weight management. | | **Surgical Option** | Unilateral arytenoid lateralization ("tie-back"). | | **Prognosis** | Variable; surgery improves breathing but does not cure the underlying neuropathy. | | **Emergency Red Flags** | Blue/purple gums, collapse, severe respiratory distress, inability to settle. | ## Understanding the Larynx and the Meaning of "Paralysis" The larynx, commonly called the voice box, sits at the entrance to the trachea (windpipe). It has two main functions: to allow air into the lungs and to protect the airway during swallowing. The larynx is made of cartilage, and two of these pieces, the arytenoid cartilages, act like swinging doors. They open wider during inhalation to let air pass and close during swallowing to prevent food or water from entering the lungs. Muscles control these cartilages. The primary muscle that opens the arytenoid cartilages is the cricoarytenoideus dorsalis muscle. In laryngeal paralysis, the nerve that supplies this muscle, the recurrent laryngeal nerve, is damaged. The muscle weakens and atrophies. As a result, the arytenoid cartilages cannot open properly. Instead of swinging wide, they are pulled into the airway by the negative pressure of breathing. This creates a partial obstruction that makes breathing noisy and difficult. ### What is GOLPP? Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP) is the most common cause of laryngeal paralysis in older dogs. It is a degenerative disease of the peripheral nerves. The term "polyneuropathy" means that the disease affects multiple nerves throughout the body, not just the nerve to the larynx. While the breathing signs are often the first thing owners notice, GOLPP is a systemic condition. Over time, it can also affect the nerves to the esophagus, the muscles of the hind legs, and other parts of the body. GOLPP is distinct from congenital laryngeal paralysis, which is seen in young dogs of specific breeds. GOLPP is an acquired condition that develops gradually in senior pets. ## Causes and Differential Diagnoses While GOLPP is the leading cause in senior dogs, laryngeal paralysis can also result from other issues. Your veterinarian will consider these possibilities during diagnosis. ### Primary Causes of Laryngeal Paralysis - **GOLPP (Geriatric Onset Laryngeal Paralysis and Polyneuropathy):** This is the most common cause in older dogs. It is a progressive, degenerative nerve disease with no known cure. - **Trauma:** Injury to the neck or chest can damage the recurrent laryngeal nerve. - **Surgery:** Accidental damage to the nerve during neck surgery, such as a thyroidectomy or a cervical disc operation. - **Cancer:** Tumors in the chest or neck can compress or invade the recurrent laryngeal nerve. - **Endocrine Disease:** Conditions like hypothyroidism have been discussed as potential contributors, although the exact link is not fully understood and is a topic of ongoing veterinary research. Your vet may check thyroid hormone levels as part of the workup. ### Differential Diagnoses Several other conditions can mimic the early signs of laryngeal paralysis. Your veterinarian will need to rule these out: - **Brachycephalic Obstructive Airway Syndrome (BOAS):** Common in flat-faced breeds like Pugs and Bulldogs, this syndrome involves narrowed nostrils, an elongated soft palate, and other airway abnormalities. It can cause similar noisy breathing. - **Tracheal Collapse:** A weakening of the tracheal cartilage rings, leading to a "honking" cough and breathing difficulty. - **Foreign Body:** A lodged object in the throat or airway. - **Laryngeal Mass or Tumor:** A growth in the larynx can obstruct airflow. - **Severe Respiratory Infection:** Such as kennel cough or pneumonia, which can cause coughing and respiratory distress. ## Breed Predisposition and Risk Factors While GOLPP can affect any senior dog, certain breeds are overrepresented. Large and giant breeds are most commonly affected. These include Labrador Retrievers, Golden Retrievers, and Siberian Huskies. The condition is less common in small breeds, but it can occur. The average age of onset is typically over 9 to 10 years old. Because GOLPP is a polyneuropathy, it is often compared to a similar human condition called Charcot-Marie-Tooth disease. The disease process is progressive, meaning the nerve damage worsens over time. The rate of progression varies between individual dogs. ## Recognizing the Symptoms: From Subtle to Severe The signs of laryngeal paralysis can develop slowly. Owners often mistake the early signs for signs of aging or being out of shape. Recognizing the symptoms early can lead to a faster diagnosis and better management. ### Early and Progressive Signs - **Voice Change:** The bark may sound hoarse, weak, or different. Some owners describe it as a "bark that lost its sound." - **Noisy Breathing (Stridor):** This is a high-pitched, harsh, wheezing sound heard when the dog breathes in (inspiration). It is often more pronounced during exercise, excitement, or in hot and humid weather. - **Exercise Intolerance:** The dog tires easily, pants excessively, or collapses after minimal activity. - **Coughing and Gagging:** Especially after eating or drinking. This happens because the larynx cannot close fully to protect the airway. - **Difficulty Swallowing:** Some dogs may have trouble swallowing food or water, leading to drooling or regurgitation. ### Signs of More Advanced GOLPP As the polyneuropathy progresses, you may notice: - **Hind Limb Weakness:** The dog may wobble, stumble, or have difficulty getting up from a lying position. They may "knuckle" their [paws](/knowledge/veterinary-medicine/clinical-methods/paws) (walk on the top of their foot). - **Muscle Wasting:** Loss of muscle mass in the hind legs and around the head and neck. - **Regurgitation:** The passive return of food or water from the esophagus. This can lead to aspiration pneumonia, a serious complication. ### Emergency Red Flags Seek immediate veterinary care if your dog shows any of these signs: - **Severe Respiratory Distress:** The dog is struggling to breathe, with exaggerated chest and belly movements. - **Blue or Purple Gums (Cyanosis):** This indicates a lack of oxygen. - **Collapse or Fainting:** The dog falls over and cannot get up. - **Panic and Pacing:** The dog is restless, anxious, and cannot settle down due to difficulty breathing. - **Open-Mouth Breathing That Does Not Stop:** Panting that continues even when the dog is at rest. ## Veterinary Examination and Diagnostic Approach Diagnosing laryngeal paralysis requires a systematic approach. Your veterinarian will start with a thorough history and physical examination. ### The Physical Examination The vet will listen to your dog's breathing with a stethoscope. They will try to localize the source of the noise. They will also assess your dog's overall health, looking for signs of hind limb weakness or muscle wasting, which would support a diagnosis of GOLPP. ### The Definitive Test: Laryngeal Examination The gold standard for diagnosing laryngeal paralysis is a direct visual examination of the larynx. This is called a laryngoscopy. The procedure is performed under light sedation. The sedation must be deep enough to allow the vet to look at the larynx, but light enough so that the arytenoid cartilages still move during breathing. During the laryngoscopy, the vet observes the movement of the arytenoid cartilages. In a normal dog, they will abduct (open) during inspiration. In a dog with laryngeal paralysis, they will not move or will be pulled inward during inspiration. The vet will assign a grade to the paralysis based on the degree of movement. ### Additional Diagnostics To rule out other causes and assess the dog's overall health, the vet may recommend: - **Blood Tests:** A complete blood count (CBC) and biochemistry profile to check for underlying diseases like hypothyroidism. - **Thyroid Function Tests:** To measure thyroid hormone levels. - **Chest X-Rays (Radiographs):** To look for signs of aspiration pneumonia, heart disease, or masses in the chest that could affect the nerve. - **Neurological Examination:** A full neurological exam can help assess the extent of the polyneuropathy. ## Evidence-Based Management: Non-Surgical Options Not every dog with laryngeal paralysis is a candidate for surgery. For dogs with mild signs, or for those who are not good surgical candidates due to age or other health problems, medical management is the primary approach. The goal is to reduce inflammation, decrease anxiety, and prevent complications. ### Medical Management Strategies - **Corticosteroids (Anti-Inflammatories):** Drugs like prednisone can help reduce inflammation and swelling in the larynx, which can temporarily improve airflow. They do not treat the underlying nerve damage. - **Sedatives:** Medications like acepromazine or trazodone can help reduce anxiety and excitement. A calm dog breathes more slowly and easily, which reduces the negative pressure on the larynx. - **Activity Restriction:** Avoid strenuous exercise, especially in hot weather. Short, slow walks on a harness are better than running or fetching. - **Weight Management:** Obesity worsens breathing in any dog. Maintaining a lean body condition is crucial. - **Dietary Adjustments:** To reduce the risk of aspiration, feed your dog from an elevated position. Offer smaller, more frequent meals. Some dogs benefit from a meatball-style diet, which encourages them to swallow rather than gulp. - **Avoid Heat and Stress:** Keep your dog in a cool, calm environment. Avoid triggers that cause excessive barking or excitement. ### Unsafe Home Remedies Never attempt to give your dog human medications without veterinary approval. Do not use essential oils or herbal supplements for breathing problems. Do not try to "clear" your dog's throat by pulling on the tongue or sticking fingers in the mouth. These actions can cause more stress and worsen the obstruction. Always consult your veterinarian before giving any over-the-counter product. ## Tie-Back Surgery (Arytenoid Lateralization) For dogs with moderate to severe respiratory distress, surgery is often the most effective way to improve their quality of life. The most common surgical procedure is called unilateral arytenoid lateralization, or "tie-back." ### What Does the Surgery Involve? The goal of the surgery is to permanently hold one of the arytenoid cartilages in a slightly open position. The surgeon makes an incision in the side of the neck, locates the larynx, and places one or two permanent sutures to pull the cartilage to the side. This creates a larger opening for air to pass through, bypassing the paralyzed cartilage. The surgery is performed on only one side (unilateral) to preserve the protective function of the other side. If both sides were tied back, the larynx could not close at all, leading to a very high risk of aspiration pneumonia. ### Is My Dog a Candidate for Surgery? Candidacy is determined by a thorough evaluation. The vet will consider: - **Severity of Clinical Signs:** Dogs with severe stridor, exercise intolerance, or episodes of cyanosis are better candidates. - **Overall Health:** The dog must be healthy enough to undergo anesthesia. This includes evaluating heart, liver, and kidney function. - **Presence of Aspiration Pneumonia:** Active pneumonia must be treated and resolved before surgery. - **Extent of Polyneuropathy:** Dogs with severe esophageal dysfunction and frequent regurgitation have a higher risk of aspiration after surgery. ### Recovery and Post-Operative Care After surgery, your dog will be hospitalized for at least one to two days. They will receive pain medication and may need oxygen support. The most critical period is the first few weeks after surgery. - **Rest:** Strict rest is required for the incision to heal. This means no running, jumping, or playing for about 2 to 4 weeks. - **Incision Care:** You will need to monitor the incision for signs of swelling, redness, or discharge. - **Diet:** You will need to continue feeding your dog from an elevated position and monitor them for coughing after eating or drinking. - **Follow-Up:** Your vet will schedule a recheck to assess the incision and your dog's breathing. ### Potential Complications of Tie-Back Surgery While the surgery is generally successful in improving breathing, it is not without risks. Complications can include: - **Aspiration Pneumonia:** This is the most significant risk. Because the larynx cannot close completely, food and water are more likely to enter the lungs. It occurs in a percentage of dogs post-operatively, and it is a leading cause of long-term morbidity. - **Seroma:** A fluid-filled swelling under the skin at the surgical site. This usually resolves on its own. - **Suture Failure:** The sutures can pull through the cartilage, causing the paralysis to return. - **Laryngeal Edema:** Swelling of the larynx after surgery, which can temporarily worsen breathing. - **Anesthetic Complications:** As with any surgery, there are risks associated with general anesthesia. ### Prognosis After Surgery The prognosis for breathing is generally good. Most owners report a significant improvement in their dog's ability to exercise and a marked reduction in noisy breathing. However, it is vital to understand that the surgery does not cure GOLPP. The polyneuropathy will continue to progress. The dog may still develop hind limb weakness, and the risk of aspiration pneumonia remains lifelong. The goal of surgery is to improve quality of life, not to halt the underlying disease. ## The Link Between Laryngeal Paralysis and Other Body Systems It is essential to view laryngeal paralysis not as an isolated problem but as a sign of a broader condition, especially in senior dogs. The same nerves that control the larynx also control the esophagus and the muscles of the hind limbs. ### Esophageal Dysfunction and Aspiration Pneumonia The recurrent laryngeal nerve also supplies the muscles of the upper esophagus. When this nerve is damaged, the esophagus loses its tone. This can lead to a condition called megaesophagus, where the esophagus becomes dilated and cannot move food to the stomach. Food and water pool in the esophagus and can be regurgitated. This pooling increases the risk of aspiration, where material is inhaled into the lungs, causing pneumonia. Aspiration pneumonia is a serious and potentially fatal complication of both the disease and the surgery. ### Hind Limb Weakness As a polyneuropathy, GOLPP affects the nerves to the hind legs. This causes progressive weakness and muscle wasting (atrophy). You may notice your dog's hind legs becoming thinner, and they may have difficulty climbing stairs or jumping onto the sofa. This weakness is not corrected by tie-back surgery. Physical therapy and supportive care, such as using a sling to support the hind end, may be helpful as the disease progresses. ## Prevention and Long-Term Management There is no known way to prevent GOLPP. It is a degenerative disease of aging. However, you can take steps to manage your dog's condition and improve their comfort. - **Maintain a Healthy Weight:** Obesity puts extra strain on the respiratory system. - **Use a Harness Instead of a Collar:** A collar puts pressure on the neck and larynx, which can worsen breathing. A harness distributes pressure across the chest. - **Control the Environment:** Keep your home at a comfortable temperature. Avoid exercising your dog during the hottest part of the day. - **Monitor for Coughing:** If your dog coughs after eating or drinking, discuss this with your vet. It may be a sign of aspiration. - **Regular Veterinary Checkups:** Routine examinations can help catch complications like pneumonia or hind limb weakness early. ## Limitations and When to Contact a Veterinarian This article provides general information about laryngeal paralysis and GOLPP. It cannot predict the specific course of the disease for your dog. Breed-level information can suggest a predisposition, but it cannot confirm a diagnosis or predict an individual dog's response to treatment. You should contact your veterinarian if you notice any of the following: - A change in your dog's bark or breathing sounds. - Increased coughing or gagging, especially after meals. - Signs of exercise intolerance or weakness. - Any signs of respiratory distress, such as blue gums or collapse. This is an emergency. Your veterinarian is the only person who can accurately diagnose your dog's condition and recommend the best treatment plan. The decision to pursue surgery is a significant one that should be made in close consultation with your veterinary surgeon, taking into account your dog's specific health status and your family's ability to provide post-operative care. ## Frequently Asked Questions ### 1. What is the life expectancy of a dog with laryngeal paralysis? Life expectancy is variable. With medical management or surgery, many dogs live for 1 to 3 years after diagnosis. The primary determinant of lifespan is the progression of the polyneuropathy and the risk of aspiration pneumonia, not the breathing problem itself. ### 2. Is laryngeal paralysis painful for dogs? The condition itself is not typically painful, but the difficulty breathing can cause significant distress and anxiety. The associated complications, such as aspiration pneumonia, can be painful and uncomfortable. ### 3. How can I tell if my dog is aspirating? Signs of aspiration include coughing or choking during or after eating or drinking, fever, lethargy, nasal discharge, and increased respiratory effort. If you suspect aspiration, contact your veterinarian immediately. ### 4. Can a dog with laryngeal paralysis bark? Yes, but the bark often sounds different. It may be hoarse, weak, or sound like a "honk." This is because the vocal folds (cords) cannot be pulled together normally. ### 5. Is tie-back surgery the only option for severe cases? Tie-back surgery is the most common and effective surgical treatment. In some cases, a ventriculocordectomy (removal of the vocal folds) may be performed, but this is less common and does not address the airway obstruction as effectively. ### 6. How long does it take for a dog to recover from tie-back surgery? The initial recovery from anesthesia is quick, but full recovery takes time. The dog needs strict rest for 2 to 4 weeks to allow the incision to heal. Breathing should improve immediately, but the dog must be monitored for coughing and aspiration. ### 7. Are there any alternatives to tie-back surgery? Yes, medical management is an alternative. This involves using anti-inflammatories, sedatives, and restricting activity. It is not a cure, but it can manage symptoms in mild cases or in dogs that are not surgical candidates. ### 8. What is the difference between laryngeal paralysis and a collapsed trachea? Laryngeal paralysis is a problem with the cartilage flaps at the top of the airway (larynx). A collapsed trachea is a problem with the windpipe itself, where the cartilage rings weaken and flatten. Both cause breathing issues but are different conditions with different treatments. ## Related Clinical & Scientific Guides * [Pancreatitis in Dogs: High-Fat Danger, Fluid Therapy and Bland Diets](/knowledge/veterinary-medicine/internal-medicine/pancreatitis-in-dogs-high-fat-danger-fluid-therapy-and-bland-diets) * [Dilated Cardiomyopathy DCM in Dogs: Diet-Related Taurine Gaps and Recovery](/knowledge/veterinary-medicine/internal-medicine/dilated-cardiomyopathy-dcm-in-dogs-diet-related-taurine-gaps-and-recovery) * [Addisons Disease in Dogs: Hypoadrenocorticism Crisis Electrolyte Balance](/knowledge/veterinary-medicine/internal-medicine/addisons-disease-in-dogs-hypoadrenocorticism-crisis-electrolyte-balance)