Performing an upper airway examination in dogs.

Background: Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic procedure that can serve to localize a disease process, confirm a definitive diagnosis, and offer therapeutic benefits.

Description: The upper airway examination consists of an external evaluation of the head and neck as well as a sedated examination of the oral cavity, the pharyngeal cavity, larynx, and nasal passages.

Summary: An upper airway examination should be performed in patients with increased inspiratory effort or increased upper respiratory noise (eg, stertor or stridor). A complete, sedated upper airway examination should be considered for patients with clinical signs of upper airway disease for which a cause is not obvious from the physical examination.

Key Points: Indications for an upper airway examination include sneezing, nasal discharge or epistaxis, reduced or absent nasal airflow, change in phonation, inspiratory difficulty, and audible respiratory sounds. Upper airway examination helps localize pathological processes and allows the clinician to confirm or exclude several differential diagnoses. Pre-oxygenation of the patient for 3-5 minutes prior to sedation will help increase the amount of time available before hypoxemia occurs, should complications arise. Upon completion of the upper airway examination, it is important to monitor the patient carefully and ensure a safe recovery. Careful planning to ensure the availability of necessary equipment and preparation of the team to react during and after the airway examination will minimize the risks of examination to patients with upper airway disease.