Many of you asked if our Bucket Fund mare , Olivia, actually had Cicatrix Syndrome and therefore her tracheostomy was a life-saving measure that needs to stay open.

First off, thank you for making me aware of Cicatrix Syndrome.

And, correct, Olivia does come from Texas where this syndrome persists (along with Florida).

But, according to the vets at Alamo Pintado Equine Medical Center what Olivia has is not that.

How can they know?  Well, immediately upon intake, they did a test to see if Olivia could breathe with the tracheostomy covered as they, too, wanted to know if this was because of Cicatrix Syndrome.  She could.  She could breathe normally.  So, they determined that whatever caused this hole to be cut in her throat,  it wasn’t Cicatrix Syndrome.

Also, the hole is much larger than a normal tracheostomy, so the vets are stumped as to why she has this hole in her throat.

Having said that, WHAT IS Cicatrix Syndrome?

Cicatrix Syndrome

Here is a link to the original story.

What is Nasopharyngeal Cicatrix Syndrome?
Nasopharyngeal cicatrix syndrome (NCS) is a respiratory condition in which a horse’s larynx (the tube-shaped organ that contains the vocal cords – sometimes called the voice box) and throat become inflamed and irritated due to unknown reasons. The cicatrix refers to a scar that has developed due to the formation of fibrous tissue within a wound. 

In instances of NCS, long-term inflammation thickens the airway by causing layers of scar tissue to form. Without treatment, this process will often continue until the horse is unable to breathe comfortably or entirely. In the case of a full airway blockage, a permanent tracheostomy (often called a tracheotomy) is warranted in order for the horse to breathe freely. The procedure, known as a tracheostomy, is when a surgical opening is created through the neck and into the trachea (windpipe), through which a breathing tube is inserted either permanently or temporarily. 

Veterinarians and horse owners attribute the cause of NCS to various factors. Since most horses are diagnosed with the condition during summer months, it’s reasonable to consider that seasonally-linked irritants such as pollen, insects, algae, mold or bacteria are at least partially responsible for some of the inflammatory response.

Nasopharyngeal cicatrix syndrome (NCS) carries aggravating symptoms such as coughing, nasal discharge, exercise intolerance, flared nostrils, increased heart rate and an extended head and neck. Some horses are labeled roarers because of their extra loud breathing. If a horse develops such symptoms, including noisy breathing, it is advisable to schedule a veterinary appointment to determine if the horse is suffering from a narrowed or constricted airway. 

One unresolved question is why this condition is mostly seen in horses living in Texas and the panhandle region of Florida. Veterinary specialists have been trying to determine why Northern horses present less with nasopharyngeal cicatrix syndrome, though these numbers may be slowly changing. One recent suggestion points toward environmental spraying programs that have been conducted in some states, but not in others. Aside from geography, risk factors that may cause some horses to develop NCS over others include age and exposure to pasture. For example, high pasture turnout greatly increases the likelihood of developing NCS, while a split between turnouts and stall-time appears to have no impact on the development of this condition.

Nasopharyngeal cicatrix syndrome (NCS) is a respiratory condition seen most often in horses living in south-central Texas and the panhandle area of Florida.
 
Symptoms of Nasopharyngeal Cicatrix Syndrome in Horses
Coughing
Nasal discharge
Noisy breathing
Extending head and neck
Exercise intolerance
Flared nostrils
Increased heart rate
Causes of Nasopharyngeal Cicatrix Syndrome in Horses
Unclear or undetermined
Environmental factors 
Irritants and allergies
Age
Location
High pasture turn-out
Diagnosis of Nasopharyngeal Cicatrix Syndrome in Horses
The most effective way to diagnose NCS is by taking a close look at the structure of the horse’s throat. This can be done during a procedure called an endoscopy, which uses a camera to determine the existence of inflammation, scar tissue, structural aberrations, and lesions.

These changes may continue to develop and lead to loud or difficult breathing. Upper airway endoscopy is necessary to secure the diagnosis, but also to measure the thickness of the tissue. A biopsy may also be taken to check the health of the tissue.
Treatment of Nasopharyngeal Cicatrix Syndrome in Horses
Surgical treatment may be the best way to make the horse more comfortable. One type of procedure may simply reduce scarring, but in more advanced cases of NCS, and if the airway is constricted enough to cause labored breathing, a tracheostomy may be warranted.

Other options are available, though results appear to be generally negligible. Success varies from horse to horse. Anti-inflammatories, throat sprays, corticosteroids, and other treatments are available through the veterinarian. Removing the horse from the current living environment may be helpful if environmental allergies were found to be causative.
Recovery of Nasopharyngeal Cicatrix Syndrome in Horses
If your horse is diagnosed with NCS, please refer to the veterinarian for the best program for ongoing treatment and care. Some may have the condition resolved surgically, while others may rely on daily anti-inflammatory treatments to keep an open airway. Pay careful attention to any new respiratory sounds or unusual posturing such as a constant stretch or elongation of the neck.