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Topic:Laryngeal Dysfunction

Laryngeal dysfunction in horses refers to a range of conditions affecting the larynx, which is a critical structure involved in breathing and vocalization. These conditions can impact the horse's performance and respiratory efficiency. Common types of laryngeal dysfunction include recurrent laryngeal neuropathy (RLN), arytenoid chondritis, and laryngeal hemiplegia. These disorders may result in abnormal respiratory noises and exercise intolerance. Diagnosis typically involves endoscopic examination to assess the structure and function of the larynx. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, diagnosis, and management of laryngeal dysfunction in horses.
Functional and histopathologic evidence of laryngeal reinnervation using the spinal accessory nerve in horses.
Veterinary surgery : VS    February 18, 2026   doi: 10.1111/vsu.70083
Campos Schweitzer A, Mespoulhes-Rivière C, Perkins JD, Ducharme NG, Piercy RJ, Lynch N, Rossignol F.To evaluate functional and histopathologic outcomes of standing selective laryngeal reinnervation using the spinal accessory nerve (SAN) in horses with experimentally induced recurrent laryngeal neuropathy (RLN). Methods: Five Thoroughbred mares. Methods: Prospective cohort study. Methods: The horses underwent left recurrent laryngeal neurectomy followed 8 weeks later by selective laryngeal reinnervation using the SAN. Follow-up evaluations at 4.5, 6, 8, and 12 months included treadmill exercising endoscopy, ultrasonography of intrinsic laryngeal muscles, and percutaneous electrical stimul...
[Equine laryngeal dysplasia – overview of variable clinical presentation based on 6 cases].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    February 13, 2026   Volume 54, Issue 1 60-67 doi: 10.1055/a-2751-7292
Werner CA, Wimmer-Scherr CM, Schwarz BC.Equine laryngeal dysplasia (ELD) is the umbrella term for various malformations of laryngeal structures that arise from the 4th and 6th branchial arches during embryogenesis. The disease is rare and may be subclinical. In symptomatic patients with clinical signs, the clinical presentation is highly variable and is the result of functional limitations of the larynx as well as of the esophageal sphincter. The spectrum of signs may range from respiratory changes such as abnormal respiratory noise, coughing, and at times dyspnea all the way to poor performance, dysphagia, aerophagia, and colic. Th...
Retrospective radiographic myelogram measurements and long-term outcomes in horses undergoing cervical interbody fusion surgery: 22 cases.
PloS one    May 7, 2025   Volume 20, Issue 5 e0323083 doi: 10.1371/journal.pone.0323083
England D, Newsom L, White C, McKenzie E.Site selection for cervical stabilization surgery in horses with spinal ataxia frequently relies on measurements derived from radiographic myelography. A variety of measurement criteria exist and can provide conflicting results. The main objectives of this study were to assess the correlation between two commonly used myelographic measures, dorsal contrast column reduction (DCCR) and dural diameter reduction (DDR), and their association with previously selected operative sites in a population of horses operated at a tertiary clinic. Secondary objectives were to determine if articular process j...
Overground endoscopic examination following laryngeal tie-forward in horses with dorsal displacement of the soft palate.
Veterinary surgery : VS    March 18, 2025   Volume 54, Issue 6 1053-1061 doi: 10.1111/vsu.14245
Barnett TP, Colgate VA, Robinson N, Smith LCR, Palmer L, Barakzai SZ.To compare overground endoscopy (OGE) findings and racing performance in horses before and after laryngeal tie-forward (LTF) surgery for the treatment of intermittent dorsal displacement of the soft palate (iDDSP). Methods: Retrospective case series with follow up. Methods: A total of 56 horses met the inclusion criteria. Methods: Clinical record review of all horses definitively diagnosed with iDDSP, treated with LTF surgery, and evaluated with a single OGE examination postoperatively. In addition to LTF, some horses underwent bilateral aryepiglottic fold resection (AEFR) and/or soft palate t...
Equine upper airway laser surgery generates plumes containing hazardous components.
American journal of veterinary research    February 6, 2025   1-6 doi: 10.2460/ajvr.24.11.0338
Sholty KA, Hecobian A, Sullivan AP, Collett JL, Koch DW, Hackett ES.To evaluate plume composition during simulated diode laser equine upper airway surgery. Unassigned: A 980-nm diode laser fiber was applied in continuous-wave mode in contact with laryngeal and pharyngeal tissues of 6 equine cadaver heads, and resultant plumes were collected for analysis. Measured parameters included the real-time concentration of particulate matter under the size of 2.5 μm (PM2.5), organic carbon (OC), elemental carbon (EC), and volatile organic compounds (VOCs). Unassigned: Visible smoke was encountered during surgical laser application and plume collection. Diode laser medi...
Yearling laryngeal function grades II.2 and below are not associated with reduced performance.
Equine veterinary journal    January 21, 2025   Volume 57, Issue 4 953-966 doi: 10.1111/evj.14452
Hardwick JL, Ahern BJ, Crawford KL, Allen KJ, Anderson BH, Rose KJ, Franklin SH.The relationship between Thoroughbred yearling laryngeal function (YLF) grade and race performance is unclear. Objective: To determine the effect of YLF on future race performance. Methods: Retrospective cohort study. Methods: Post-sale endoscopic recordings were reviewed from Australian yearling sales in 2018-2019. Race performance was evaluated for career and as 2-, 3- and ≥4-year-olds. Multivariable generalised linear modelling examined the association between YLF and performance, with risk estimates presented as coefficients (95% CI). Results: The YLF in 5175 examinations was graded I in...
A genome-wide association study for recurrent laryngeal neuropathy in the Thoroughbred horse identifies a candidate gene that regulates myelin structure.
Equine veterinary journal    January 10, 2025   doi: 10.1111/evj.14461
McGivney CL, McGivney BA, Farries G, Gough KF, Han H, Holtby AR, MacHugh DE, Katz LM, Hill EW.Equine recurrent laryngeal neuropathy (RLN) is an economically important upper respiratory tract (URT) disease with a genetic contribution to risk, but genetic variants independent of height have not been identified for Thoroughbreds. The method of clinical assessment for RLN is critical to accurately phenotype groups for genetic studies. Objective: To identify genetic risk loci for RLN in Thoroughbreds in a genome-wide association study (GWAS) following high-resolution phenotyping. Methods: Case-control. Methods: Thoroughbred horses were characterised as RLN cases and controls using resting a...
Comparative analysis of racing performance following surgical correction of epiglottic entrapment in standardbreds and thoroughbreds.
Frontiers in veterinary science    November 19, 2024   Volume 11 1479144 doi: 10.3389/fvets.2024.1479144
Norton AM, Rosanowski SM, O'Brien T.Epiglottic entrapment (EE) is a common cause of poor performance in racing standardbreds (STBs) and thoroughbreds (TBs). There is limited information published on the condition in STB racehorses and limited information on factors associated with return to racing available for either breed. Unassigned: This study investigated and compared the pre surgical findings, post-surgical complications and racing performance in STBs and TBs undergoing surgery for correction of EE. Associations between signalment and pre-surgical findings, and the presence of complications and racing post-surgery were com...
A first step towards objective grading of equine laryngeal function.
Veterinary journal (London, England : 1997)    October 26, 2024   Volume 308 106259 doi: 10.1016/j.tvjl.2024.106259
Hardwick J, Ahern B, Franklin S.Due to concerns about disagreement between veterinarians when grading resting laryngeal function (LF), a diagnostic decision tree (DDT) has been developed by codifying the Havemeyer grading system and objectively defining certain terms to remove ambiguity. Videoendoscopic examinations of the equine larynx that had previously been assigned a unanimous LF grade by 3 experienced observers were used to develop the DDT and determine the cut-off values. The DDT is a flow chart consisting of a series of dichotomous (yes/no) decisions, to dictate the order of decision making and direct the observer do...
Explainable machine learning for assessing upper respiratory tract of racehorses from endoscopy videos.
Computers in biology and medicine    August 21, 2024   Volume 181 109030 doi: 10.1016/j.compbiomed.2024.109030
Tahir AM, Guo L, Ward RK, Yu X, Rideout A, Hore M, Wang ZJ.Laryngeal hemiplegia (LH) is a major upper respiratory tract (URT) complication in racehorses. Endoscopy imaging of horse throat is a gold standard for URT assessment. However, current manual assessment faces several challenges, stemming from the poor quality of endoscopy videos and subjectivity of manual grading. To overcome such limitations, we propose an explainable machine learning (ML)-based solution for efficient URT assessment. Specifically, a cascaded YOLOv8 architecture is utilized to segment the key semantic regions and landmarks per frame. Several spatiotemporal features are then ex...
Do tight nosebands have an effect on the upper airways of horses?
Veterinary medicine and science    June 17, 2024   Volume 10, Issue 4 e1478 doi: 10.1002/vms3.1478
Scholler D, Wittenberg J, Zablotski Y, May A.The public perception relating to the welfare of horses involved with equestrian sports is associated with training methods used and the presentation of horses at events. In this context, very tight nosebands, which are intended to prevent the horse from opening its mouth, also attract a lot of attention. Various studies have evaluated the impact of tight nosebands on stress parameters, whereas the effect of tight nosebands on upper airway function is unknown. Therefore, the aim of the study was to use overground endoscopy to evaluate changes in pharyngeal and laryngeal function when a tight n...
Yearling laryngeal function in Thoroughbreds that underwent a laryngoplasty differs from controls.
Equine veterinary journal    June 7, 2024   doi: 10.1111/evj.14110
Hardwick JL, Ahern BJ, Crawford KL, Allen KJ, Franklin SH.Yearling laryngeal function (YLF) is frequently assessed at the time of sale and the outcomes of these assessments can have significant economic implications. The YLF of horses that subsequently underwent a prosthetic laryngoplasty (PL) is unknown. Objective: We hypothesised horses with YLF ≥grade II.2 would be at increased risk of requiring PL, compared with YLF
Jugular venous thrombosis as a risk factor for exercise-induced pulmonary hemorrhage in thoroughbred racehorses.
Open veterinary journal    May 31, 2024   Volume 14, Issue 5 1111-1116 doi: 10.5455/OVJ.2024.v14.i5.4
Shawaf T.Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low environmental temperature, and distance of the race have been studied in racehorses. Unassigned: The aim of this study was to study the relationship between EIPH and the presence of jugular vein thrombose in racehorses. Unassigned: Forty-eight thoroughbred racehorses randomly selected from animals with exercise intolerance due to respiratory disorders were enrolled in the present study. Clinical and tracheobronchoscopy examinations w...
Prevalence of Exercise-Induced Pulmonary Hemorrhage, Tracheal Mucus and Recurrent Laryngeal Neuropathy in Competitive Draft Pulling Horses.
Journal of equine veterinary science    July 28, 2023   Volume 129 104895 doi: 10.1016/j.jevs.2023.104895
Burns JJ, MacMillan KM, John E.Respiratory disease is common in the horse population and is often associated with poor performance in equine athletes. Despite their outstanding strength and aerobic capacity, little regard is given to draft horses and the respiratory disorders they may encounter when performing athletic activity. For this reason, the objectives of this study were: (1) to determine the prevalence of exercise-induced pulmonary hemorrhage (EIPH), tracheal mucus (TM) and recurrent laryngeal hemiplegia (RLH) in a population of competitive draft pulling horses, and (2) to determine if there was an association betw...
Evaluation of recurrent laryngeal neuropathy in domestic and feral horse populations in Australia using histologic and immunohistochemical analysis: A pilot study.
Veterinary medicine and science    June 15, 2023   Volume 9, Issue 4 1610-1617 doi: 10.1002/vms3.1186
Lean NE, Franklin SH, Steel C, Woolford L, White J, Ahern BJ.Little is known about potential differences in the left recurrent laryngeal nerve (Lrln) and left cricoarytenoideus dorsalis (LCAD) muscle between domestic and feral horse populations. If a difference exists, feral horses may provide a useful control population for research related to recurrent laryngeal neuropathy (RLN) and increase our understanding of potential population pressures influencing the incidence RLN. The objective of this study was to compare the Lrln and LCAD of domestic and feral horses using histological and immunohistochemical techniques (IHC). Sixteen horses, domestic (n = ...
Three-dimensional models of the equine larynx can be used to perform traditional measures of arytenoid abduction and permit the positioning of modeled implants to demonstrate the anatomic feasibility of placing a rigid implant across the cricoarytenoid joint.
American journal of veterinary research    May 13, 2023   Volume 84, Issue 6 ajvr.22.11.0202 doi: 10.2460/ajvr.22.11.0202
Roe HA, Biedrzycki AH, Davenport PW, Freeman DE, Porter EG, McCarrel TM.To develop 3D models of larynges to compare arytenoid abduction measurements between specimens and models, and to investigate the anatomic feasibility of placing an implant across the cricoarytenoid joint (CAJ) with or without arthrotomy. Methods: Cadaveric equine larynges (n = 9). Methods: Equine larynges underwent sequential CT scans in a neutral position and with 2 arytenoid treatments: bilateral arytenoid abduction (ABD) and bilateral arytenoid abduction after left cricoarytenoid joint arthrotomy (ARTH). Soft tissue, cartilage, and luminal volume 3-dimensional models were generated. Rima g...
Computational fluid dynamic analysis of upper airway procedures in equine larynges.
Frontiers in veterinary science    April 17, 2023   Volume 10 1139398 doi: 10.3389/fvets.2023.1139398
Tucker ML, Wilson DG, Bergstrom DJ, Carmalt JL.Computational fluid dynamics (CFD) has proven useful in the planning of upper airway surgery in humans, where it is used to anticipate the influence of the surgical procedures on post-operative airflow. This technology has only been reported twice in an equine model, with a limited scope of airflow mechanics situations examined. The reported study sought to widen this application to the variety of procedures used to treat equine recurrent laryngeal neuropathy (RLN). The first objective of this study was to generate a CFD model of an box model of ten different equine larynges replicating RLN a...
A biomechanical comparison of a novel two-loop suture technique and two sutures for laryngoplasty in the horse.
American journal of veterinary research    March 7, 2023   Volume 84, Issue 5 ajvr.22.11.0189 doi: 10.2460/ajvr.22.11.0189
Wilson DG, Roquet I, Tucker ML, Carmalt JL.Evaluation of the strength of the novel suture technique by comparison with a 2-interrupted suture technique. Methods: 40 equine larynges. Methods: 40 larynges were used; 16 laryngoplasties were performed using the currently accepted 2-suture technique and 16 using the novel suture technique. These specimens were subjected to a single cycle to failure. Eight specimens were used to compare the rima glottidis area achieved with 2 different techniques. Results: The mean force to failure, as well as the rima glottidis area of both constructs, were not significantly different. The cricoid width did...
Laryngeal tie-forward in standing sedated horses.
Veterinary surgery : VS    November 30, 2022   Volume 52, Issue 2 229-237 doi: 10.1111/vsu.13920
Lean NE, Sole-Guitart A, Ahern BJ.To investigate the feasibility and describe the clinical experience of performing laryngeal tie-forward (LTF) in standing horses unaffected (experimental) and affected (clinical) by intermittent dorsal displacement of the soft palate (iDDSP). Methods: Experimental study and case series. Methods: Five normal experimental controls and five client owned horses affected by iDDSP. Methods: Standing LTF was performed and evaluated in five experimental horses and five clinical cases diagnosed with iDDSP. Standing LTF was performed under endoscopic guidance with horses sedated and the surgical site de...
Tongue ties do not widen the upper airways in racehorses.
Equine veterinary journal    September 14, 2022   Volume 55, Issue 4 642-648 doi: 10.1111/evj.13867
Barton AK, Troppenz A, Klaus D, Lindenberg I, Merle R, Gehlen H.There is contradictory evidence on the potential benefits of tongue ties on upper airway function and their efficacy in inhibiting intermittent dorsal displacement of the soft palate (DDSP) in racehorses. Objective: To test the hypothesis that tongue ties increase the pharyngeal diameter and decrease the occurrence of dynamic airway obstruction in racehorses. Methods: Prospective, crossover blinded clinical study. Methods: Data of 22 Thoroughbred and 8 Standardbred racehorses examined using overground endoscopy under full-intensity exercise on training racetracks with and without fixation of t...
Laryngeal reinnervation using the spinal accessory nerve: Electromyographic study of the sternomandibularis muscle.
Equine veterinary journal    August 5, 2022   Volume 55, Issue 3 515-523 doi: 10.1111/evj.13859
Campos Schweitzer A, Mespoulhès-Rivière C, Möller D, Ducharme N, Genton M, Farfan M, Rossignol F.Selective laryngeal reinnervation using the first and second cervical nerve (C1C2) is a treatment option for recurrent laryngeal neuropathy that aims to restore the function of the cricoarytenoideus dorsalis (CAD) muscle. Despite the technique's satisfying success rate, it has several limitations. These triggered the search for another potential donor nerve that could reduce CAD muscle fatigue and shorten rehabilitation. The ventral branch of the spinal accessory nerve, providing motor innervation to the sternomandibularis (SM) muscle, was identified as a potentially well-adapted nerve. Object...
Upper and Lower Airways Evaluation and Its Relationship with Dynamic Upper Airway Obstruction in Racehorses.
Animals : an open access journal from MDPI    June 17, 2022   Volume 12, Issue 12 doi: 10.3390/ani12121563
Lo Feudo CM, Stancari G, Collavo F, Stucchi L, Conturba B, Zucca E, Ferrucci F.Dynamic upper airway obstructions (DUAO) are common in racehorses, but their pathogenetic mechanisms have not been completely clarified yet. Multiple studies suggest that alterations of the pharyngo-laryngeal region visible at resting endoscopy may be predictive of the onset of DUAO, and the development of DUAO may be associated with pharyngeal lymphoid hyperplasia (PLH), lower airway inflammation (LAI) and exercise-induced pulmonary hemorrhage (EIPH). The present study aims to investigate the possible relationship between the findings of a complete resting evaluation of the upper and lower ai...
Association between dynamic upper airway obstructions and fitness parameters in Standardbred racehorses during high-speed treadmill exercise.
Journal of the American Veterinary Medical Association    May 27, 2022   Volume 260, Issue 11 1343-1350 doi: 10.2460/javma.22.02.0072
Lo Feudo CM, Stucchi L, Cavicchioli P, Stancari G, Conturba B, Zucca E, Ferrucci F.To evaluate the association between the severity of dynamic upper airway obstruction (DUAO) and selected fitness parameters in Standardbred racehorses measured by treadmill test. 191 Standardbred racehorses that underwent a standardized diagnostic protocol for poor performance evaluation between 2002 and 2021 at the Veterinary Teaching Hospital, University of Milan. Horses underwent a diagnostic protocol including clinical examination, lameness evaluation, laboratory analyses, ECG, resting upper airway endoscopy, metabolic incremental treadmill test, high-speed treadmill endoscopy, postexercis...
Effect of a combination of butorphanol and detomidine on endoscopic assessment of laryngeal function in Thoroughbred yearlings.
The Veterinary record    March 29, 2022   Volume 190, Issue 9 e1483 doi: 10.1002/vetr.1483
Almonte H, Schumacher J, Johnson CR, Berk JT, Bell RP.To the authors' knowledge, the effect of a combination of butorphanol tartrate and detomidine hydrochloride on the laryngeal function and symmetry of the arytenoid cartilages in young Thoroughbred horses has not been examined. Therefore, this study aimed to examine the effects of administration of butorphanol and detomidine on left-to-right rima glottidis ratio (L:R RGR), cross-sectional area of the rima glottidis (CSARG) and grade of laryngeal function of Thoroughbred yearlings examined endoscopically at rest. Forty-six Thoroughbred yearlings underwent laryngeal video endoscopy, at rest, befo...
Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy.
American journal of veterinary research    February 8, 2022   Volume 83, Issue 5 443-449 doi: 10.2460/ajvr.21.03.0040
Tucker ML, Wilson DG, Reinink SK, Carmalt JL.To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure. Methods: 10 cadaveric horse larynges. Methods: While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left lary...
The impact of grade of laryngeal function immediately prior to laryngoplasty and ipsilateral ventriculocordectomy on postoperative performance: 623 Thoroughbred racehorses (1998-2013).
Equine veterinary journal    October 21, 2021   Volume 54, Issue 5 856-864 doi: 10.1111/evj.13523
Broyles AH, Embertson RM, Brett Woodie J, Machado V.There is persistent concern among some trainers, owners and veterinarians regarding the effect of preoperative laryngeal function grade on the outcome of laryngoplasty and ventriculocordectomy (LPVC). Objective: To determine the effect of laryngeal function grade prior to LPVC on postoperative performance. Methods: Retrospective case-series. Methods: Medical and race records of Thoroughbred racehorses diagnosed with recurrent laryngeal neuropathy (RLN) and treated with LPVC between 1998 and 2013 were reviewed. Horses were placed into three groups based on preoperative laryngeal function grade ...
Inspiratory muscle training for the treatment of dynamic upper airway collapse in racehorses: A preliminary investigation.
Veterinary journal (London, England : 1997)    June 17, 2021   Volume 275 105708 doi: 10.1016/j.tvjl.2021.105708
Fitzharris LE, Franklin SH, McConnell AK, Hezzell MJ, Allen KJ.Exercise-induced upper airway collapse (UAC) probably occurs when the stabilising muscles of the upper airway are unable to withstand the dramatic changes in airflow and pressure that occurs during exercise. In racehorses, the mainstay of treatment is surgical intervention. In human athletes, exercise-induced laryngeal obstruction has been treated successfully with inspiratory muscle training (IMT). The aims of this study were: (1) to assess the feasibility of IMT in racehorses; and (2) describe the exercising endoscopy findings pre- and post-IMT in racehorses diagnosed with dynamic UAC. Horse...
Outcome analysis of 95 harness racehorses with confirmed dorsal displacement of the soft palate treated with laryngeal tie-forward surgery.
Equine veterinary journal    June 8, 2021   doi: 10.1111/evj.13479
Vermedal H, O'Leary JM, Fjordbakk CT, McAloon CG, Løkslett H, Stadsnes B, Fretheim-Kelly ZL, Strand E.The laryngeal tie-forward (LTF) procedure is commonly used to treat intermittent dorsal displacement of the soft palate (iDDSP). There is a wide range in reported efficacy of treating horses with and without a definitive diagnosis of iDDSP. Objective: To evaluate the racing performance of harness racehorses in which iDDSP had been definitely diagnosed and treated solely with the LTF procedure. Methods: Retrospective case series. Methods: Ninety-five harness racehorses were treated with LTF for confirmed iDDSP. A definite diagnosis of iDDSP was made with high-speed treadmill or overground endos...
Transendoscopic Ventriculocordectomy Using Monopolar Electrosurgical Instrumentation for Conjunctive Treatment of Laryngeal Hemiplegia in Horses: 24 Cases (2017-2019).
Frontiers in veterinary science    March 1, 2021   Volume 8 628410 doi: 10.3389/fvets.2021.628410
Caspers MK, Bell CD, Tatarniuk DM.Objective: The objective of this study is to evaluate the safety, efficacy, and owner satisfaction following electrosurgical ventriculocordectomy (EVC), in conjunction with prosthetic laryngoplasty, in equine clinical cases affected with left- or right-sided recurrent laryngeal neuropathy. Methods: Retrospective data analysis of clinical signalment, surgery, athletic outcome, intra- and postoperative complications, and postoperative examinations from clinical cases wherein EVC was performed in conjunction with traditional prosthetic laryngoplasty from one practice. Owners were contacted by pho...
Evaluation of Overground Endoscopy Findings in Colombian Criollo Paso Horses.
Journal of equine veterinary science    January 12, 2021   Volume 99 103374 doi: 10.1016/j.jevs.2021.103374
Joó K, Duque Betancourt D, Vasquez Marin T, Parra Moyano LA.The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < ...
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