The Guttural Pouch: Friend or Foe?

The unique qualities of the horse can be a blessing or a curse. Sometimes, they can be both. Consider the peculiar guttural pouches. Present in only a few other animals, these structures are diverticula of the auditory (eustachian) tubes and, until recently, were thought to serve no purpose (see Mystery Solved in the June 2000 issue). An uncommon source of disease in horses, they must be taken into account if certain signs such as bleeding from the nose, swelling of the salivary glands, damage to nerves of the head or throat, or upper respiratory illness are present. Unfortunately, their location and closeness to vital structures such as arteries and nerves makes diagnosis and treatment of guttural pouch disease difficult.

The guttural pouches are framed by the base of the skull at the top, the pharynx and esophagus at the bottom, and the salivary glands and mandible on the sides. There is a slit-like opening from each guttural pouch into the pharynx that is hard to see, and even harder to open for examination or drainage purposes. Now add the internal and external carotid arteries, five cranial nerves, a few lymph nodes, and some delicate bones and joints, and the difficulty of diagnosing and treating guttural pouch problems increases.

There are three main problems associated with the guttural pouches. These are guttural pouch mycosis (fungal disease), empyema (pus), and tympany (swelling of the pouches due to air accumulation). Other conditions such as tumors, fractures, and foreign bodies occur much less frequently.

Guttural Pouch Mycosis

While there is no age, gender, breed, or geographic predisposition to guttural pouch mycosis, it does seem to occur more frequently in stabled horses during the warmer months of the year. Although the Aspergillus organism has been obtained from infections, the actual cause of the disease is not yet known. The most common clinical sign of a fungal infection of the guttural pouches is severe bleeding from the nose (epistaxis) not related to exercise. This is a result of erosion of the wall of the internal carotid artery, in most cases. When local nerves are damaged, the horse might have difficulty swallowing (dysphagia).

Your veterinarian will diagnose guttural pouch mycosis based on the history that you provide, the clinical signs that he or she observes, and examination with an endoscope. Because of the life-threatening nature of the disease and its treatment, referral to a hospital equipped to deal with complications is recommended. Surgery is the treatment of choice for horses with severe bleeding. The goal of surgery is to find and block off the affected artery. Medical treatment includes topical antifungal agents; response is highly variable.


Guttural pouch empyema can affect horses of any age. This pus in the guttural pouches (a mixture of white blood cells, infectious organisms, and dead cells) usually results from upper respiratory tract infections, although it can develop as a complication of other guttural pouch diseases, local treatment with irritating drugs, or birth defects. Horses with this disease might show nasal discharge off-and-on, swollen lymph nodes or salivary glands, and have difficulty breathing or swallowing. Like guttural pouch mycosis, diagnosis of this disease is best done through endoscopic examination, to make sure that the discharge seen is coming from the guttural pouches and not the lungs or sinuses. Radiographs (X rays) of the region and culture/sensitivity testing of the discharge might provide additional information.

Treatment involves daily flushing of the guttural pouches by your veterinarian for up to four weeks to dislodge and remove dead cells, debris, infectious organisms, and other materials. Only non-irritating, physiological flushing solutions should be used to prevent further irritation, which could lead to nerve damage and additional inflammation. Other medications or treatments can be administered based on the individual horse's clinical signs and condition.


Unlike the first two conditions, tympany of the guttural pouch is age-related, developing in foals shortly after birth and for up to one year of age. It is also gender-related, with more fillies than colts affected. Several causes for air being trapped in the guttural pouches have been suggested, such as congenital defect or local tissue swelling from a previous respiratory infection, but none have been proven. Like other guttural pouch conditions, history and clinical signs are helpful, but endoscopic examination and radiographs confirm the suspicion, rule out secondary problems, and assist in the selection of a treatment. Surgery is the most satisfactory treatment.

Chances are, your horse might not develop guttural pouch disease. But if it does occur, follow your veterinarian's recommendations for diagnosis and treatment carefully. Guttural pouch diseases are not only tricky to manage medically and surgically, but they can lead to permanent nerve or other tissue damage, or even be fatal.

Lydia F. Miller, DVM, AAEP Owner Education Director, and David Freeman, MVB, MRCVS, PhD, Dipl. ACVS, AAEP member.

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