Beyond the Traditional Tieback of Laryngeal Paralysis (GOLPP)

Laryngeal paralysis is one of the most common upper airway disorders encountered in older dogs. Increasingly recognized as part of Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP), the condition extends far beyond the larynx and represents a progressive neurological disorder affecting multiple body systems.

While surgical intervention remains the cornerstone of treatment, advances in regenerative medicine and minimally invasive airway management are opening new possibilities for affected patients.

Current Standard of Care

The established treatment for laryngeal paralysis remains:

Unilateral Arytenoid Lateralisation (Tieback Surgery)

This procedure permanently abducts one arytenoid cartilage to improve airflow through the larynx and alleviate upper airway obstruction.

Tieback surgery continues to achieve excellent clinical outcomes in appropriately selected patients and remains the gold standard intervention.

Importantly, bilateral arytenoid lateralisation is not recommended because it substantially increases the risk of aspiration pneumonia by compromising normal airway protection during swallowing.

Silicone Laryngeal Stents: A Minimally Invasive Alternative

One of the most promising recent developments is the use of silicone laryngeal stents.

These medical-grade silicone devices are placed endoscopically without the need for open surgery. The stent holds the arytenoid cartilages in an abducted position, improving airflow while avoiding surgical dissection.

Potential advantages include:

• Reduced anaesthetic time

• No surgical incision

• Lower perioperative risk in geriatric patients

• Immediate restoration of airway patency

• Use as a temporary bridge during respiratory emergencies

Design features such as anchoring studs help prevent migration, while biocompatible materials reduce the risk of local tissue reactions.

Although long-term data are still accumulating, laryngeal stenting may become an important option for dogs deemed poor surgical candidates.

Stem Cell Therapy and Laryngeal Reinnervation

Perhaps the most exciting area of current research involves regenerative therapy.

Researchers led by Dr. Robert Paniello at Washington University are investigating implantation of muscle progenitor (myosatellite) cells into denervated laryngeal muscles.

The goal is fundamentally different from conventional surgery.

Instead of permanently modifying airway anatomy, researchers aim to:

• Restore functional nerve-muscle connections

• Improve muscle mass and strength

• Re-establish active arytenoid movement

• Recover natural airway function

Early canine investigations have demonstrated encouraging improvements in muscle bulk and signs of neural recovery.

While still in the pre-clinical phase, this NIH-funded research represents one of the first attempts to biologically repair the underlying pathology responsible for laryngeal paralysis.

Photobiomodulation: Can Light Promote Nerve Healing?

Another emerging area is photobiomodulation therapy, also known as low-level laser therapy.

The technique involves applying specific wavelengths of light to tissues surrounding the recurrent laryngeal nerve.

Proposed biological effects include:

• Increased mitochondrial activity

• Enhanced cellular energy production

• Improved nerve regeneration

• Reduced inflammation

Although currently considered investigational within veterinary medicine, photobiomodulation has attracted growing interest as a non-invasive treatment that may complement future regenerative approaches.

Further studies are needed to determine its effectiveness in canine GOLPP patients.

A Shift in Understanding: GOLPP as a Polyneuropathy

One of the most important developments in recent years is the recognition that GOLPP is not an isolated laryngeal disorder.

Affected dogs frequently develop:

• Hindlimb weakness

• Reduced proprioception

• Generalised neuromuscular dysfunction

• Oesophageal motility abnormalities

• Megaoesophagus

This broader understanding has changed management strategies significantly.

Modern treatment plans increasingly incorporate:

Nutritional and Feeding Modifications

Elevated feeding stations and careful post-meal positioning may reduce aspiration risk in dogs with oesophageal dysfunction.

Physiotherapy and Mobility Support

Targeted exercise and rehabilitation can help preserve hindlimb strength and mobility as neurological disease progresses.

Aspiration Pneumonia Surveillance

Aspiration pneumonia remains one of the leading causes of morbidity and mortality in GOLPP patients and requires ongoing monitoring.

The Future of GOLPP Treatment

For decades, treatment focused primarily on mechanically enlarging the airway through tieback surgery.

Today, the field is evolving toward a more comprehensive understanding of GOLPP as a progressive neurodegenerative disorder.

The next generation of treatments may include:

1. Endoscopic laryngeal stenting

2. Nerve regeneration therapies

3. Stem cell-based muscle restoration

4. Photobiomodulation-assisted healing

5. Comprehensive neurological management strategies

While unilateral arytenoid lateralisation remains the gold standard today, the future may lie in restoring normal laryngeal function rather than permanently altering anatomy.

References

Paniello R. (2025). Novel stem cell treatment for vocal fold paralysis reinnervation. Washington University School of Medicine.  Washington University Research Article

ABTVET (2025). Silicone laryngeal stent placement for LARPAR/GOLPP.  ABTVET Clinical Overview