Equis ISSN 2398-2977

Guttural pouch: empyema

Synonym(s): Diverticulitis, diverticulum, empyema of the auditory tube

Contributor(s): Safia Barakzai, Tim Brazil, Christopher Brown, John P Caron, Tim R C Greet, Geoff J Lane


  • Accumulation of purulent inflammatory debris in the guttural pouch (GP).
  • Cause: most common infections areStreptococcalspecies, egS. equi var. zooepidemicus,S. equi var. equi(see Strangles   Strangles (Streptococcus equi infection)  ). Chronic carrier state is common.
  • Signs: persistent, strongly posturally dependent, unilateral (or bilateral),purulentnasal discharge.
  • See distension of pharyngeal area often, and rarer neuropathies (dysphagia, facial nerve paralysis, Horner's syndrome) or hemorrhage from nostrils.
  • Diagnosis: endoscopy and culture to rule outS. equi var. equi.
  • Treatment: drainage and irrigation of the GP, antibiotics alone almost useless.
  • Prognosis: guarded for complete cure.



  • Bacterial infections primarilyStreptococcusspp   Streptococcus spp  , especiallyS. equi.
  • Unknown predisposing factors, together with anatomical aspects such as poor natural drainage from the GP, as the ostium is well above the most ventral aspects of the pouch.


  • Infection of the GP with bacteria and accumulation of pus.
  • NormallyStreptococcusspp   Streptococcus spp  .
  • Can be subsequent to upper respiratory infections particularly strangles   Strangles (Streptococcus equi infection)  and retropharyngeal lymph node abscessation with subsequent rupture into the pouch.
  • Infection can be seen in very young animals due to some postulated defect in neurologic control of ostium and pharyngeal function.
  • May occur secondary to guttural pouch tympany   Guttural pouch: tympany  .
  • Natural pouch drainage is poor and thus the pus produced can accumulate and become inspissated with resulting in chondroid (discrete balls of inspissated pus formed in chronic infections, look like small beach pebbles) formation   Guttural pouch: chondroids 01 - endoscopy  .
  • Presumed to result from rupture of adjacent abscessated retropharyngeal lymph nodes   →   reservoir of infectious material   Guttural pouch: retropharyngeal lymph node abscessation - endoscopy  .
  • Failure of natural drainage into pharynx via pharyngeal pouch opening may occur in >10% of strangles cases   →   chronic GP empyema.


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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hahn C (2008) Common peripheral nerve disorders in the horse. In Pract 30 (6), 322-329 VetMedResource.
  • Fogle C A et al (2007) Spontaneous rupture of the guttural pouch as a complication of treatment for guttural pouch empyema. Equine Vet Educ 19 (7), 351-355 VetMedResource.
  • Perkins J D & Schumacher J (2007) Complications incurred during treatment of horses for empyema of the guttural pouch. Equine Vet Educ 19 (7), 356-358 VetMedResource.
  • Judy C E, Chaffin M K & Cohen N D (2000) Empyema of the guttural pouch (auditory tube diverticulum) in horses: 91 cases (1977-1997). JAVMA 215 (11), 1666-1670 PubMed.
  • Newton J R, Verheyen K, Talbot N C et al (2000) Control of strangles outbreaks by isolation of guttural pouch carriers identified using PCR and culture of Streptococcus equi. Equine Vet J 32 (6), 515-526 PubMed.
  • Smyth D A et al (1999) Primary distension of the guttural pouch lateral compartment secondary to empyema. Can Vet J 40 (11), 802-804 PubMed.
  • Newton J R, Wood J L N, Dunn K A, DeBrauwere M N & Chanter N (1997) Naturally occurring persistent and asymptomatic infection of the guttural pouches of horses with Streptococcus equi. Vet Rec 140, 84 (very good paper on the carrier state of S. equi in the guttural pouches) PubMed.
  • Wilson J (1985) Effects of indwelling catheters and povidone iodine flushes on the guttural pouches of the horse. Equine Vet J 17 (3), 244-247 (early article indicating that some of the solutions used to flush sensitive internal structures of the horse do more harm than good) PubMed.

Other sources of information

  • Newton J R (1999) Strangles - diagnosis and treatment of sequelae. In: Proc 38th BEVA Congress. pp 120-121.
  • Rose R J & Hodgson D R (1993) Manual of Equine Practice. W B Saunders Co. pp 148-149. ISBN 0-7216-3739-6 (excellent summary on this disease).


  • Animal Health Trust, Center for Equine Studies, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK (excellent source of help on all aspects of this disease. Ask for any member of the strangles research team).