Accumulation of purulent exudate in the guttural pouch is often caused by Streptococcus species. These horses have fever and intermittent purulent nasal discharge. A painful swelling in the parotid area, stiff head carriage and stertorous breathing are seen in more severe cases. Treatment consists of antibiotic therapy in combination with guttural pouch lavage and sometimes surgical drainage of the affected guttural pouch.  Some horses even need an emergency tracheotomy to avoid suffocation.