[Dysphonia in children: Retrospective and comparative study between the late 1980s and today].

Child dysphonia is a frequent pathological situation which concerns 6 to 38 percent of a school attending population. Thus it demands a specific and adapted treatment. Because of its direct consequences on social, family and school lives, parents often seek advice from a speech specialist. This study focuses on the specificities of those individuals having diagnosed child dysphonia, as well as the treatment which can be given to them. Our work covers a period of twenty years of comparative studies. We have read through dr Coulombeau's files, from 2005 to 2011, and we have made up a series of questions addressed to the speech therapists having speech impaired children in their practice. We have cross-examined these data with those of Dr Cornut's, covering a period of seven years (1985-1991). The qualitative and quantitative studies which have been carried out enabled us to highlight the fact there has been a constant background of child dysphonia and an evolution in the offered treatments. Indeed, we have realised that the number of individuals having diagnosed child dysphonia are less and less operated on. In the same time people tend to ignore the offered treatments. Though the follow-ups to a prior visit at a speech therapist have decreased for twenty years, it still remains the most common treatment. Our analysis does not focus on the effects of the given treatments on a long term basis. It thus appears that a study consisting in analysing the development of these children through adulthood would be greatly accurate.

The benefit of phoniatricians and ENT surgeons working together?

These 3 clinical cases relate dysphonia and dystonia with female speaking and singing performers whose medical care was messy and involving several physicians. A close collaboration between phoniatricians and phonosurgeons brought effective solutions to these cases.

[Evaluation of the use of hyaluronic acid in iatrogenic scars after phonosurgery (excluding surgical oncology) and ligamento-epithelial abnormalities of the vocal cords]. / Evaluation de l'usage de l'acide hyaluronique dans les cicatrices iatrogènes après phonochirurgie (chirurgie oncologique exclue) et les anomalies ligamento-épithéliales des cordes vocales.

Between January of 2007 and December of 2011, six patients underwent revision microphonosurgery because of scarring complicating the initial surgery. The technique consisted of detaching the scarred area, the insertion of fibrils of hyaluronic acid (Merogel), a microsuture and possibly intra-cordal fat injection. A pre-and post-operative phoniatric protocol assessed the results which appear encouraging.

[Laryngeal schwannoma: a case report]. / Schwannome laryngé: a propos d'un cas.

The authors report the case of a patient of 67 years, an active teacher active with no relevant history, which noticed several months ago, a gradually progressive dysphonia, though not major (G1R2B0). The stroboscopic examination which proved extremely difficult, could only demonstrate normal laryngeal mobility, while the left ventricular band and left vocal fold appeared affected by a subepithelial tumoral aspect, appearing as a regular swelling. These data were confirmed by naso-fibroscopy, and later by computed tomography. Endoscopy, which was also extremely difficult, brought about the diagnosis of schwannoma in the region of the left ventricular band. We will discuss the nosology of this lesion, particularly thanks to Kleinsasser, and the surgical management that can be offered.

[The "intra-cordal polyp": a clinical alternative to recognize?]. / Le polype "intra-cordal" : une variante clinique à reconnaitre?

UNLABELLED: The vocal cord polyp is an inflammatory false tumour of the larynx. It is characterized mainly by the specific existence of fibrinous exsudats organized in loose network or mounds, surrounded by newly formed vascular slits. The epithelium covering the polyp is usually more or less impaired. CLINICAL CASES: The authors report two adult patients among whom the initial presentation in video-stroboscopy was that of an intracordal lesion of a cystic type, however; with unusual characteristics (purplish color, angiomatous aspect). The surgery consisted of a cordotomy, the surface epithelium appearing normal. After dissection, the two lesions seemed to be presenting the typical aspect of fibrinoïd mound of a polyp, observation confirmed by the anatomo-pathological study. In these cases, the resection was finally carried out with no mucous loss. CONCLUSION: The particular etiopathogeny of these lesions is been discussed. The treatment, medical and of rehabilitation could achieve a partial recovery. In the event of surgery, an access to the lesion through a cordotomy and not directly by removal with microcissors is advised.

[Lateral fixation of the vocal fold (Lichtenberger's technique): interest in the bilateral laryngeal immobilities]. / Aryténoïdopexie selon la technique de Lichtenberger: intérêt dans les immobilités laryngées bilatérales.

UNLABELLED: In patients presenting a bilateral laryngeal immobility, the potential reversibility of certain cases, the refusal or the bad tolerance of long term tracheotomy bring up the question of the choice of the surgical technique if it is indicated. OBJECTIVES: To report our experience with the technique of lateralization of the paralyzed vocal fold (arytenoidopexy) suggested by Lichtenberger. CLINICAL CASES: After having described the technique, we report 5 cases (3 pos-thyroidectomy, I of central origine, 1 post-burn). From 1 to 12 months after surgery 2 patients were fully satisfied, a patient (central origin) recovered spontaneously at the end of a month and the 2 last had a partial result. Only one patient required several surgical gestures. CONCLUSION: The Lichtenberger's technique combines theoretical reversibility and conservation of a functional glottic plan. It avoids tracheotomy. This approach can according to us validly replace the traditional techniques, medium or long term tracheotomy , or endoscopic arythenoid or posterior vocal fold resection.

[These vocal cords lesions termed sulcus glottidis: clinico-anatomical considerations]. / Ces lésions des cordes vocales baptisées vergetures: considerations anatomo-cliniques.

Among the difficult cases which phonosurgeons may encounter, the problem of vergetures is one of the most complex. The primum movens would seem to be a particular vocal fold lesion in the form of more or less pronounced ligament atrophy. About a retrospective study of 52 cases, the authors present their conclusions: This atrophy co-exists anatomically, with (a sometimes considerable amount of atrophied mucosa opposite, "glottal tension" clearly perceptible during surgery, especially along the lower edge); videostroboscopically, with (great vibratory rigidity, more or less severe glottal air-loss). This lesion is completely distinct from a sulcus (the surgical treatment wil be discussed in an other paper).

[Basic principles for managing and post-operative follow-up in phono-surgery]. / Principes de la prise en charge et du suivi post-opératoire en phono-chirurgie.

The management of the voice in patients with benign lesions of the larynx causing chronic dysphonia follows certain simple rules, on which depend the final functional result. It also requires the closest collaboration between the voice surgeon and the speech therapy team. The indication for surgery rests on the most precise diagnosis of the condition, after examination of the larynx with the rigid endoscope and video-stroboscopy of the cord movements. When a final decision for surgery has been taken, it is essential that the patient should be thoroughly prepared for surgery if the post-operative phase is to pass smoothly, which is the criterion for a good functional recovery. The surgery must be both precise and thorough, with due respect to the structural elements of the vocal folds, and must involve the minimum of resection. Afterwards, a period of complete voice rest is mandatory, before the voice rehabilitation can commence. Finally, post-operative follow-up will be the best guide for selecting the appropriate speech therapy, which will allow the patient to overcome the anatomoical and functional changes brought about by surgery, to recover the potential qualities of his voice, and to resume his vocal and professional activity under the best conditions.

[Results of six years experience using an injection of autologous fat into the vocal cord]. / Bilan de six ans d'utilisation de la technique d'injection intra-cordale de graisse autologue.

Several techniques are available for medialising the vocal cord or for compensating for glottic air escape. The authors have used the technique of injection of autologous fat into the vocal cord over a six year period for various indications, in a total of 124 patients (65 having unilateral palsy, and 59 glottic air escape). The later results depend on the initial problem, but in general demonstrate a notable reduction in air escape.

["Bamboo nodes": a clinical study of 19 cases]. / "Bamboo nodes": étude clinique à propos de 19 cas.

This is an account of 19 cases undergoing surgery for submucosal deposits on the cords of a particular type, 8 of the 19 cases having an auto-immune disorder. The nineteen patients were operated and followed up between December 1986 and December 2001, the main symptom being dysphonia. Stroboscopy demonstrated a yellowish appearance, often transverse, of the middle third of the cord, giving the characteristic appearance of a bamboo node. Suspension microlayngoscopy was performed in all cases. Cordotomy was invariably required. Examination of the case notes of these patients has shown either a pre-existing auto-immune disorder or the development of suggestive pointers in 8 of these female patients. Histological examination necessarily demonstrates the common characteristics of these deposits, and may be able to show features which have predictive value in the absence of known auto-immune pathology.

[Anatomy and anatomopathology of benign vocal cord lesions]. / Anatomie et anatomopathologie des lésions bénignes des cordes vocales.

After 30 years of experience comprising more than 3000 suspension laryngoscopies, we are putting forward a classification of the main benign lesions of the vocal cords. Among the acquired group, we make a distinction between those caused by vocal overuse and abuse and those with a cause within the vocal cord. Congenital lesions are certainly more common than is usually thought. The hypothesis of a congenital origin would certainly justify a larger prospective study.