International consensus (ICON) on basic voice assessment for unilateral vocal fold paralysis.

There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts have been made to reach a consensus, including the Dejonckere protocol for the European Laryngological Society in 2001. This suggested to perform objective and quantifiable measures in the following domains: perception, acoustic, aerodynamic, self-evaluation by the patient and videolaryngostroboscopy. But in a PubMed® search with the keywords "Voice Assessment" and "Voice Outcome" since 2001 retrieving 452 articles, only 33 of them were using methods taking into account the first four dimensions proposed by Dejonckere. To elaborate a new and simpler protocol, we chose to focus on unilateral vocal fold paralyses (UVFP), which represents a homogeneous disease in terms of physiology. This protocol was elaborated on the basis of a review of the literature and of the database and experience of the IFOS panel members. In summary, our group recommends the use and implementation of the ELS "basic protocol" with some minor modifications. Voice audio recordings are an indispensable prerequisite, and may even have medico-legal implications. We recommend the systematic use of the Voice Handicap Index (VHI). Perceptual analysis must be performed by using Hirano's GRB scale and voice breathiness has to be prioritized. Currently, acoustic analysis remains optional given the lack of data to support clinical usefulness. Aerodynamic studies should include at a minimum an evaluation of the Maximum Phonation Time, calculated in seconds following multiple trials in order to obtain a recording representing the patient's best possible glottis closure.

[Silent sinus syndrome associated with intrasinusal ossification]. / Syndrome du sinus silencieux et ossification intrasinusienne.

BACKGROUND: The silent sinus syndrome (SSS) is a rare cause of diplopia and facial asymmetry. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. Surgical dissection of the maxillary sinus mucosal lining is known to cause auto-obliteration by bone formation. CLINICAL CASE: A 45 year-old female patient was referred for vertical diplopia with enophthalmia, and a slight depression of the left cheekbone. Antrostomy was performed for chronic obstructive maxillary sinusitis six months before. CT scan revealed a major collapse of superior, anterior, and posterior left maxillary sinus with expansion of the orbital volume. The de novo maxillary sinus ossification evolved over two years of follow-up. It was normal lamellar bone. The left orbital floor was rebuilt. Diplopia progressively resolved. DISCUSSION: The association of SSS and intraluminal osteogenesis has never been reported. The first might be due to a peroperative dissection of the maxillary sinus mucosal lining. SSS was due to meatal obstruction secondary to inadequate antrostomy.