[Guidelines for the management of chronic cough in adults]. / Recommandations de prise en charge de la toux chronique de l'adulte.

Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.

Pharyngolaryngeal semiology and prognostic factors in multiple system atrophy.

INTRODUCTION: Multiple system atrophy (MSA) is a rare degenerative neurological disorder in adults. It induces parkinsonian and/or cerebellar syndrome associated with dysautonomia. Pharyngolaryngeal symptoms are common. Our aim is to describe the Pharyngolaryngeal semiology on one hand, and to ascertain whether the presence of these symptoms represents a prognostic factor for MSA on the other. METHODS: Thus, we carried out a retrospective, single-centre study, on a cohort receiving care at the centre of reference for MSA. The patients were referred for otorhinolaryngology assessment. The data was collected over the year 2020 with the help of computer software from the university hospital centre (UHC). Firstly, we described the Pharyngolaryngeal semiology specific to MSA by questioning patients, and by the results of nasofibroscopic examinations and swallowing tests. We then used multivariate analysis of variance to describe the prognostic factors of MSA progression (in UMSARS I and II points per month of progression) and survival (number of years between the first symptoms and death). RESULTS: This study included a hundred and one patients and made it possible to define a Pharyngolaryngeal semiology profile of MSA, which is: a reduction in laryngeal mobility (primarily vocal cord abduction defects), abnormal movements (particularly at rest or when initiating a movement) and a defect in the protection mechanisms of the upper airways. The swallowing difficulties are moderate and the main mechanisms are delayed pharyngeal swallow and/or an oro-pharyngeal transport defect. In the multivariate analyses, the contributing factors are laryngeal anomalies, modification of solid food to fluid food and nutritional complication. CONCLUSION: ENT specialists should pay close attention to problems in the Pharyngolaryngeal dynamic and then consider a neurological cause. They can also itemize the clinical factors that could have a negative effect on the prognosis of the patient with MSA. Indeed, early detection makes it possible to provide care for respiratory and nutritional complications.

Optimizing linguistic materials for feature-based intelligibility assessment in speech impairments.

Assessing the intelligibility of speech-disordered individuals generally involves asking them to read aloud texts such as word lists, a procedure that can be time-consuming if the materials are lengthy. This paper seeks to optimize such elicitation materials by identifying an optimal trade-off between the quantity of material needed for assessment purposes and its capacity to elicit a robust intelligibility metrics. More specifically, it investigates the effect of reducing the number of pseudowords used in a phonetic-acoustic decoding task in a speech-impaired population in terms of the subsequent impact on the intelligibility classifier as quantified by accuracy indexes (AUC of ROC, Balanced Accuracy index and F-scores). A comparison of obtained accuracy indexes shows that when reduction of the amount of elicitation material is based on a phonetic criterion-here, related to phonotactic complexity-the classifier has a higher classifying ability than when the material is arbitrarily reduced. Crucially, downsizing the material to about 30% of the original dataset does not diminish the classifier's performance nor affect its stability. This result is of significant interest to clinicians as well as patients since it validates a tool that is both reliable and efficient.

Narrow-Band Imaging in oncologic otorhinolaryngology: State of the art.

OBJECTIVES: To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. MATERIAL AND METHODS: A PubMed search was carried out according to the PRISMA method. RESULTS: Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. CONCLUSION: The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins.

Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic.

Procedures putting healthcare workers in close contact with the airway are particularly at risk of contamination by the SARS-Cov-2 virus, especially when exposed to sputum, coughing, or a tracheostomy. In the current pandemic phase, all patients should be considered as potentially infected. Thus, the level of precaution recommended for the caregivers depends more on the type of procedure than on the patient's proved or suspected COVID-19 status. Procedures that are particularly at high risk of contamination are clinical and flexible endoscopic pharyngo-laryngological evaluation, and probably also video fluoroscopic swallowing exams. Voice rehabilitation should not be considered urgent at this time. Therefore, recommendations presented here mainly concern the management of swallowing disorders, which can sometimes be dangerous for the patient, and recent dysphonia. In cases where they are considered possible and useful, teleconsultations should be preferred to face-to-face assessments or rehabilitation sessions. The latter must be maintained only in few selected situations, after team discussions or in accordance with the guidelines provided by health authorities.

Vocal-fold leukoplakia and dysplasia. Mini-review by the French Society of Phoniatrics and Laryngology (SFPL).

Vocal-fold leukoplakia and dysplasia are together designated "epithelial hyperplastic laryngeal lesions" (EHLL). Work-up and follow-up are founded on optical examination with high-definition imaging, stroboscopy and narrow-band imaging. Diagnosis is based on pathology, using the new 2017 WHO classification, dichotomizing "low grade" and "high grade". Statistically, the risk of cancerous progression is 20% within 5 to 10 years of diagnosis, or more in over-65 year-old males; risk for any given patient, however, is unpredictable. Research focuses on the genetic criteria of the lesion and characterization of the tumoral microenvironment. Treatment is exclusively microsurgical. Resection depth is adjusted according to infiltration. EHLL is a chronic disease, necessitating long-term follow-up, which may be hampered by residual dysphonia and surgical sequelae in the vocal folds. Sequelae need to be minimized by good mastery of microsurgical technique and indications. When they occur, biomaterials such as autologous fat and hyaluronic acid can be useful. Tissue bio-engineering is a promising field.

Assessment of impairment of intelligibility and of speech signal after oral cavity and oropharynx cancer.

BACKGROUND: Perceptual evaluation is a means of assessing speech disorder severity in clinical practice. Although limited in reliability and reproducibility, its ease of application makes it very widely used. Choice of assessment criteria and type of speech sample are key points. OBJECTIVE: To compare a panel's perceptual evaluations on two tasks with different criteria. MATERIAL AND METHOD: The corpus comprised 87 samples from patients treated for oral cavity or oropharynx cancer, assessed by 6 experts on two criteria (impairment of intelligibility and of speech signal) and two kinds of speech sample (semi-spontaneous versus reading speech) RESULTS: Although strong correlations were found between tasks (r>0.8), the speech signal criterion gave a score distribution providing a better metric. Severity was greater in oral cavity (mean, 5.44±2.47) than oropharyngeal cancer (6.46±2.24). Semi-spontaneous speech tended to show less severity score ceiling effect than reading speech (mean, 6.06/10 for picture description and 6.51/10 for reading). CONCLUSION: Speech signal impairment in semi-spontaneous speech seems to be the best clinical measure to assess speech disorder following treatment of oral cavity or oropharynx cancer.

The Carcinologic Handicap Index (CHI): A disability self-assessment questionnaire for head and neck cancer patients.

INTRODUCTION: The present prospective study sought to draw up and validate a self-assessment questionnaire for disability following head and neck cancer treatment. MATERIAL AND METHOD: The Carcinologic Handicap Index (CHI) was designed empirically based on the Voice Handicap Index. It comprises 9 dimensions, self-assessed by the patient: pain, swallowing, feeding, respiration, phonation, hearing, vision, olfaction-gustation, and psychosocial. For each dimension, 4 items are scored in terms of frequency, providing dimension and global scores. The CHI was tested on 86 head and neck cancer patients (pathologic group: male predominance; mean age, 59 years) and 18 control subjects, for validation. RESULTS AND DISCUSSION: Global internal coherence was 0.905 (Cronbach alpha); content validity (r, between questionnaire scores and corresponding visual analog scales) ranged between 0.6 and 0.8 except for the vision dimension and for total score compared to general health rating on VAS (r≤0.5: i.e., the pathology did not directly impair vision and was only one factor among others affecting general health status); temporal validity was satisfactory (r>0.7; P<0.0001) except on the respiration dimension (r=0.624, probably due to fluctuation in pulmonary congestion). Impact on swallowing, feeding and respiration varied with lesion site. There were no significant differences between patients and controls on the pain, hearing and vision dimensions. CONCLUSION: The CHI showed acceptable psychometric qualities and can be considered as an authentic clinical tool for health professionals, assessing the impact of ENT pathology on quality of life, mainly in the functional domains directly affected by the pathology or treatment.

[Head and neck intensity-modulated radiation therapy: Normal tissues dose constraints. Pharyngeal constrictor muscles and larynx]. / Radiothérapie conformationnelle avec modulation d'intensité des cancers des voies aérodigestives supérieures : dose de tolérance des tissus sains. Muscles constricteurs du pharynx et larynx.

Radio-induced pharyngolaryngeal chronic disorders may challenge the quality of life of head and neck cancer long survivors. Many anatomic structures have been identified as potentially impaired by irradiation and responsible for laryngeal edema, dysphonia and dysphagia. Some dose constraints might be plausible such as keeping the mean dose to the pharyngeal constrictor muscles under 50 to 55Gy, the mean dose to the supra-glottic larynx under 40 to 45Gy and, if feasible, the mean dose to the glottic larynx under 20Gy. A reduction of the dose delivered to the muscles of the floor of the mouth and the cervical esophagus would be beneficial as well. Nevertheless, the publications available do not provide an extensive enough level of proof. One should consider limiting as low as possible the dose delivered to these structures without compromising the quality of irradiation of the target tumor volumes.

[Therapeutic education of total laryngectomy patients: Influence of social factors].

Current health policies promote patient education, parti­cu­lar­ly in oncology. Therapeutic education program must be tailo­red to the characteristics, needs and expectations of the population. In the ENT Department of Head and Neck Surgery, Larrey Hospital in Toulouse, a therapeutic education program for patient with total laryngectomy has been experienced since 2011. But its propagation remains difficult. The aim of this study is to determine if social factors are nfluencing the parti­cipation of the laryngectomized population in the program. The brochure explaining this program and a registration form coupled with a survey questionnaire were distributed to the regio­nal population of patient with total laryngectomy. After two months of investigation we collected 42 responses. It is clear from their analysis that social factors underlie partici­pa­tion, particularly educational level, available financial resources level and the socio-professional group.

Validity of cervical auscultation in the screening for aspiration.

INTRODUCTION: Cervical auscultation could improve the performance of bedside swallowing test to predict aspiration, especially silent aspiration. The aim of this study is to compare the predictive values of bedside swallowing test performed with and without cervical auscultation by logopedist students who had intensive training on cervical auscultation. MATERIALS AND METHODS: 64 patients were included in the study. They all underwent swallowing test alone, combined swallowing test and cervical auscultation, and videofluoroscopic swallowing study as defined gold standard. Two logopedist students, at the end of their training, performed the auscultation and noted their results. RESULTS: 128 tests were performed, 96% of the tests were judged positive for aspiration. When comparing the results of the two different clinical tests, the detection of clinical signs is not improved by the addition of auscultation. Using a penetration aspiration scale threshold >5, the area under the curve measured for the swallowing test alone was significantly higher than that measured for the combined tests (p = 0.03) (0.66 for the swallowing test alone (95% CI between 0.49 and 0.83), and 0.50 for the combined tests (95% CI between 0.31 and 0.69). CONCLUSION: This study showed no advantage in performing cervical auscultation with bedside swallowing test. Cervical auscultation seems to hamper the assessment, mainly the perception of wet voice and laryngeal motion. These results are compatible with literature but need further confirmation using studies performed with trained logopedists.

[From intelligibility to comprehension, which measurement in practice?]. / De l'intelligibilité à compréhensibilité de la parole, quelles mesures en pratique clinique?

UNLABELLED: The modelling of the tests assessing speech disorders in touch with the international classification of the functioning implies a reflection on measurement tools. The access to the sense of the message from decoding of the signal to the action infers at the interlocutor's justifies various methods. The objective of this work is to demonstrate the limit of the usual tests of intelligibility. MATERIAL AND METHOD: A population of 10 subjects presenting a speech disorder secondary to a Head and Neck cancer and 2 subjects controls recorded a corpus of 80 syllables developed with the most frequent 16 French consonants and 5 vowels. The test of intelligibility consisted of a task of identification of consonants by a jury of 11 listeners. RESULTS: About is the method used to estimate the informative value of the consonants tested, the uvular consonant /r/ and the nasal In/, /m/ are very well perceived. The weighting by the rate of confusion makes tipped over the position of labiodentales If/, /v/ and that of / p/. The just perception of the sound/p/ would be underestimated while sounds /v/ and /f/ would be overestimated. Sounds /g/, /k/, /j/ remain the least well received. This observation results probably from the profile of distortions produced by the selection of the population and probably from the frequency of the syllables containing these consonants in the french language for the sample of the corpus. CONCLUSION: The rate of confusion appears as a fundamental element, inciting to look for more relevant methods of analysis of the results of the tests of intelligibility.

A case of laryngeal sialolipoma: pathology in focus.

We are reporting a rare case of laryngeal sialolipoma in a 66-year-old male affected by Parkinson's disease. He was evaluated for dysarthria and swallowing disorders during which a swelling of the left ventricular fold, was always present and enlarged over a span of six months. Surgical removal of the left ventricular fold was performed. Microscopic examination, showed a circumscribed mass with organoid seromucous glands surrounded by numerous mature adipocytes, separated from the parenchyma and fatty tissue by dense fibrous tissue. This mass fulfilled the diagnostic criteria of sialolipoma. Sialolipomas can develop in a variety of sites in which there is both adipose and salivary gland tissue. To our knowledge, this is the first case of sialolipoma arising in the larynx.

[Free sorting task of speech disorders by expert and non-expert listeners]. / Catégorisation libre dans les troubles de la production pathologique de la parole.

Understood the strategies underlying the perception of speech motor disorders (SMD) is useful for the management of people with this kind of disorders. Our hypothesis was that intelligibility of speech is a dramatic decision factor for the classification of speech production independently of the type of listeners. Two types of listeners: 15 experts (logopedists and phoniatricians), and 15 non experts (students in the field of heath care without any experience) participated at this study performing a free sorting task of 33 stimuli. The stimuli are a sentence readed by 13 control subjects and 20 subjects with a SMD of several kinds of etiologies. The methodology used for the analysis is the visualization of proximity trees by a sorting mathematical algorithm and the analysis of the free commentaries as a discourse. The results confirm that the degree of alteration of intelligibility is the main factor distributed in the sorts, but the reference to the "normality" is an other strong criteria and this notion is frequently associated with a description of the stimuli at a level of voice more than a level of speech. These results lead to a new hypothesis of a classification of perception of speech included a speech disorders, determined at an extremity by a comparison with a "prototype of normality" and at the other extremity by the characteristic of "intelligibility or understandibility" reinforcing some concepts of speech rehabilitation.

The "Deglutition Handicap Index" a self-adminitrated dysphagia-specific quality of life questionnaire: sensibility to change.

OBJECTIVE: The aim of this study is to assess the efficacy of UES's dysfunction treatments with the DHI (Deglutition Handicap Index). MATERIAL AND METHOD: 24 patients suffering of UES's dysfunction were included prospectively between 2008 and 2009 in 2 centers (France and Netherlands). Patients completed DHI before and after treatment. For statistics, Wilcoxon two-sample tests were used. RESULTS: The mean score was 57 +/- 17 in the preoperative and 26 +/- 19 in the post operative time. The statistical difference was significant p < 0.0001. The difference is also significant for the 3 subscales (symptoms, functional, emotional). CONCLUSION: The DHI has been validated in terms of content, concurrent, construct validity and temporal reliability. It can be used for assessing efficacy of treatments used for dysphagia.

Quality of life in patients treated for advanced hypopharyngeal or laryngeal cancer.

OBJECTIVE: To study quality of life in patients treated for advanced hypopharyngeal or laryngeal cancer, with laryngeal conservation or laryngectomy. PATIENTS AND METHODS: A retrospective 2-center study included 100 patients in remission from squamous cell carcinoma, treated between 1998 and 2009. Seventy patients (24 hypopharynx, 46 larynx) were treated by total (pharyngo-) laryngectomy followed by external radiation therapy, and 30 (13 hypopharynx, 17 larynx) underwent an organ-conservation protocol with concurrent radiochemotherapy or with induction chemotherapy using platin-5FU or taxan-platin-5FU followed by radiation therapy. All patients responded to the quality of life questionnaires (EORTC QLQ-C30 and QLQ-H&N35). RESULTS: Advanced tumor stages IVa and IVb were significantly more frequent in the surgery groups (hypopharynx: 71.6% vs. 45.9%, p=0.01; larynx: 72.4% vs. 37.5%, p<0.01). In pharyngeal cancer, the only significant difference between surgical treatment and laryngeal conservation was for "sensory disorder" (taste and odor), with better results in case of laryngeal conservation (p<0.0001). For the other items, there was a trend for quality of life to appear better in patients with laryngeal conservation (p=NS). In laryngeal cancer, the only significant difference was for "dry mouth", which was significantly less invalidating with surgical treatment (p<0.001). The impairment of the other quality of life items did not differ between surgical and conservative treatment. CONCLUSIONS: Quality of life is impaired in all patients treated for pharyngeal or laryngeal cancer. The type of treatment, surgical or conservative, affects differently various aspects of quality of life.

The "Deglutition Handicap Index" a self-administrated dysphagia-specific quality of life questionnaire: temporal reliability.

OBJECTIVE: The aim of this study is to contribute to the psychometric validation of the self-administrated dysphagia-specific quality of life questionnaire, the Deglutition Handicap Index. Created on the model of the "Voice Handicap Index". this questionnaire consists of 30 statements on deglutition related aspects in daily life (5 point-rating scale). It is subdivided in three domains of 10 items: physical (symptoms), functional (nutritional and respiratory consequences) and emotional (psychosocial consequences). MATERIAL AND METHOD: 57 patients were included suffering of any kind of swallowing disorders. 17 questionnaires were eliminated because 1 to 3 items were not anchored. A test retest performed in an interval of 2 weeks, allowed the measure of the intraclasse correlation coefficient and the limits of agreement with Bland and Altman graphics. RESULTS: The intraclasse correlation coefficient was respectively 0.77 (0.64-0.90), 0.87 (0.79-0.94), 0.90 (0.84-0.96), 0.91 (0.85-0.96) for the Physical, Functional, Emotional and Total Scores. The limits of agreement are 9 points for the subscales and 20 points for the total score. CONCLUSION: The DHI has been validated in term of content, concurrent and construct validity. The reliability was satisfied in term of internal consistency. It is now validated for the temporal reliability. The DHI is the solely specific quality of life questionnaire related to deglutition available for all kind of oropharyngeal swallowing disorders in adults available in clinical practice.

[Construction and validation of a quantitative assessment of speech intelligibility for speech disorders]. / Elaboration et validation d'un test quantitatif d'intelligibilité pour les troubles pathologiques de la production de la parole.

UNLABELLED: Intelligibility of speech measure is based on the perception of the listeners. OBJECTIVE: The aim of this study was the construction and the validation of a quantitative test of speech disorders severity allowing the the follow up and the measure of management impact. MATERIAL AND METHOD: After a first step of construction and feasibility, the psychometric validation was performed. 37 patients with a speech disorder and 13 normal subjects were recorded. The reference was the global score obtained by reading a text. The whole recordings were scored by a panel of 5 judges. The test was composed by a automatic series of words (the months of the year) with a phono-orthographic score, the semantic transcription of a list of words and sentences, a qualitative score of spontaneous speech obtained by the description of a photography. RESULTS: The intra and inter judges reliability are correct (intraclasse coefficient of 0.97 and 0.98). The different parts of the test are well correlated to the reference proof (r = 0.75 to 0.82). Chronbach alpha is 0.98, the limits of agreement are 14.88 +/- 3 on a maximum score of 88. The dispersion is enough for a good differentiation of the patients. (11 to 88, avec mean 62.93, SD 22.45) with a significant difference p < 0.002 between the control group and the population with speech disorders. CONCLUSION: This test constructed on the concept of a composite assessment is validated.

[Validation of a self assessment for speech disorders (Phonation Handicap Index)]. / Validation d'un questionnaire d'auto-evaluation de la parole (Parole Handicap Index).

OBJECTIVE: The aim of this work is the psychometric validation of a self assessment questionnaire about speech in dysarthria. MATERIALS AND METHODS: A prospective study was performed on 91 persons to analyze reliability and validity of this new questionnaire. It is composed of 25 items subdivided in 3 domains: Physical, functional and emotional. We first compared 17 normal speakers to 21 dysarthric patients. Then we analysed the intra-individual variability with 53 patients who completed the questionnaire twice with two weeks interval between the completion. The statistical analysis verified internal consistency of each item, intra-subject reliability was analyzed through Pearson test and clinical validity was calculated through the non parametric Mann Whitney test. RESULTS: The internal consistency reliability was correct (Cronbach's alpha > 0.9). It appeared a statically significant difference between normal speakers and dysarthric patients (p < 0.05). The correlations to the handicap and severity felt were fair ensured us of the content's validity. However the absence of difference for 5 items drove us to eliminate them. Also, analysis the test / retest by the correlation matrix allowed to delete 5 other questions. The obtained total score was 0,861. As for the validity of contents, the correlations in the handicap and in the degree of severity felt by the dysarthric patients were satisfactory. CONCLUSION: The results of this study allows to resume the validation of this questionnaire, its short form of 15 items is particularly adapted to dysarthric patients. It now remains to test its reliability with the medical evolution of the patients. We propose to name it "Phonation Handicap Index".

[Study of the predictive value of detection tests for silent aspirations]. / Etude de la valeur prédictive des tests de détection des fausses routes silencieuses.

UNLABELLED: Screening for aspiration in patients with swallowing disorders is important in preventing complications. The tests used in this regard are insufficient due to silent aspiration relating to abnormal protective reflexes in many patients with swallowing problems. OBJECTIVE: The aim of this study is to determine the predictive values of simple tests in screening for silent aspiration. MATERIAL AND METHOD: The reference test used was videofluoroscopic examination on swallowing. In the presence of aspiration (FR+) the presence (ME+) or not (ME-) of a cough of throat clearing was noted. The tests being studied were a nasal test with isotonic saline and swallowing according to a set time. RESULTS: For screening for aspiration the presence of a "wet voice" was considered to be a sign of reduced protective reflexes. 1) During the nasal test, the results are 100% for the positive predictive value (VPp) and 83.3% for the negative predictive value (VPn); 2) These results are respectively 84.6% and 35.9% during the swallowing test. Regarding screening for silent aspiration, 1) during the nasal test, the results are 62.5% for the positive predictive value (VPp) and 36.3% for the negative predictive value (VPn); 2) These results are respectively 54.5% and 26.6% during the swallowing test. CONCLUSION: This preliminary study points out the lack of predictive value of the nasal test and the swallow test for the silent aspirations. However the results could be useful for other researchers developing other tests in this area.