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1.
Eur Arch Otorhinolaryngol ; 280(5): 2411-2419, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36525078

RESUMEN

OBJECTIVES: To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders. METHODS: The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions. CONCLUSIONS: This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.


Asunto(s)
Otolaringología , Telerrehabilitación , Trastornos de la Voz , Humanos , Consenso , Reproducibilidad de los Resultados , Pandemias , Técnica Delphi
2.
Eur Arch Otorhinolaryngol ; 279(12): 5939-5943, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35916924

RESUMEN

INTRODUCTION: Flexible endoscopic procedures (FEP) using a working channel allowed otolaryngologists to perform more procedures on the pharynx and the larynx under local anesthesia. The purpose of this work is to demonstrate the feasibility and safety of this technique by studying the adverse effects of this practice in an office-based setting. METHODS: This is a monocentric retrospective cohort study. We searched the database using the French procedural code for FEP performed in an outpatient setting between January 2005 and December 2020. Data regarding the patient's characteristics, indications, and periprocedural complications were extracted. RESULTS: In total, we included 231 patients with a total of 308 FEP: 36% biopsy, 20% hyaluronic acid injection (including 3.5% at the level of the cavum), 20% injection of other substances (in descending order: botulinum toxin, cidofovir, physiological serum, cortisone), 20% exploration for an occult tumor, 3% samples for microbiological analysis, 1% other procedures. Of the 308 FEP included in this study, 24 patients (10.3%) had complications corresponding to 7.8% of the procedures performed. During the procedures, reported complications include minor laryngeal bleeding (n = 5), vasovagal syncope (n = 5), laryngospasm (n = 1) or nausea (n = 3), dysphagia (n = 3), and voice disorders (n = 3). Post-procedural complications were hypertensive crisis (n = 1), asthma attack (n = 1), pneumonia (n = 1), laryngitis (n = 1). Using the Clavien-Dindo classification system, these complications could be defined as grade I (laryngeal bleeding, vasovagal syncope, laryngospasm, dysphagia, nausea, voice disorders, and laryngitis) and grade II (hypertensive crisis, asthma attack, pneumonia) in 9.1% and 1.2% of cases, respectively. Most of these complications were self-limiting, while asthma attacks, pneumonia, laryngitis, and voice disorders required a medical intervention. All complications were managed without sequelae. There was no serious complication grade (no grade III, IV or V). CONCLUSIONS: FEP, which is now well standardized in our institution, makes it possible to carry out a wide range of interventions with little morbidity. These results are in line with those of literature but this technique remains out of nomenclature in France. Our experience led to the development of an evidence-based standard of care that can serve as a framework for practitioners on a nationwide level, while the work to establish official guidelines by the French society of phoniatrics and laryngology is in progress.


Asunto(s)
Asma , Trastornos de Deglución , Laringismo , Laringitis , Laringe , Síncope Vasovagal , Trastornos de la Voz , Humanos , Anestesia Local , Faringe , Estudios Retrospectivos , Laringitis/patología , Laringismo/etiología , Laringismo/patología , Síncope Vasovagal/patología , Laringe/patología , Trastornos de la Voz/patología , Náusea/patología
3.
Clin Oral Investig ; 26(2): 1823-1833, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34636941

RESUMEN

OBJECTIVES: Probe-based confocal laser endomicroscopy (pCLE) is a noninvasive and real-time imaging technique allowing acquisition of in situ images of the tissue microarchitecture during oral surgery. We aimed to assess the diagnostic performance of pCLE combined with patent blue V (PB) in improving the management of early oral cavity, oro/hypopharyngeal, and laryngeal cancer by imaging squamous cell carcinoma in vivo. MATERIALS AND METHODS: The prospective study enrolled 44 patients with early head and neck lesions. All patients underwent white-light inspection or panendoscopy depending on the lesion's location, followed by pCLE imaging of the tumor core and its margins after topical application of PB. Each zone imaged by pCLE was interpreted at distance of the exam by three pathologists blinded to final histology. RESULTS: Most imaged zones could be presented to pathologists; the final sensitivity and specificity of pCLE imaging in head and neck cancers was 73.2-75% and 30-57.4%, respectively. During imaging, head and neck surgeons encountered some challenges that required resolving, such as accessing lesions with the flexible optical probe, achieving sufficiently precise imaging on the targeted tissues, and heterogeneous tissue staining by fluorescent dye. CONCLUSION: Final sensitivity scores were reasonable but final specificity scores were low. pCLE zones used to calculate specificity were acquired in areas of tumor margins, and the poor quality of the images acquired in these areas explains the final low specificity scores. CLINICAL RELEVANCE: Practical adjustments and technical training are needed to analyze head and neck lesions in various anatomical sites in real-time by pCLE.


Asunto(s)
Neoplasias de Cabeza y Cuello , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Rayos Láser , Microscopía Confocal , Estudios Prospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen
4.
Respir Med Res ; 83: 101011, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37087905

RESUMEN

Patients with chronic cough experience a high alteration of quality of life. Moreover, chronic cough is a complex entity with numerous etiologies and treatments. In order to help clinicians involved in the management of patients with chronic cough, guidelines on chronic cough have been established by a group of French experts. These guidelines address the definitions of chronic cough and the initial management of patients with chronic cough. We present herein second-line tests that might be considered in patients with cough persistence despite initial management. Experts also propose a definition of unexplained or refractory chronic cough (URCC) in order to better identify patients whose cough persists despite optimal management. Finally, these guidelines address the pharmacological and non-pharmacological interventions useful in URCC. Thus, amitryptilline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are a mainstay of treatment strategies in URCC. Other treatment options, such as P2 × 3 antagonists, are being developed.


Asunto(s)
Trastornos Respiratorios , Enfermedades Respiratorias , Humanos , Adulto , Tos/diagnóstico , Tos/etiología , Tos/terapia , Calidad de Vida , Enfermedad Crónica
5.
J Emerg Med ; 41(5): e107-10, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19022603

RESUMEN

BACKGROUND: Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely. OBJECTIVE: Lingual abscesses call for prompt and aggressive management because they are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated. CASE REPORT: A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan. DISCUSSION: Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection. CONCLUSION: We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy.


Asunto(s)
Absceso/terapia , Enfermedades Raras/terapia , Enfermedades de la Lengua/terapia , Absceso/diagnóstico por imagen , Enfermedad Aguda , Antibacterianos/uso terapéutico , Biopsia con Aguja , Urgencias Médicas , Humanos , Masculino , Radiografía , Enfermedades Raras/diagnóstico por imagen , Enfermedades de la Lengua/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
6.
Am J Clin Pathol ; 144(3): 511-6, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26276782

RESUMEN

OBJECTIVES: Laryngeal inflammatory myofibroblastic tumors (IMTs) are rarely reported in the literature but may be underrecognized. To better characterize their features, we report a series of six cases. METHODS: The clinicopathologic findings, including immunohistochemistry, fluorescence in situ hybridization (FISH) analysis, and follow-up, were evaluated and a review of the literature was performed. RESULTS: These cases presented as small polypoid vocal cord or ventricular band lesions, with a more advanced mean age at diagnosis (49 years) than typically reported in other localizations. Apart from one secondary revision surgery, no complementary treatment and no recurrences were observed. Histologically, various morphologic features were seen. All tumors were spindle cell proliferations on a myxoid background with more or less atypia and significant inflammatory infiltrate. All six cases showed anaplastic lymphoma kinase (ALK) immunohistochemical expression. FISH rearrangement was present in four of six cases. Only two cases were initially diagnosed as IMT. CONCLUSIONS: According to our series, laryngeal IMTs are easily misdiagnosed. They have a good prognosis, and ALK immunohistochemistry should be carried out to assess this diagnosis when spindle cell proliferations are observed in this localization.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/metabolismo , Neoplasias de Tejido Muscular/diagnóstico , Neoplasias de Tejido Muscular/metabolismo , Proteínas Tirosina Quinasas Receptoras/metabolismo , Adulto , Anciano de 80 o más Años , Quinasa de Linfoma Anaplásico , Errores Diagnósticos/prevención & control , Femenino , Humanos , Inmunohistoquímica/métodos , Hibridación Fluorescente in Situ/métodos , Masculino , Persona de Mediana Edad
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