[Laryngeal amyloidosis: a clinical case and review of literature]. / Amyloïdose laryngée: revue de la littérature et cas clinique.

Amyloidosis consists of different forms of systemic or isolated organ lesions characterised by fibrillary protein deposits in extra-cellular tissue. The isolated involvement of the larynx is the most frequent form in the ENT sphere. We present a clinical case of a 67 year-old woman addressed for a sub-acute laryngitis resistant to conservative treatment, and finally diagnosed with laryngeal amyloidosis. We reviewed its physiopathology, the scientific literature as well as the different possibilities of management. Laryngeal amyloidosis is rare. A thorough additional work-up for the research of multifocal or systemic forms is highly recommended. The treatment aims at a minimal invasive endoscopic surgery with functional organ preservation.

[Swallowing in disorders of consciousness]. / Déglutition et états de conscience altérée.

INTRODUCTION: Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients. STATE OF ART: Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT. PERSPECTIVES: This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method. CONCLUSION: The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.

[Bamboo nodes of vocal folds: case report and review of literature]. / Bamboo nodes des cordes vocales: description d'un cas clinique et revue de La literature.

Bamboo nodes are sub mucous lesions localized in the vocal folds. Their aspect reminds of the nodes in a bamboo, which gives them their name. The diagnosis is made by laryngoscopy. Those lesions are always associated with autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, Hashimoto, progressive systemic sclerosis. The treatment is not clearly described in literature. It is recommended to start with systemic steroids and speech therapy. If the regression of laryngeal lesions is not suf- ficient, it is advised to complete with local steroid injections. Surgery should be consi- dered as the last treatment. We describe a clinical case of bamboo nodes and make a review of literature.

[Transsexuality: speech therapy supporting the "voice" of transformation]. / Transsexualité : accompagnement logopédique sur la "voix" de la transformation.

These past years, the Unité de Phoniatrie & Logopédie du CHUV, in Lausanne, has been increasingly requested to provide care to transsexual patients. If the sex change from female to male does not generally entail vocal problems as a result of hormonotherapy, such is not the case the other way around. Thus, our patients are mostly men converting into women. Since the male larynx cannot be modified on an organic level, speech therapy is of the utmost importance in ensuring vocal adaptation. In this article, we briefly describe the complete gender transformation program, and detail the therapeutic approach supported by our unit. In addition to raising the fundamental frequency, we also focus on various factors such as articulation, intonation, vocabulary, and phrase structure, keeping in mind that the female voice is not only high pitched....

[Early neurorehabilitation in an acute university hospital: from dream to reality]. / Neurorééducation précoce au Centre hospitalier universitaire vaudois: du rêve à la réalité.

The need for an early neurorehabilitation pathway was identified in an acute university hospital. A team was formed to draw up and implement it. A neuro-sensorial, interdisciplinary and coordinated therapy program was developed, focused on tracheostomised patients as soon as they were admitted to the intermediate care in neurology and neurosurgery. The impact of this care plan was evaluated by comparing the results obtained with that pertaining to patients treated previously in the same services. The comparison showed a reduction of 48% of the mean duration of tracheostomy, of 39% in the time to inscription in a neurorehabilitation centre and of 20% in the length of stay in the intermediate care. An early neurorehabilitation care program, with an interdisciplinary and coordinated team, reduces complications and lengths of stay.

[Swallowing disorders in the elderly]. / Troubles de la déglutition de la personne âgée.

Swallowing disorders are common in the elderly and may become life-threatening when they cause aspiration, inhalation pneumonia, malnutrition or dehydration. Dysphagia and malnutrition go hand in hand and lead to progressive worsening of mobility, immunity and quality of life. The aging of swallowing, so-called presbyphagia, is still not noticeable by 65. It becomes clinically relevant from 80 years onwards, especially during intercurrent and neurodegenerative disease, oncological treatments, or after trauma. This article aims to help practitioners in detecting these disorders and to implement appropriate therapeutic measures, which are often easy and may imply a multidisciplinary approach.

[Gastroesophageal reflux: a possible cause of paroxysmal laryngeal dyspnea]. / La dyspnée laryngée paroxystique: une manifestation extra-oesophagienne peu connue du reflux gastro-oesophagien.

An important number of patients are referred to the ENT specialist because of extraoesophageal manifestations of gastroesophageal reflux. The most alarming symptom is a paroxysmal dyspnea secondary to a laryngospasm. The patients report a laryngeal choking sensation associated to an aphonia. We report three cases of laryngospasm secondary to acid gastric reflux. The diagnosis was made with the clinical history, a laryngeal examination and a 24-hour pH-monitoring enabled us to demonstrate a clear temporal relation between the reflux episodes and the choking episodes. In conclusion, the pharyngo-laryngeal reflux is a possible cause of laryngospasm. In our three patients, a high dose antiacid treatment was efficient to bring a lasting relief of the symptoms.

Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement.

Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. Patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.

Medialization laryngoplasty.

Medialization laryngoplasty was performed in 25 patients between 1993 and 1997. The underlying pathology resulting in glottal incompetence was vocal cord paralysis in 22 patients and vocal cord bowing in 3 patients. Two types of implants were used: self-carved Proplast in 19 patients and prefabricated hydroxyapatite prostheses in 6 patients. Preoperative and postoperative results were compared in terms of dysphagia, vocal quality as graded by three experienced voice specialists, and computer measurements of the glottal gap. All patients showed improvement both subjectively and on the objective measurements used. Swallowing returned to normal in all patients who had isolated recurrent laryngeal nerve paralysis. The voice improved in all patients but was rarely judged as entirely normal.

Unilateral cricothyroid contraction and glottic configuration.

It is frequently stated that unilateral cricothyroid muscle (CT) paralysis can be diagnosed by physical examination, noting rotation of the glottis, and shortening and vertical displacement of the ipsilateral vocal fold. These signs, however, are inconsistently observed, and there is considerable controversy regarding the direction of glottic rotation. To determine the effects of CT contraction on three-dimensional glottic configuration, we performed computerized tomography on cadaver larynges before and after simulated CT contraction. Radiopaque makers were used to compute distances. Unilateral CT contraction equally increased the length of both membranous vocal folds, and rotated the posterior glottis less than 1 mm. CT contraction neither adducted the vocal processes, nor significantly their altered vertical level. These results suggest that unilateral CT paralysis cannot be diagnosed on the basis of any clinically apparent change in glottal configuration.

[Rehabilitation of the hemianopsia patient from the viewpoint of the ergotherapist]. / Rehabilitation des Hemianopsie-Patienten aus der Sicht der Ergotherapeutin.

Hemianopsia, above all if it is associated with other neuropsychological deficits (neglect, disturbances of spatial orientation) is very disturbing for the patient in daily life. The patient has difficulty dressing, exhibits poor spatial orientation, has difficulty construing spatial relations or reading. Ergotherapy tries to combat all these disorders. There are various methods of treatment at the ergotherapist's disposal: activities of everyday life, such as self-help and household training, functional games, craft skills and neurotraining, which aims in particular at improving intellectual function. In a well-protected environment the patient learns to judge his or her capabilities correctly once again and to make the best of his or her strength or weaknesses in daily life.

[Alcoholism from the systemic viewpoint]. / Alkoholismus aus systemischer Sicht.

In this paper we attempt to view the phenomenon alcohol abuse and dependence within the family or partnership and to describe the important impact of alcoholism on social relation. Understating the role of alcohol in the familial structure may help to draw conclusions for competence and effectiveness of individual or familial psychotherapeutic interventions.

The anatomy of the inferior laryngeal nerve.

Contradictory opinions are found in the literature concerning the precise anatomy and role of the inferior laryngeal nerve, the terminal portion of the recurrent laryngeal nerve. Moreover, operative damage to this nerve beyond the thyroid area is seldom described. Twenty-one human larynges were dissected to give a precise description of the inferior laryngeal nerve and to draw attention to the risks of injury to the nerve during specific laryngological operations. In contrast with the varied descriptions found in the literature, only small variations in the terminal branching of the nerve were found. The nerve divides generally extralaryngeally into two branches: a motor, anterior one, innervating the intrinsic laryngeal musculature (except the cricothyroid muscle), and a sensory, posterior one, forming Galen's anastomosis. The anterior branch of the nerve is particularly susceptible to damage just behind the cricothyroid joint; two of its terminal rami, supplying respectively the interarytenoid and thyro-arytenoid muscles, incur potential risks of injury during endoscopic CO2 laser surgery.

Immunological decay in thymectomized infants.

Four infants underwent radical thymectomy for a suspected malignancy of the thymus. Histology revealed no malignant cells. The patients did clinically well as long as 14 years after the operation. There was laboratory evidence for a cellular and humoral immunodeficiency. Affected were mainly the response to oral poliomyelitis vaccinations and the skin tests of delayed type hypersensitivity.

Single-fiber electromyography of the laryngeal muscles.

Single-fiber electromyography (SFEMG) is useful in the evaluation of disorders of neuromuscular transmission and the assessment of motor unit morphology. Standard EMG techniques are used routinely in the evaluation of laryngeal dysfunction, but the feasibility of laryngeal SFEMG has not been established. We, therefore, performed laryngeal SFEMG in 10 normal individuals to demonstrate the feasibility of the technique and generate preliminary normative data. We also studied 2 patients with amyotrophic lateral sclerosis and 1 patient previously treated with botulinum toxin for comparative purposes.