[A single appointment with a speech therapist can release a patient, even from a long-term aphonic status! Three clinical cases]. / Consulter un(e) phoniatre peut "Libérer" d'une "aphonie rebelle"! Trois cas cliniques évoqués.

Those three clinical cases involved aphonic female patients without any laryngeal disorders for their ENTs. 1) The first one had been out of work since 11/2 year because of her aphonia. She was still suffering from it in spite of a weekly speech therapy session and a monthly psychotherapy appointment. 2) The second patient had been aphonic for 3 weeks. Three different ENTs had renewed her prescription of work stoppage, even with normal laryngeal exam. 3) The third had lost her singing voicing ability during a performance in a national festival of songs and had to cancel the followings events. Even if all of them were waiting for a "miracle pill" they recorded their training session and left this single phoniatrician appointment with their restored voicing ability.

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.

Phoniatric management of 3 clinical cases of voice disorders involving the recurrent nerve.

These three cases involve aphonia or dysphonia as a consequence of entrapment of one of the recurrent nerves, in the absence of any prior surgical history. Depending on the particular case, one to two months was needed to normalize phonatory function; One case relapsed after a year. The phoniatric management of these cases involved: New functional and acoustic pattern, recorded by the patient as a form of daily maintenance; Laryngeal and perilaryngeal manual therapy, applied according to the "osteovox" method. Manual therapy and different phonatory habits, in association with alternative medicine can reduce the time to recovery in the case of cold-induced unilateral paresis.

When some clinical cases can challenge the phoniatric taxonomy.

It is proposed that taxonomy--the science and practice of classification--can offer significant help in the assessment of vocal dysfunction and in expanding the range of treatment options available to physicians. The first two clinical cases involve instances of "spasmodic dysphonia" which are susceptible to the usual botulinum toxin injections; those two cases were improved by an equally-effective phoniatric orientation that does not subject the patient to repeated injections. Treatment in the second two cases was also redesigned using a phoniatric approach to the patients' problem, after earlier ENT consultations had failed to diagnose malignancy.

Therapeutic choices for curing dysodia?...three clinical cases.

These three clinical cases provide an approach to the management of anatomical voice disorders. When confronted with a laryngeal diagnosis, talented musicians often suffer a crisis of self-confidence which may propel them toward maladaptive compensations; these may destabilize their usual techniques, already disrupted by the changes in their vocal acoustics. In their forties, each of these patients presents with an angiomatous lesion of the vocal fold, associated in two of the cases with a congenital structural weakness. For the three of them, the recommended therapeutic choice was alternating recorded laryngoscopic follow-up, alternative medicine prescriptions, and "artistic sessions" that required that their phoniatrician adapt to their repertory, their temperament, the constraints of the stage and their laryngeal disorder in order that they achieve a compromise between the needs of their career and the laryngeal anatomic realities of the moment. These "artistic guidance sessions" are recorded so as to allow the patient to become aware of the quality of their public performance and to learn the functional elements contributing to it.

[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.

[Is it possible to evolve the strategic approach to phonation problems?]. / La stratégie fonctionnelle, associée aux enjeux phoniatoires, serait-elle susceptible d'évolution?

The suggested anatomic/functional hypothesis would seem to favor a more balanced phonatory efficiency. The airways are respected in "welcoming" the incoming air, rather sucking it more or less violently toward the abdomen. The resonant architecture and resistances to expiratory force are also respected in the form of a comfortable compromise between the acoustic characteristics of fluent speech and the prolongation of phonatory durations.

[Optimizing vocal efficiency by shifting the "laryngeal mechanism"]. / Optimiser les performances vocales par le choix des mécanismes laryngés.

Optimizing vocal efficiency by shifting the "laryngeal mechanism". Some factors, either socio-cultural or anatomical, genetic, or habitual, may orient our acoustical and phonatory expectations toward a specific "laryngeal mechanism" (referred to by Roubeau, Castellengo and Henrich). We prefer to keep the laryngeal mechanism we are used to even if our cultural environment or personal development offers us another one. Our vocal preferences may thus limit the modalities of professional exercise that we choose, and may confront us with compensatory symptomatology of vocal fatigue. Professional obligations or artistic choices may suggest to the consulting therapist a different orientation with respect to laryngeal mechanism whereby functional comfort and acoustical efficiency of ambitious vocal performances are optimized. We illustrate this with some clinical observations.

[Different therapeutic suggestions used in 4 types of laryngopathies presenting in professional singers]. / Suggestions thérapeutiques différentes appliquées à quatre types de laryngopathies présentées par des professionnels de l'expression chantée.

Four clinical cases involving non-surgical approaches to disorders usually treated surgically are considered. The emphasis is placed on the collaboration of artists with laryngologists combining their musical and medical training in their daily work at their office and an alternative clinical management of disorders.

[Different clinical approaches: clinical reports]. / Approche clinique différenciée: cas cliniques.

The three reported clinical cases discussed clearly show that patients may often benefit from clinical pathways beyond the usual paradigms. Less known therapeutic options may avoid surgical intervention or seriously protracted rehabilitation programs if the patient can be made to accept the suggested acoustic and functional changes as every day habits. Different clinical approaches, associated with personal expressive development, can sometimes foster favorable therapeutic growth and avoid recourse to surgical intervention.

[Cerebellar ataxia preceding cutaneous symptoms in chickenpox]. / Ataxie cérébelleuse précédant les signes cutanés au cours d'une varicelle.

The authors describe a case of cerebellar ataxia developing 8 days before the exanthema of varicella. Evolution was quickly favorable. On the occasion of this rare observation, the pathophysiology of the neurological complications of varicella are discussed.