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.

Functional assessment of glottal insufficiency treated by hyaluronic acid injection: Retrospective 20-case series.

OBJECTIVES: The objectives of the present study were to describe hyaluronic acid injection to the vocal folds as treatment for glottal insufficiency, assess indications and report vocal results at 1 month and later than 6 months postoperatively. PATIENTS AND METHODS: A single-center retrospective study was performed for the period March 2012 to August 2015. Inclusion criteria comprised: unilateral recurrent nerve palsy or vocal fold closure defect with conserved mobility. Exclusion criteria comprised: previous thyroplasty, severe swallowing disorder, and cognitive disorder hindering subjective vocal assessment. Restylane® injection was performed under general or local anesthesia. The Vocal Handicap Index (VHI), maximum phonation time (MPT) and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) score were assessed preoperatively and at 1 month and more than 6 months postoperatively. RESULTS: Twenty patients were included: 14 with unilateral recurrent nerve palsy and 6 with vocal fold closure defect. Restylane® injection was performed under general anesthesia in 16 patients and local anesthesia in 4 (20%). At 1-month assessment, there was significant reduction in VHI (by 36 points; P=0.0001) and GRBAS score (by 6.95 points; P=0.0001) and significant increase in MPT (by 4.95sec; P=0.0001). At 6 months, VHI, MPT and GRBAS scores remained significantly improved (respectively, P=0.0002, P=0.001 and P=0.0001), without significant difference from 1-month levels. Three patients had minor complications; two recovered normal vocal fold mobility. CONCLUSION: Hyaluronic acid injection was effective in treating glottal failure, improving objective and subjective vocal parameters, which remained satisfactory even 6 months postoperatively.

[Multidisciplinary daytime hospitalisation for swallowing disorders: Its value and limitations. Our practice in the University Hospital of Tours]. / Hospitalisation de jour pluridisciplinaire en déglutition: intérêts et limites. Notre expérience au CHU de Tours.

Swallowing disorders are in many cases serious and complex. Their management needs to be considered from several perspectives. Multidisciplinary daytime hospitalisation (MDH) for swallowing disorders is an appropriate solution for many patients: a single day is sufficient for a complete check-up and the initiation of a therapeutic programme. A Ministerial Direction (15 June 2010), the content of which is discussed in this article, lays out the conditions of this approach. Our institution (Regional University Hospital of Tours) has substantial experience of MDH for swallowing disorders and here we take a look at the organisational, human, medical, and financial aspects of this activity.

Ultrasound analysis of the upper esophageal sphincter during swallowing in the healthy subject.

OBJECTIVES: The purpose of this study was to develop a methodology and standard settings for ultrasound study of the upper esophageal sphincter (UES) during swallowing. MATERIAL AND METHODS: This was a prospective study of 25 healthy volunteers (15 women and 10 men) aged 20 to 56 years. Neck ultrasonography was performed as each volunteer swallowed 10 mL of water three times. The parameters studied were: diameter of the closed UES; diameter of the open UES; anterior and lateral displacement (measured in cm) of the UES as the water bolus flowed through it; duration of UES opening; and average duration of UES displacement (measured in ms). Student's t tests for paired and unpaired samples were applied for the statistical analysis. RESULTS: The mean diameter of the closed UES was 0.78 ± 0.13 cm, while the mean duration of opening was 415 ± 57.66 ms and the mean duration of displacement was 937 ± 120.98 ms. Maximum anterior and lateral displacement of the UES was 0.42 ± 0.12 cm and 0.35 ± 0.18 cm, respectively. There was a significant difference between men and women for lateral displacement of the UES (P=0.04). CONCLUSION: This study established standards for ultrasound study of the UES during swallowing, using a non-invasive readily accessible method that may be useful for assessing swallowing disorders involving the UES (Zenker's diverticulum, fibrosis, stricture).

[Post intubation collected septic cricoarytenoid arthritis: case report]. / Arthrite infectieuse collectée de l'articulation crico-aryténoïdienne secondaire a une intubation: cas clinique.

We report a rare case of post intubation cricoarytenoid arthritis. A 18-year-old man admitted to emergency was easely intubated for 14 days for a non neck injury. Sixty-six days after intubation, he consulted for severe odynophagia with dyspnoea. Nasofibroscopic examination revealed a right arytenoid granuloma with oedema and inflammation, and bilateral arytenoid immobility. There was evidence on the CT scan of cricoarytenoid arthritis with fluid accumulation. Antibiotic treatment and two punctures for drainage allowed healing. There were cricoid and arytenoid calcifications. The patient recovered total and stable laryngeal mobility and function. This case is unusual, with features unlike those previously reported: intubation being the probable cause, the unusual clinical presentation with painless cricoid palpation, and the contrast between imaging findings during follow-up and the evolution under treatment. Indeed, there was an apparent discrepancy between the favourable clinical course and the CT-images revealing calcifications.