[Exercise-induced laryngeal obstruction†: diagnosis and management]. / Obstruction laryngée induite à l'effort: méthodes diagnostiques et prise en charge.

Exercise-induced laryngeal obstruction (EILO) is a condition characterized by temporary narrowing or closure of the larynx during physical activity, in particular during intense physical exertion. It generally affects teenagers and young adults and is often misdiagnosed as exercise-induced asthma. Symptoms include dyspnea, wheezing and a feeling of throat tightness during exercise. The aim of this article is to review this often underrecognized condition, its diagnosis and its management.

L'obstruction laryngée induite à l'effort (EILO) est une affection caractérisée par le rétrécissement ou la fermeture temporaire du larynx au cours d'une activité physique, en particulier lors d'un effort physique intense. Elle touche généralement les adolescents et les jeunes adultes et est souvent diagnostiquée à tort comme de l'asthme d'effort. Les symptômes comprennent une dyspnée, une respiration sifflante et une sensation d'oppression au niveau de la gorge pendant l'exercice. Cet article passe en revue cette pathologie souvent méconnue, son diagnostic et sa prise en charge.

[ORL. Drug induced sleep endoscopy (DISE): indications and benefits]. / ORL. Endoscopie du sommeil induit par les médicaments (DISE): indications et bénéfices.

Obstructive sleep apnea (OSA) is a common condition that can cause daytime or nocturnal symptoms with long-term impact on the patient's health. Various therapies and surgeries have been introduced over the years, and patient wishes and compliance are essential factors in the success of treatment. Drug-induced sleep endoscopy (DISE) is a procedure that assesses the opening and closing of the upper airway in real time. This article summarizes the indications and contraindications of DISE, with a review of sedation methods and the VOTE classification system, in order to facilitate the use of a common nomenclature based on a protocol applied at the CHUV.

Le syndrome d'apnées obstructives du sommeil (SAOS) est une affection courante pouvant provoquer des symptômes diurnes ou nocturnes ayant un impact à long terme sur la santé du patient. Diverses thérapies et chirurgies ont été introduites au fil des années et les souhaits des patients et l'observance thérapeutique sont des facteurs essentiels dans le succès du traitement. L'endoscopie du sommeil induit par les médicaments (DISE: drug-induced sleep endoscopy) permet d'évaluer l'ouverture et la fermeture des voies respiratoires supérieures en temps réel. Cet article résume les indications et contre-indications de la DISE avec un rappel des méthodes de sédation et le système de classification VOTE, afin de faciliter l'utilisation d'une nomenclature commune basée sur un protocole appliqué au CHUV.

Oropharyngolaryngeal manifestations in severe toxic epidermal necrolysis: a single-center's retrospective case series.

BACKGROUND: Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions. METHODS: This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019. RESULTS: Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases. CONCLUSION: This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement.

Pediatric vascular anomalies with airway compromise.

Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.