[Evaluation of quality of life and swallowing in patients with cancer of the oropharynx treated with assisted transoral robotic surgery]. / Evaluation de la qualité de vie et de la déglutition des patients atteints d'un cancer de l'oropharynx traités par chirurgie transorale assistée par robot.

OBJECTIVES: To present the preliminary results of the qualiit of life and quality of swallowing in a series of 15 patien! treated with oropharyngectomy by transoral robotic-assisted (CTAR) (robot da Vinci, Intuitive Surgical ). MATERIALS AND METHODS: A prospective monocentric non-randomized study of 15 patients with cancer of the oropharynx. Were analyzed: demographics, quality of life questionnaires (QLQ-C30 and H&N 35 EORTC) and quality of swallowing questionnairex (MDADI, DHI and EAT 10) with an average of 1 year after the end of the treatment. RESULTS: Fifteen patients (10 males and 5 females), mean age of 65 years (47-73 years) were included. The tumours were classified as: cT1: 4; cT2: 10 cT3: 1. Five of the 15 patients received postoperative chemoradiotherapy as histo-pathological studies showed multiple metastatic cervical lymph nodes +/- capsular rupture. For the analysis of the quality of life and quality of swallowing, the patients were divided into two groups. Group A included patients who underwent CTARs and group B, patients operated by CTAR with adjuvant chemoradiotherapy. At 12 months of the procedure, all patients had a deglutition considered as normal without feeding tube nor tracheostomy. With the three scales used, the quality of swallowing was satisfactory for all patients. It was better for patients in group A than for patients in group B. In terms of quality of life, the EORTC QLQ-C30 scale showed our patients had a high rate of satisfaction scale in "health and overall quality of life". For the EORTC H&N35 questionnaire, mean scores for "specific symptoms" were also low except for the following three items "dry mouths", "sticky saliva" and "sexuality problem". The first two items were statistically more frequent (p = 0.02 and p = 0.001) in group B patients. CONCLUSION: After transoral robotic-assisted oropharyngectomy, patients have a good quality of life and swallowing. Postoperative chemoradio-therapy compromises the quality of swallowing. Multicentric studies are required to confirm these preliminary results.

[Formant structures of vowels produced in stutterers' speech in normal and fast speech rates]. / Etude de la structure formantique des voyelles dans la parole bègue en vitesses d'elocution normale et rapide.

OBJECTIVE: The aim of this study is to analyse the steady-state portion of the first two formants (F1 and F2) in the production of [CVp] sequences, containing vowels [i, a, u] pronounced in two speech rates (normal and fast), by groups of untreated and treated stutterers, and control subjects. MATERIAL AND METHOD: We recorded 15 speakers (5 control speakers, 5 non-treated stutterers and 5 treated stutterers) who had to repeat sentences containing [CV] sequences ten times, in normal and fast speech rates, where [C] was [p], [t] or [k] and [V], [i], [a] or [u]. RESULTS: Comparing data between the three groups of speakers, a vowel space reduction is observed for stutterers at a normal speaking rate, compared with control speakers and treated stutterers. When speech rate increases, no reduction of vowel space is noticeable for non-treated stutterers, contrary to treated stutterers and controls. CONCLUSION: Results for stutterers could be interpreted in terms of lack of articulatory flexibility.

[Stuttering and Tourette's syndrome: a short tutorial and account of a four years experience in a stuttering clinic constriction of the vocal tract]. / Bégaiement et syndrome de Gilles de la Tourette: rappel clinique et bilan de quatre années de consultation médicale du bégaiement.

The author presents a short tutorial of Gilles de la Tourette's syndrome followed by a state of the art of review of the clinical links between stuttering and the different kinds of Tourette and tics disorders. The author relates her own experience of working for four consecutive years at the new stuttering diagnostic center at the "Hôpital Européen Georges Pompidou ". The article ends with a practical review of the actual therapies available when such a diagnosis is made.

[Attention deficits in the school aged stuttering child: constituent trait or comorbidity]. / Les déficits attentionnels chez l'enfant bègue d'âge scolaire: extrait constitutif ou comorbidité?

A first account of a prospective study of attention deficit disorders among school-age stutterers--in the settings of a fluency clinic newly opened in a large general hospice--has led to the evidence of a significant association between impulsivity and stuttering. It seems therefore necessary to include attention tests among the subtests of our assessment protocols. Ways of helping the young stutterers with ADD are later thoroughly described.

Comparison and evolution of perceptual and acoustic characteristics of voice after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

The present prospective study, based on a series of 12 male patients managed with supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP), was designed i) to compare the perceptual and acoustic parameters before surgery and at 6 months after sugery, ii) to evaluate the evolution of the perceptual and acoustic parameters between 6 and 18 months postoperatively, and iii) to determine the correlations between the perceptual and acoustic parameters preoperatively and at 18 months postoperatively. The roughness was found to be significantly worsened after SCPL-CHEP. The jitter, shimmer, noise-to-harmonic ratio, and degree of voiceless increased significantly after SCPL-CHEP. Neither acoustic nor perceptual parameters varied significantly between 6 and 18 months postoperatively. Preoperatively, a strong statistical correlation was found between grade, roughness and strain and all acoustic parameters but F0. Breathiness was statistically correlated with all acoustic parameters but jitter. Postoperatively the only statistical correlation noted was between roughness and F0.

[Contribution and limits of acoustic analysis of the voice and alaryngeal speech with a computerized system]. / Apports et limites de l'analyse acoustique de la voix et de la parole alaryngée au moyen d'un système informatique.

Through a review of published acoustical analyses of alaryngeal voice and speech, our aim was to establish the interest and the limitations of a computerized acoustical system. One case of esophageal voice and one case of tracheoesophageal voice were analysed with the Kay Elemetrics Multidimensional Voice Program for voice and Computerised Speech Lab for speech. All the acoustical parameters are altered in alaryngeal voice. The automatic calculation of frequential parameters are promising but there are errors due to the importance of altered voicing. Speech analysis is an important complement to evaluate the phonatory behavior of laryngectomized patients.

[Disfluency disorders other than stuttering]. / Les disfluences autres que celles du bégaiement.

Fluency disorders other than stuttering, which is the major and above all most known form, can be observed and require rehabilitation. Fluency is the quality which enables speech to flow effortlessly with a comfortable delivery, pace and simple transitions. Acquired over a period of several years during childhood, fluency can be altered by numerous neurological syndromes, such as Parkinson's disease, spasmodic dysphonia, or substitution phonations such as the esophageal or tracheoesophageal voice. Their severity is variable and judged above all by the efficacy of communication. Management of the duration and spacing of language segments and their homogeneity with respect to meaning are just as important as the stability of the phonatory organs.

[Subjective evaluation of voice and speech after supra-cricoid partial laryngectomy]. / Evaluation subjective de la voix et de la parole après laryngectomie partielle supra-cricoïdienne.

A prospective perceptual evaluation of the voice and speech after supra-cricoid partial laryngectomy over the first post-operative six months was performed. Ten male patients were evaluated at one, three and six months by five listeners. A voice profil was drawn from defined acoustical parameters studied, and a chronology in the voice improvement was observed. Voice therapy aims could be suggested.

[Computerized evaluation of acoustic parameters of voice and speech after partial supracricoid laryngectomy with cricohyoidoepiglottopexy]. / Evaluation informatisée des paramètres acoustiques de la voix et de la parole après laryngectomie partielle supracricoidienne avec cricohyoidoepiglottopexie.

Nineteen supracricoid porticol laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) speakers and 19 normal adult laryngeal (NAL) male speakers took part in this prospective study. Computed analysis of the voice and speech parameters was performed using the Computed Speech Lab from Kay Elemectrics. Parameters recorded for voice analysis were the average fundamental frequency, the fundamental frequency standard deviation, the jitter, the shimmer, the noise to harmonic ratio and the degree of voiceless. Parameters recorded for speech analysis were the maximum phonation time of the /a/ vowel, the phrase grouping and number of words read per minute. Speech and voice parameters statistically differed among NAL and SCPL with CHEP speakers. Among SCPL with CHEP speakers, none of the following factors (age, cricopharyngeal myotomy, piriform sinus tension, associated ipsilateral neck dissection, speech rehabilitation therapy) were statistically related to the frequential and durational variables. Jitter of SCPL with CHEP speakers was reduced as time elapsed from CHEP completion increased (p = .002). Maximum phonation time was reduced if one arytenoid cartilage was resected (p = 0.025).

[Results of the treatment of spontaneous widening of tracheo-esophageal punctures after laryngeal implant]. / Résultats des traitements de l'élargissement spontané des punctures trachéo-oesophagiennes avec implant phonatoire.

Vocal rehabilitation by tracheosophageal puncture procedure and voice prosthesis was employed in a series of 68 patients (64 men and 4 women). The mean age was 68.4 years and ranged from 39 to 78 years. Enlarging tracheoesophageal fistula and leakage occurred in 31 patients. One or several conservative treatments were employed in 23 patients. Surgical closure of the tracheoesophageal fistula was performed in 5 patients (closure without muscular interposition: 3 patients, closure with sternomastoid muscle interposition: 2 patients). Leakage around the prosthesis was noted 8 days to 39 months postoperatively (mean: 11 months). Successful rates of conservative treatments were as following: prosthesis replacement with a small gauge catheter for several days followed by a prosthesis replacement: 9/17 (52.9%), replacement of prosthesis: 4/12 (33%), Gax Collagen injection: 3/9 (33%), cauterization of the tracheoesophageal tract: 0/1. Surgical closure was successful in all cases. Repuncture and prosthesis replacement was successful in one patient. Conservative treatment is initially recommended including prosthesis replacement with a small gauge catheter for several days and followed by a prosthesis replacement. Surgical treatment with muscular interposition is recommended in case of failure of conservative treatments.

[Classification of dysphonia. Vocal dysfunction]. / Classification des dysphonies: la dysfonction vocale.

A review of functional dysphonia is presented, pointing out the frequent association with organic dysphonia as a releasing or an aggravating factor. Each pathology is described with its psychopathological and histological features, its clinical and psychophysiological symptoms and its treatment, most of the time based on voice therapy.

[Acoustic evaluation and use of computers]. / Le bilan acoustique et l'utilisation de l'informatique.

Thanks to the measurements of the acoustical parameters of voice and speech, an objective semeiology can be set up to assess a diagnosis and, to a certain extent, a prognosis and the follow up after therapy. A computerized analysis is a good complement to the clinical evaluation. It gives quantitative values, with statistics and the means to compare patients to themselves and to other patients. After defining the parameters we are interested in, we review the different softwares at our disposal with their limits.