[Quality of life evaluation after total laryngectomy: interests and limits in speech therapy]. / Qualite de vie apr s laryngectomie totale. intérêts et limites en rééducation orthophonique.

OBJECTIVES: In order to improve the speech therapy process after total laryngectomy (TL), an "ecological" approach of the rehabilitation of the TL has been used to adapt our technique to the appropriate situation of each patient (according to his expectations, his needs, etc...), and therefore to ensure the success of the training of an substitution voice. METHODS: Patients were evaluated with auto-evaluation scales: EORTC QLQ C30 dealing with common aspects affecting all patients with cancer, EORTC QLQ H&N 35 dealing with characteristics more particular of cancers of head and neck and a scale of vocal handicap (VHI) to be able to compare quality of life and felt vocal handicap. We completed this study by a perceptive evaluation with the I(I)NFVo scale corresponding to the GRBAS for non-laryngeal voices. POPULATION: 37 subjects, 31 men (84%), 6 women (16%). average age: 60 years. 9 subjects implanted with a tracheo-oesophageal prosthesis (24%). Average post-operative period: 5 years. RESULTS: The quality of life among patients with TL is relatively well preserved, the principal complaint being in the social field. Neither the age, the sex, the post-operative period, nor the use of a tracheo-oesophageal voice (TOV) instead of an oro-oesophageal voice (OOV) seem to have an influence on the quality of life of the questioned patients. The results with the VHI show that only the post-operative period influences the vocal handicap. As for the perceptive analysis, only the postoperative period and the use of the TOV influence the scores. CONCLUSION: This study enabled us to note the absence of correlation between the quality of life, the vocal handicap, and the perceptive quality of the non-laryngeal voice. These scales are complementary tools and can constitute an invaluable help in the treatment of the TL thanks to simple methods (self-evaluation), which are standardized, reproducible, with an aim of assessment at the beginning or at the end of treatment, or to control and follow-up.

[Evaluation of the handicap by means of the EORTC scale in partial glossectomies]. / Evaluation du handicap au moyen des échelles de l'EORTC pour les glossectomies partielles.

OBJECTIVES: Different treatments for tongue cancer are more and more efficient but there are heavy functional and aesthetic sequels. The aim of this study was to evaluate the quality of life after partial glossectomy and to adapt the rehabilitation program after surgery. METHODS: Our population of 16 patients (5 females and 11 males), who underwent partial glossectomy, had to quote the auto questionnaire on quality of life (EORTC QOL-C30) and the specific head and neck cancer scale (H&N35). RESULTS: In our population, the patient's satisfaction for the global quality of life was 71%; the functioning scale was 83%, and the mean rate of generic symptoms was 13%. On the contrary, the specific Head & Neck symptom rate was high, with 76% of complains. CONCLUSIONS: The QOL scale could be considered as a good tool for patients to express their difficulties in daily life. It is a reliable and reproducible tool for a follow up study of patients. It allows proposing specific rehabilitation procedures in the post operative period.

[Diagnosis of non-organic dysphonia in adult]. / Diagnostic d'une dysphonie non organique de l'adulte.

Non organic dysphonia or functional voice disorders are the consequence of a vocal misuse or overuse with inefficient oral communication. Any stage of voice production can be altered. A review of physiopathological, aerodynamic and biomechanical mechanisms will help to understand the onset of dysphonia. Organic lesions as a consequence of functional voice disorders are frequent but the link is not easy to establish. It is important to look for various physiologic, anatomic, environmental, behavioural and infectious factors that could induce or aggravate non organic dysphonia, as they can benefit from specific treatment. A thorough functional and organic assessment is the first step of the rehabilitation process, taking into account the patient's expectations about his voice handicap.