The development of new clinical instruments in laryngopharyngeal reflux disease: The international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.

INTRODUCTION: To analyze the epidemiological characteristics of placebo controlled randomized trials (RCTs) that evaluated the effectiveness of medical treatments over placebo in laryngopharyngeal reflux (LPR). MATERIAL AND METHODS: PubMed, Cochrane database, and Scopus were assessed for subject headings using the PRISMA recommendations. Placebo RCTs published between 1990 and 2018 describing clinical evolution throughout LPR treatment were extracted and analyzed for evidence-based level, number of patients, inclusion and exclusion criteria, gender, age, symptoms and signs used as therapeutic outcomes, and treatment schemes. RESULTS: The database search identified 15 placebo RCTs with a total of 763 patients. The mean age of patients was 48.59 years and 52.68% of patients were female. Among the 15 placebo RCTs, 9 have demonstrated a partial or total superiority of a medical treatment over placebo. Most of authors based the LPR diagnosis on symptoms and signs without additional examination. Our analysis reveals an important heterogeneity between studies with regard to the diagnosis criteria, treatment schemes and signs and symptoms used as therapeutic outcomes. Many commonly reported signs and symptoms related to LPR were not used as therapeutic outcomes. Half of the authors did not prescribe diet and behavioral changes along the treatment. CONCLUSION: The controversy in the RCTs about the superiority of medical treatment over placebo in LPR disease is probably due to discrepancies in the diagnosis method, exclusion criteria, therapeutic schemes and the lack of comprehensive tools for the assessment of signs and symptoms. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies developed two new instruments to precisely assess signs and symptoms throughout the treatment. These two instruments could be used in future trials comparing medical treatment over placebo in LPR disease.

Change of signs, symptoms and voice quality evaluations throughout a 3- to 6-month empirical treatment for laryngopharyngeal reflux disease.

OBJECTIVE: To assess the usefulness of voice quality measurements as a treatment outcome in patients with laryngopharyngeal reflux (LPR)-related symptoms. DESIGN: Prospective uncontrolled multi-centre study. MATERIAL AND METHODS: A total of 80 clinically diagnosed LPR patients with a reflux finding score (RFS)>7 and a reflux symptom index (RSI)>13 were treated with pantoprazole and diet recommendations during 3 or 6 months, according to their evolution. RSI; RFS; blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) and aerodynamic and acoustic measurements were evaluated at baseline, 3 months (n = 80), and 6 months (n = 41) post-treatment. We conducted a correlation analysis between the adherence to the diet, and the evolution of both signs and symptoms and between videolaryngostroboscopic signs and acoustic measurements. RESULTS: Reflux symptom index, RFS, perceptual voice quality evaluations (dysphonia, roughness, strain and instability), and aerodynamic and acoustic measurements (ie, percent jitter and percent shimmer) were significantly improved at 3 months post-treatment but not at 6 months. Percent jitter was the most useful outcome for evaluating the clinical evolution of patients throughout the treatment course. A significant relationship between globus sensation and posterior commissure hypertrophy was documented; both seemed to significantly improve from 3 to 6 months. The correlation analysis revealed correlations between adherence to diet recommendations and the improvement of symptoms and between posterior commissure granulation severity and acoustic measurement impairments. CONCLUSION: Voice quality improved in a manner similar to both signs and symptoms throughout a 6-month empirical treatment with better improvement the 3 first months. Voice quality assessments can be used as indicators of treatment effectiveness in patients with LPR-related symptoms.

Voice quality outcomes of idiopathic Parkinson's disease medical treatment: A systematic review.

INTRODUCTION: To investigate voice quality (VQ) impairments in idiopathic Parkinson's disease (IPD) and to explore the impact of medical treatments and L-Dopa challenge testing on voice. METHODS: Relevant studies published between January 1980 and June 2017 describing VQ evaluations in IPD were retrieved using PubMed, Scopus, Biological Abstracts, BioMed Central and Cochrane databases. Issues of clinical relevance, including IPD treatment efficiency and voice quality outcomes, were evaluated for each study. The grade of recommendation for each publication was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels. RESULTS: The database research yielded 106 relevant publications, of which 33 studies met the inclusion criteria, for a total of 964 patients with IPD. Data were extracted by 3 independent physicians who identified 21, 11 and 1 trials with IIIb, IIb and IIa evidence levels, respectively. The main VQ assessment tools used were acoustic testing (N = 27), aerodynamic testing (N = 10), subjective measurements (N = 8) and videolaryngostroboscopy (N = 3). The majority of trials (N = 32/33) identified subjective or objective VQ improvements after medical treatment (N = 10) or better VQ evaluations in healthy subjects compared to patients with IPD (N = 22). Especially, our analysis supports that VQ overall improves during the L-Dopa challenge testing, making the VQ evaluation an additional tool for the IPD diagnosis. The methodology used to assess subjective and objective VQ substantially varied from 1 study to another. All of the included studies took into consideration the patient's clinical profile in the VQ analysis. CONCLUSION: The majority of studies supported that VQ assessments remain useful as outcome measures of the effectiveness of medical treatment and could be helpful for the IPD diagnosis based on L-Dopa challenge testing. Further controlled studies using standardised and transparent methodology for measuring acoustic parameters are necessary to confirm the place of each tool in both IPD diagnosis and treatment evaluation.

[Transgender voice and communication treatment: Review of the literature]. / La prise en charge communicationnelle chez les patients transsexuels.

Transgender persons constitute a small but growing population in ENT department: as a matter of fact, many voice parameters significantly contribute to the perception of gender (fundamental frequency, supraglottic resonance patterns, etc.). The persons involved in transition processes may therefore aim at changing their own voice properties, either by means of speech therapy or by medical intervention (hormonotherapy and/or surgery). The current voice assessment and outcome measures for this population before and after treatment are nevertheless still lacking validity. A well-accepted general framework including self-perception, subjective assessment of the practitioner and objective measures is not well documented. This review is therefore meant as a contribution to the development of a state of the art in the field.

[Pathophysiology, assessment and treatment of laryngopharyngeal reflux]. / Physiopathologie, évaluation et traitement du reflux laryngopharyngé.

Laryngopharyngeal reflux is a prevalent, yet incompletely understood, ENT disorder accounting for 8 to 10% of patients consulting ENT. This clinical entity, increasingly considered as different from gastroesophageal reflux disease, may greatly affect the quality of life of patients through vocal and digestive symptoms. Debate persists concerning pathophysiology, diagnosis, and treatment. The aim of this review is to study the current literature about the pathophysiology, diagnosis, treatment, and the outcomes in the follow-up.

Acoustical control of voice changes after surgery: an exploratory essay.

In this preliminary study, the authors try to validate the use of a quantitative method based upon the use of Long Term Average Spectra (LTAS) and indices of spectral (dis)similarity. The whole spectral information is used and an evolution ratio is introduced. The technique has been tested on 5 patients with organic lesions of the vocal cords (oedema, polypoid degeneration, hyperkeratosis, polyp, pseudocyst). Each patient has been recorded three times: the day before surgery, one and 5 weeks later. The obtained values suggest good correlation between the index variability and the magnitude of clinical change. The values obtained from the quantitative technique turn out to be well correlated with the evolution of the patients' state.