Quantitative rating of video-laryngostroboscopy: a reliability study.

The purpose of this study is to examine the most reliable and valid way for rating and comparing videolaryngostroboscopic recordings with a differentiated protocol. 30 high quality videostroboscopic recordings (2-5 minutes) of all kinds of vocal fold pathology were rated independently by 7 experienced laryngologists/phoniatricians, using a standardized and exhaustive protocol form. Interobserver agreement is high for amplitude, mucosal wave, and type of closure/symmetry, is satisfactory for regularity, consistency and vibration of the lesion (if any), and is rather moderate to low for grade of glottic closure and symmetry. As a general rule, raters trained with the protocol form show higher agreement than raters without such experience. Intraobserver consistency is good for all parameters.

[Comparative intensity-pressure study of patients with a voice prosthesis]. / Etude comparative intensité-pression chez les patients porteurs d'implant phonatoire.

We have studied the qualities of the voice of the laryngectomized patients and theirs possibilities to modify the intensity depending to the pressure. During the measurement, it was necessary to explain to the patient how to use the material and it was an opportunity to help him in the way to product a voice prosthesis. Most of the patients produced a higher intensity with a higher pressure. However, some of them obtained high pressures without producing a voice. These patients modified the use of the prosthesis or could have an oedema for example. In conclusion, these measurements show that there is a relation between intensity and pressure but not absolutely in relation with a better voice quality.

[Idiopathic recurrent paralysis. Retrospective analysis of 67 cases]. / Paralysie récurrentielle idiopathique. Analyse rétrospective de 67 cas.

Sometimes incorrectly termed paralyses, idiopathic abnormalities of laryngeal movement pose many problems about their physiopathological mechanism and treatment. In an analysis of 67 cases, the outcome as far as the voice was concerned was favourable in 51 cases, but a return to normal mobility occurred in only 26 cases. An important factor is the delay before treatment is instituted. In addition to repeated investigation of the areas of ENT, neurology, chest and speech therapy, laryngeal electromyography can yield useful information, and should always be undertaken before surgery is advised. As long as the clinical conditions remains unimproved, the question of its idiopathic nature must be constantly reviewed. A multicentre standardised investigation into this condition would seem desirable to shed further light on its pathology and outcome.

[ORL and speech aspects in DiGeorge syndrome]. / Aspects ORL et phoniatrique du syndrome de DiGeorge.

The DiGeorge syndrome presents clinically as a combination of a congenital cardiopathy with immune deficiency and predisposition to infections, signs of hypoparathyroidis with severe hypocalcaemia in the neonatal period, and facial dysmorphism. New techniques in molecular cytogenetics (in-situ fluorescent hybridisation--FISH) have provided evidence of microdeletion of chromosome 22q11 in most cases of the DiGeorge syndrome. There is an important overlap between this syndrome, the velo-cardio-facial syndrome, and certain other cono-truncal cardiac anomalies which are linked with the same microdeletion syndrome. Basing their observation on a case of the partial syndrome, the authors emphasise the otological and maxillo-facial aspects, and especially the effects on speech and language. It is essential to carry out repeated audiometric testing to exclude an audiometric cause for the speech and language problems. At the same time, thorough speech and language assessment is necessary to establish the degree of velar insufficiency (rhinolalia). These will guide the speech therapy rehabilitation, and quantify the psycho-affective component. Surgery on the palate may be a possibility, depending on the progress in speech and language improvement.

[Vocal rehabilitation after total laryngectomy: 15 years' experience with phonation implant]. / Réhabilitation vocale aprés laryngectomie totale: 15 ans d'expérience avec l'implant phonatoire.

Progress in voice rehabilitation after total laryngectomy is probably the most significative event of the last 15 years. The first to realise this procedure in France, the authors describe the state of the art in this field with a study of 160 cases. The results are in the main very positive with approximately 85% of success with all rehabilitation technics used currently. The future is establishing total functional rehabilitation of the larynx with new techniques researched specially in Europe with several groups : GREL, EGFL, BIOMED I program of Europe "Artificial Larynx" and so on... The work goes on and we shall see whether the next 15 years will be as satisfying as the last 15 years.

[Phoniatric record during voice rehabilitation for kissing nodules in a child]. / Bilan phoniatrique au cours d'une rééducation vocale pour kissing-nodules chez un enfant.

Dysphonia in the child occurs relatively frequently. More often than not it is the result of strain, but a phoniatric examination is worthwhile to determine whether or not vocal rehabilitation is required, the purpose being to make the child aware of the vocal gesture and correct his or her vocal attitude. A phoniatric follow-up can sometimes determine the need for surgery when the nodules hinder the vocal development of a young singer.

[Complementary tests in the evaluation of velar insufficiency]. / Les examens complémentaires dans le bilan de l'insuffisance vélaire.

In order to assess the degree of velar deficiency as accurately as possible, three tests can be made: a nasofibroscopy, X-rays, and notably xeroradiography, a radiography made under brightness amplification. This check-up indicates the course of action to be undertaken: orthophonic rehabilitation followed, depending on the results, by a surgical operation. These tests are incorporated into a pluridisciplinary treatment.

[Value of the retraining of patients with laryngectomy at special centers]. / Intérêt de la rééducation des laryngectomisés en centre spécialisé.

The authors tell about the interest of a voice therapy in a special center for the total laryngectomised patients. The oesophageal voice therapy is followed in the collaboration of orthophonist, psychologist and a logopedist doctor. The patient is positioned to insert himself socialy. The medical control is realised by an oto-rhino-laryngologist. After the final of voice therapy (4 to 6 weeks), the laryngectomised patient will continue the exercises helped with an logopedist.