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Introduction Informed consent for any surgical intervention is necessary, as only well-informed patients can actively participate in the decision-making process about their care, and better understand the likely or potential outcomes of their treatment. No consensus exists on informed consent for suspension microlaryngoscopy (SML). Materials and methods Informed consent procedures in nine countries on five continents were studied. Results Several risks can be discerned: risks of SML as procedure, anesthesiologic risks of SML, specific risks of phonosurgery, risks of inadequate glottic exposure or unexpected findings, risks of not treating. SML has recognized potential complications, that can be divided in temporary (minor) complications, and lasting (major) complications. Conclusion SML is a safe procedure with low morbidity, and virtually no mortality. Eleven recommendations are provided.

Resumen El estudio de la voz tiene un doble objetivo: establecer una evaluacion del trastorno vocal en un momento dado con vistas a una comparacion posterior y evaluar la eficacia del tratamiento, sea del tipo que sea, asi como buscar los elementos pertinentes que pueden intervenir en la propia eleccion terapeutica. Salvo la exploracion de las cuerdas vocales, que es un acto exclusivamente medico, este estudio puede realizarlo un medico o un logopeda, pero debe constar, como minimo, de cuatro elementos: una grabacion de la voz en un sistema que conserve la calidad para comparaciones posteriores; la autoevaluacion por parte del paciente de su voz y de su alteracion mediante alguna de las escalas disponibles. Los problemas de la voz son de tipo funcional y se debe analizar la demanda del paciente; se puede proponer una evaluacion cuantitativa e instrumental del problema vocal del paciente. Dependiendo del material disponible, se pueden proponer distintos parametros: tiempo maximo de fonacion y mediciones acusticas mas o menos complejas. En realidad, ninguna medida basta por si sola para caracterizar la voz patologica; la evaluacion de las tensiones musculares, posturales y respiratorias del paciente ayuda a determinar las referencias para la rehabilitacion vocal.

To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders.The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected.The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions.This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.

International audience; Background: To analyze worldwide practices regarding the initiation of oral feeding after total laryngectomy (TL).Methods: Online survey.Results: Among the 332 responses received, 278 from 59 countries were analyzed. Our results showed that 45.6% of respondents started water and 45.1% started liquid diet between postoperative days 7 and 10. Semi-solid feeds were initiated between days 10 and 14 for 44.9% of respondents and a free diet was allowed after day 15 for 60.8% of respondents. This timing was significantly delayed in cases of laryngo-pharyngectomy and after prior radiotherapy (p < 0.001). A greater proportion of respondents in Africa and Oceania allowed early oral feeding before day 6 as compared with the rest of the world (p < 0.001).Conclusion: Despite increasing number of publications, there is still a lack of evidence to support early oral feeding. The majority of respondents preferred to delay its initiation until at least 7 days after surgery.

International audience; Objectives/Hypothesis. Vocal folds (VF) scarring leads to severe dysphonia which negatively impacts daily life of patients. Current therapeutic options are limited due in large part to the high complexity of the micro-structure of the VF. Innovative therapies derived from adipose tissue such as stromal vascular fraction (SVF) or adipose derived stromal/ stem cells (ASC) are currently being evaluated in this indication and paracrine anti-fibrotic effects are considered as predominant mechanisms. Methods. The paracrine anti-fibrotic effects of SVF and ASC from healthy donors were tested in an innovative in vitro fibrogenesis model employing human VF fiboblasts (hVFF) and the principles of macromolecular crowding (MMC). Biosynthesis of collogen and alpha-smooth-muscle actin (aSMA) expression in hVFF were quantified after five days of indirect coculture with ASC or SVF using silver stain, western blot and RT-qPCR analysis. Results. Fibrogenesis was promoted by addition of transforming growth factor beta 1 (TGFb1) combined with MMC characterized by an enhanced deposition of fibrillar collagens and the acquisition of a myofibroblast phenotype (overexpression of aSMA). Adipose-derived therapies led to a reduction in the aSMA expression and the collagen content was lower in hVFF co-cultivated with SVF. Conclusions. ASC and SVF promoted significant prevention of fibrosis in an in vitro fibrogenesis model through paracrine mechanisms, supporting further development of adipose-derived cellular therapies in VF scarring.

International audience; Objectivesthis study concerns the subjective perception of the quality of the voice, more particularly in the case of dysphonia. Our general objective is to study the perceptual mechanisms, which constitute Hirano's GRBAS multidimensional perceptual rating scale.Material and methodsWe tested the reliability of the GRB perceptual scale both in terms of test-retest reliability (intra-listener stability) and in terms of inter-listener agreement. We also studied how listeners process the three different parameters of the scale by varying the perceptual rating conditions of G, R, and B. The three attributes were rated simultaneously in one condition and in isolation in a second condition. The experiment was based on texts read by fifty dysphonic speakers. We selected five listeners specialized in voice assessment to provide perceptual judgments of the voices.Results and conclusionsOur results show that G is strongly correlated with R and/or B. When the GRB rating process is simultaneous, G is almost equal to the maximum score assigned to the R and/or B parameter (R² = 0.97). Conversely, R and B are poorly correlated. While intra-listener variability was limited, inter-judge variability was important even in a homogeneous panel of judges.Perceptual evaluation of dysphonia—Voice quality—GRBAS—Perception—Perceptual agreement

Resume Objectifs Elaborer un protocole experimental permettant d’etudier l’effort vocal genere par l’introduction d’obstacles a la communication et etudier la relation entre celui-ci et certains traits de personnalite. Materiel et methodes Le protocole experimental consistait en un jeu interactif dans lequel le sujet devait donner au premier examinateur des consignes pour qu’il realise differentes positions (situation de communication semi-dirigee). La situation controle etait realisee sans contrainte de communication puis il etait introduit une contrainte de distance (augmentation de la distance interpersonnelle) et une contrainte temporelle (generation d’un stress de performance en placant le sujet en competition avec les autres). Les parametres vocaux etudies comprenaient l’intensite vocale et la frequence fondamentale en milieu de voyelle, sur 3 phonemes cibles. Chaque sujet etait soumis au test de personnalite NEO FFI-R. Resultats L’etude a porte sur 41 femmes âgees de 18 a 52 ans. L’intensite et la frequence fondamentale augmentaient significativement lors de l’introduction des contraintes (p Conclusions Ce protocole ecologique permet d’etudier l’impact d’obstacles physiques mais aussi emotionnels. Le lien entre effort vocal et traits de personnalite n’a pas ete demontre. Une etude avec des effectifs superieurs serait necessaire afin de caracteriser le continuum entre effort vocal et forcage vocal pour une meilleure prise en charge orthophonique des dysphonies dysfonctionnelles.

Objectives Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck. Material and methods Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015. Results Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n = 11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P = 0.03). Conclusions Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.

L’étude des troubles de la voix et de la parole est sortie du cadre de la recherche clinique. Par l’observation des dysfonctionnements, les chercheurs non cliniciens confrontent les résultats de leur recherche établis sur des corpus de parole « normale » à des situations de dysfonctionnement. Le défi est immense car le cadre « pathologique » induit une variation considérable dans ses manifestations de surface. Toute généralisation à une population clinique particulière nécessite l’observation d’un grand nombre de patients du fait de la très forte variation interindividuelle. Il est donc important de capitaliser et mutualiser les enregistrements existants. Or pour être utilisables, ces enregistrements doivent répondre à de fortes exigences. Le maillon faible reste la normalisation et la structuration des données sur les locuteurs et leurs productions langagières. Concrètement, si les données sonores sont souvent accessibles, elles ne présentent au final aucun intérêt si les liens entre les enregistrements et les caractéristiques cliniques du locuteur sont rompus ou erronés. L’objectif de ce travail est de présenter différentes actions de terrain et de proposer des recommandations pour la structuration des données sonores, physiologiques et cliniques dans le cas de corpus de parole issue de patients atteints de troubles de la voix et de la parole. Voice and speech disorders are now studied beyond the framework of clinical research. By observing dysfunctions, non-clinical researchers compare the results of their research established on "normal" speech with dysfunctional situations. The challenge is important because the "pathological" framework induces a great variation in its audible manifestations. Any generalization to a particular clinical population requires the observation of a large number of patients due to the very strong interindividual variation. It is therefore important to capitalize and share existing records. However, to be usable, these recordings require a high level of quality. The main problem remains the standardization and structuring of data on speakers and speech productions. Concretely, if the audio data is accessible, it is useless if the links between the recordings and the speaker’s clinical characteristics are broken or erroneous. The objective of this work is to present various actions in the field and to propose recommendations for the structuring of sound, physiological and clinical data in the case of speech corpus from patients with voice and speech disorders.

International audience; Purpose: To evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP).Methods: This was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor.Results: Forty-seven out of the 63 patients had an ipsi- or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001).Conclusion: These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.

International audience; Background: The objective of this study was to evaluate the impact of early oral hydration on the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) or total pharyngolaryngectomy (TPL).Methods: A prospective series of 25 patients operated on between October 2017 and March 2019 who received early oral hydration starting 2 days after surgery were compared to a retrospective cohort of 28 patients who did not receive any early oral hydration. These are two consecutive series including all operated patients.Results: There was no significant difference between the two groups in terms of risk factors for PCF. In univariate and multivariate analysis, early oral hydration was significantly associated with a decreased risk of PCF: 50% vs 20% (odds ratio [OR], 0.25; 95% confidence interval [95% CI], 0.07-0.85; P = .03, vs OR, 0.24; 95% CI, 0.07-0.85; P = .02).Conclusion: Early oral hydration after TL or TPL reduces the risk of PCF.

Purpose Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. Methods A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. Results Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /3/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. Conclusion Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations., European Archives of Oto-Rhino-Laryngology, Springer Verlag, 2020

Resume Les gestes mettant le personnel soignant en contact etroit avec les voies aeriennes sont particulierement a risque de contamination par le virus SARS-Cov-2, en particulier en cas de crachats, toux, ou presence d’une tracheotomie. Dans la phase pandemique actuelle, tous les patients sont a considerer comme potentiellement infectes donc l’attitude du soignant est a adapter au statut COVID-19 du patient mais aussi et surtout au geste effectue. Ainsi, s’il s’agit d’un geste invasif comme une fibroscopie ou une pose de sonde naso-gastrique notamment, les precautions sont identiques pour tous les patients quel que soit leur statut COVID. Les reeducations vocales sont a considerer comme non urgentes dans ce contexte. Les recommandations presentees ici en date du 9 avril 2020 sont donc surtout destinees a la prise en charge des troubles de la deglutition (ceci pouvant parfois etre dangereux pour le patient) ou d’une dysphonie recente inquietante. Des qu’elles sont possibles techniquement et reglementairement, les tele-consultations seront a privilegier. Seules les urgences non differables seront realisees en presentiel et ce apres decision collegiale (ou en fonction des informations venues des autorites de sante) et en prenant les precautions adequates detaillees ici.

Background Vocal fold (VF) scarring, caused by surgery or inflammation, often results in severe voice problems or aphonia. Effective lasting treatment is lacking. Previous in vitro and in vivo animal studies reported positive effects on VF scar resolution with mesenchymal stromal cell (MSC) implantation. The principal aim of this study was to examine safety aspects and secondly treatment efficacy vocal fold function in patients with VF scarring and severe voice problems. Methods In this open-label phase I/II study, 16 patients were treated with surgical scar resection followed by injection of autologous MSCs (0.5–2 × 106 MSCs/patient). Patients were monitored 1 year for serious adverse events (SAE) or minor complications. Therapeutic efficacy on treated VFs was evaluated by measurement of VF vibrations using high-speed laryngoscopy (HSL) and phonation pressure threshold (PTP) for elasticity and VF function. Patients self-reported voice change using the Voice Handicap Index (VHI). Results No SAE or minor side effects were reported. Video ratings of VF vibrations and digitized analysis of HSL and PTP were significantly improved for 62–75% of the patients (depending on parameter). Two patients showed deteriorated VF vibrations, but improved PTP. VHI was significantly improved in 8 patients, with the remaining experiencing no significant change. Conclusions The results indicate that local injection of autologous MSC into scarred VFs with severe voice problems may offer a safe and feasible therapeutic option. VF vibration and elasticity were improved in approximately two thirds of treated patients. This clinical study is registered in clinicaltrials.gov (ID: NCT01981330). Retrospective registration of first patient (20130511). https//: register.clinicaltrials.gov/.

Background: Vocal folds (VF) scarring leads to severe dysphonia which negatively impacts daily life of patients. Current therapeutic options are limited due in large part to the high complexity of the micro-structure of the VF. Innovative therapies derived from adipose tissue such as stromal vascular fraction (SVF) or adipose derived stromal/ stem cells (ASC) are currently being evaluated in this indication and paracrine anti-fibrotic effects are considered as predominant mechanisms. Methods: The paracrine anti-fibrotic effects of SVF and ASC from healthy donors were tested in an innovative in vitro fibrogenesis model employing human VF fiboblasts (hVFF) and the principles of macromolecular crowding (MMC). Biosynthesis of collogen and alpha-smooth-muscle actin (αSMA) expression in hVFF were quantified after five days of indirect coculture with ASC or SVF using silver stain, western blot and RT-qPCR analysis. Results: Fibrogenesis was promoted by addition of transforming growth factor beta 1 (TGFβ1) combined with MMC characterized by an enhanced deposition of fibrillar collagens and the acquisition of a myofibroblast phenotype (overexpression of αSMA). Adipose-derived therapies led to a reduction in the αSMA expression and the collagen content was lower in hVFF co-cultivated with SVF. Discussion: ASC and SVF promoted significant prevention of fibrosis in an in vitro fibrogenesis model through paracrine mechanisms, supporting further development of adipose-derived cellular therapies in VF scarring.

International audience; Procedures putting healthcare workers in close contact with the airway are particularly at risk of contamination by the SARS-Cov-2 virus, especially when exposed to sputum, coughing, or a tracheostomy. In the current pandemic phase, all patients should be considered as potentially infected. Thus, the level of precaution recommended for the caregivers depends more on the type of procedure than on the patient's proved or suspected COVID-19 status. Procedures that are particularly at high risk of contamination are clinical and flexible endoscopic pharyngo-laryngological evaluation, and probably also video fluoroscopic swallowing exams. Voice rehabilitation should not be considered urgent at this time. Therefore , recommendations presented here mainly concern the management of swallowing disorders, which can sometimes be dangerous for the patient, and recent dysphonia. In cases where they are considered possible and useful, teleconsultations should be preferred to face-to-face assessments or rehabilitation sessions. The latter must be maintained only in few selected situations, after team discussions or in accordance with the guidelines provided by health authorities.

International audience; Objective. To analyze the range of values of the contact pressure between the membranous vocal folds with Reinke’s edema and to compare it to those observed in the absence of such a lesion.Methods. Two human larynges were separately tested on the experimental bench, one of them with a bilateral loose swelling of the vocal folds. Once in a glottal prephonatory configuration, airflow was increased until achievement of self-sustained oscillations while recording aerodynamic, acoustic, electroglottographic data, and contact pressure between the folds.Results. We observed well-documented variations in acoustical parameters, as the decrease of the fundamental frequency and the increase of the phonation threshold pressure. The results of the study also point to a significant increase in the amplitude of the contact pressure in presence of the Reinke’s edema, and a lower degree of harmonicity of the produced sounds.Conclusion. This is the first report of ex vivo study of a larynx with Reinke’s edema. It highlights the increase in the contact pressure during phonation, which possibly contributes to sustain the lesion once it appeared.

International audience; Purpose: To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies).Methods: Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure.Results: We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy.Conclusions: This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

Resume Objectifs Evaluer la frequence et la distribution des metastases ganglionnaires chez des patients operes de laryngectomie totale ou de pharyngolaryngectomie totale. Materiel et methodes Etude retrospective monocentrique realisee a partir de 136 patients ayant beneficie d’une laryngectomie totale ou d’une pharyngolaryngectomie totale pour carcinome epidermoide pharyngolarynge associee a un traitement chirurgical des aires ganglionnaires. Resultats Au total, 110 patients presentaient une tumeur du larynx et 26 patients une tumeur de l’hypopharynx. Soixante-trois patients etaient operes en premiere intention et 73 patients etaient operes en situation de recidive. Le taux de metastases ganglionnaires confirmees histologiquement etait de 44,8 %, quelle que soit la localisation de la tumeur primitive. La localisation tumorale hypopharyngee etait un facteur de risque de metastases ganglionnaires (73,1 %, p = 0,002) tout comme la sous-localisation tumorale sus-glottique (64,3 %, p = 0,039). Les groupes IIa et III etaient envahis dans 28,7 % et 25,7 % des cas respectivement. Parmi les patients ayant beneficie d’un evidement des groupes VIb, le taux d’envahissement ganglionnaire dans ces territoires etait de 23,8 %. Le taux de recidive ganglionnaire etait de 10,3 % dans les groupes II a IV et de 13,2 % dans les groupes VIb. Conclusions Quelle que soit la localisation tumorale, les groupes IIa et III sont les plus frequemment envahis. L’importance du taux d’envahissement histologique dans les groupes VIb evides, mais egalement de recidive, doit faire discuter un evidement ganglionnaire prophylactique bilateral systematique de ces territoires dans certaines localisations tumorales.

Resume La microstructure des cordes vocales est complexe et peut etre alteree par une microchirurgie laryngee. On peut alors observer un etat cicatriciel n’autorisant plus le decouplage mecanique entre epithelium et muscle, responsable de difficultes vibratoires a l’origine d’une dysphonie invalidante. Les possibilites therapeutiques actuelles sont reduites et souvent inefficaces sur la vibration : elles n’apportent qu’un effet volumateur limitant la fuite glottique. L’objectif de cette revue de la litterature etait double : i) decrire l’etat actuel de la litterature quant a l’interet de la therapie cellulaire dans la prise en charge des cordes vocales cicatricielles ; ii) analyser l’interet therapeutique de la fraction vasculaire stromale d’origine adipeuse parmi l’arsenal therapeutique preexistant. Notre recherche sur PubMed® en septembre 2016 a reference les articles originaux de langue anglaise ou francaise traitant de l’usage des cellules souches dans la prise en charge des cordes vocales cicatricielles. Vingt-sept articles publies entre 2003 et 2016 repondaient aux criteres de selection. Les cellules souches mesenchymateuses etaient les plus utilisees, majoritairement extraites de la moelle osseuse ou du tissu adipeux. Quatre etudes etaient realisees in vitro sur fibroblastes et dix-huit in vivo chez l’animal. Les criteres d’evaluation etaient : i) l’analyse de la cicatrisation (morphologie macroscopique et microscopique, proprietes viscoelastiques, matrice extracellulaire, fibroblastes) ; ii) l’evaluation de la survie et differenciation des cellules souches. Ces etudes demontrent l’action benefique des cellules souches mesenchymateuses, notamment d’origine adipeuse. Par ailleurs, la fraction vasculaire stromale possede des proprietes qui pourraient permettre d’ameliorer ces resultats, en facilitant la logistique de production.

Vocal fold microstructure is complex and can be affected by laryngeal microsurgery, inducing scarring that prevents mechanical uncoupling of epithelium and muscle, leading to vibration disorder and disabling dysphonia. Treatment options presently are few, and often without efficacy for vibration, having only an impact on volume to reduce glottal closure defect. The present review of the literature had two aims: (i) to report the current state of the literature on cell therapy in vocal fold scarring; and (ii) to analyze the therapeutic interest of the adipose-derived stromal vascular fraction in the existing therapeutic armamentarium. A PubMed® search conducted in September 2016 retrieved English or French-language original articles on the use of stem cells to treat vocal fold scarring. Twenty-seven articles published between 2003 and 2016 met the study selection criteria. Mesenchymal stem cells were most widely used, mainly derived from bone marrow or adipose tissue. Four studies were performed in vitro on fibroblasts, and 18 in vivo on animals. End-points comprised: (i) scar analysis (macro- and micro-scopic morphology, viscoelastic properties, extracellular matrix, fibroblasts); and (ii) assessment of stem cell survival and differentiation. The studies testified to the benefit of mesenchymal stem cells, and especially those of adipose derivation. The stromal vascular fraction exhibits properties that might improve results by facilitating production logistics.

International audience; Objectives: To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life.Design: Prospective cohort study.Setting: University Teaching Hospital of La Conception, Marseille, France.Participants: Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy.Main outcome measures: Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject.Results: The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03).Conclusions: Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

The objective of the study was to analyze temperament and character in females with vocal nodules (VN) compared to a vocally healthy control population. 61 females were examined over a 17-month period for dysphonia with VN (mean age 46 years, duration of vocal complaints from 2 months to 6 years). 71 control females were recruited in their environment (mean age 34 years). The validated French Version of the Temperament and Character Inventory (TCI) was used. Patients with VN had significantly (p

Aim Providing head and neck cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate patient perceptions of the information received, the predictive factors of such perceptions and their potential correlation with patient quality of life (QoL). Methods We conducted a prospective multicentric study using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25 and QLQ-C30 questionnaires before and after surgery. Results This study enrolled 200 patients, 149 men and 51 women, mean age 63.5 ± 10.3 years. Before and after treatment, global QLQ-INFO25 scores were 39.3 and 42.5, respectively, whereas satisfaction with the information received scores were 69.9 and 58.1, respectively. Regarding EORTC QLQ-INFO25 scores, between the pre- and post-treatment periods, we observed a significant increase in three scales/items (information about other services, information about different places of care and information about things you can do to help yourself) and a significant decrease in two scales/items (satisfaction with the information received and overall the information has been helpful). Before and after treatment, global QoL scores were 62.7 and 61.0, respectively. Overall, we found low correlations between QLQ-INFO25 and QLQ-C30 scores. Patient age and education level, centre of care, tumour site and treatment characteristics had a significant impact on QLQ-INFO25 scores. Conclusion Perceived information was satisfactory in the perioperative period for head and neck cancer patients. Several demographic and clinical factors were identified as significant predictors of QLQ-INFO25 scores.

Purpose: Vocal fold scar is one the most challenging benign laryngeal pathologies. The purpose of this paper is to propose a classification that will allow for a common description of this entity between laryngologists, prevent discrepancies in interpretation, allow for comparison of related studies, and offer a training tool for young laryngologists. Methods/Results: Based on the depth and laterality of scarring, we propose 4 types: type I, characterized by atrophy of lamina propria with/without affected epithelium; type II, where the epithelium, lamina propria, and muscle are affected; type III, where the scar is located on the anterior commissure; type IV, which includes extended scar formation in both anteroposterior and rostro-caudal axis with significant loss of vocal fold mass. Conclusion: We believe that our proposal is comprehensive and encompasses all existing iatrogenic and non-iatrogenic etiologies in a simple and concise manner. It also serves its purpose as a descriptive, comparative, and training tool.

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