Gauthier Desuter

Postcricoid hemangioma: an overlooked cause of dysphagia in infants?-a case report.

Feeding and swallowing disorders in children remain a major challenge owing to a wide differential diagnosis. Hemangioma of the upper aerodigestive tract represents one of the numerous non-neoplastic causes of dysphagia. We report two cases of postcricoid hemangioma causing inhalation and recurrent respiratory infections, treated successfully with systemic corticotherapy alone. To our knowledge, these are the second and third cases described in the literature. After a short review of the literature, the diagnostic procedures are discussed and a management strategy is proposed for this clinical entity, by far underestimated.

Delayed endovascular coil extrusion after embolisation for post-tonsillectomy haemorrhage: case report and literature review.

OBJECTIVEnTo report a rare case of delayed endovascular coil extrusion following embolisation of a lingual artery pseudoaneurysm.nnnCASE REPORTnA 23-year-old woman presented with dysphagia and odynophagia 11 months after having experienced massive post-tonsillectomy haemorrhage. At that time, the bleeding had been stopped by embolisation of a lingual artery pseudoaneurysm and the external carotid artery. Clinical examination at admission showed extrusion of the embolisation coils in the lateral lower pharyngeal wall. The coils were removed under general anaesthesia in the presence of an interventional radiologist. The procedure and post-operative period were without complication and no bleeding was observed. The dysphagia and pain disappeared and the subsequent seven-month follow-up period was uneventful.nnnCONCLUSIONnAlthough selective embolisation is a safe and effective treatment for severe post-tonsillectomy haemorrhage, the possibility of delayed coil extrusion should be kept in mind.

The use of adalimumab for cricoarytenoid arthritis in ankylosing spondylitis--an effective therapy

This report describes cartilaginous regeneration in a cricoarytenoid joint affected by spondyloarthropathy using tumor necrosis factor‐alpha (TNF‐α) blockade, monitored by magnetic resonance (MR) and computed tomography (CT) imaging. This case is interesting for several reasons. It is only the eighth case of destructive ankylosing spondylitis‐related cricoarytenoid arthritis published in the English language literature. It describes, for the first time, full recovery of vocal cord mobility following TNF‐α blockade. It is also the first case to be published with MR imaging demonstrating regeneration of the cricoarytenoid cartilage following treatment. This case represents a landmark in the treatment of patients presenting with destructive arthritis involving the cricoarytenoid joint.

Laryngeal signs of Ehlers Danlos syndrome in an adult: the first case reported.

Many patients with Ehlers Danlos syndrome (EDS) complain of pharyngeal discomfort and various vocal problems, in all subtypes of the disease. Despite the high incidence of subjective pharyngeal and/or laryngeal symptoms within this EDS population, no clinical observation of anatomical or physiological abnormalities has ever been published in the English-language literature. We describe the first case ever published of laryngeal signs seen in an adult with EDS. A 20-year-old Caucasian woman consulted as an emergency due to the sudden onset of aphonia. There were no predisposing factors such as vocal misuse or laryngeal trauma that could explain the cause of the aphonia. The patient reported a recent diagnosis of hypermobility type (formerly type III) Ehlers Danlos syndrome (EDS). The diagnosis was based on the histologic examination of a skin biopsy specimen. The sole symptom that led to this EDS work-up was frequent temporomandibular joint dislocation. After careful general clinical examination, indirect laryngoscopy using an ENF type V2 videoscope (Olympus Inc, Hamburg, Germany) was performed. Indirect laryngoscopy revealed rupture of the epithelium with ligament exposure and hemorrhagic infiltration of Reinke’s space of the right vocal fold (Fig 1). In addition, evidence of vascular enhancement obtained by narrow band imaging (NBI) illumination (Olympus Inc, Hamburg, Germany) showed multiple microvascular aneurysms within the laryngeal vestibule and the pharyngeal walls (Fig 2). Mobility of the larynx was normal. Office-based right vocal fold biopsy was performed with the patient under local anesthesia using an ENF type VT videoscope and a swing-jaw biopsy forceps (Olympus Inc, Hamburg, Germany). The biopsy encompassed a superficial area of the remaining epithelium together with subepithelial tissue and a few muscular fibers of the thyroarytenoid muscle. The vocal ligament was carefully preserved. Electron microscopy of the biopsy specimen confirmed the presence of abnormal collagen, similar to that observed in the skin biopsy performed previously. Conservative therapy (eight days total voice rest) led to complete voice recovery and normalization of the laryngeal appearance after five days.

Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue.

OBJECTIVEnThis study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS).nnnMETHODSnA retrospective cohort study was performed on 20 consecutive patients who underwent MTIS. Voice outcome variables were the relative decrease in Voice Handicap Index (%) and the absolute increase in maximum phonation time (MPT) (in seconds). Material variables were the angle between the thyroid cartilage laminae (α-angle), the size of the prosthesis, and a combination of both (the α-ratio). Continuous variables were analyzed using medians and were compared between groups using the Mann-Whitney U test. Factors associated with the outcome variables were assessed by multivariable linear regression. A Pearson coefficient was calculated between material variables.nnnRESULTSnThe absolute increase in MPT between the pre- and postoperative period was significantly different between men and women, with a median absolute increase of 11.0 seconds for men and of 1.3 seconds for women (Pu2009<u20090.001). A strong inverse correlation between the α-ratio and the absolute increase in MPT is observed in all patients, with a Pearson correlation coefficient Ru2009=u2009-0.769 (Pu2009<u20090.001). No factors were significantly associated with the relative Voice Handicap Index decrease in univariable or multivariable analyses. A better Pearson coefficient between the α-angle and the prosthesis size was found for females (0.8 vs 0.71).nnnCONCLUSIONnThe MTIS is a good thyroplasty modality for male patients, but inadequate design of MTIS female implants leads to poor MPT outcomes. This represents a gender issue that needs to be further studied and eventually tackled.

What do web sites tell us about quality management in Belgian hospitals

PURPOSEnFollowing the Patient Quality and Safety Contract launch by the Belgian Federal Authorities, Belgian hospital web sites were scrutinized. The aim of this paper is to assess the presence of some sort of quality management strategy within Belgian Acute Care Hospital digital external communications.nnnDESIGN/METHODOLOGY/APPROACHnDigital communications were assessed using a pre-established grid focusing on direct quality improvement testimonies, like a quality manager presence, a quality committee, a specific strategy, etc.nnnFINDINGSnTwo hypotheses explain the poor results: structured quality improvement exists in organizations but senior managers do not feel the need to transparently communicate the subject; and quality improvement does not exist in a sufficiently structured way to allow open communication.nnnPRACTICAL IMPLICATIONSnThe proposed Federal Contract should improve both quality initiative quality and frequency as well as transparent communication to healthcare workers and patients.nnnORIGINALITY/VALUEnThe paper underlines the urgent need for Belgian healthcare executives to be aware of structured quality management strategys importance and to be eager to openly communicate the strategy.

Neurolaryngological Disorders and Deglutition

Dysphagia and dysphonia are commonly associated with neuromuscular disorders. The symptoms and complications arise from the sensorimotor dysfunction of the oral and pharyngeal phases of swallowing. These symptoms may be unapparent due to compensation strategies, absent sensory cough reflex, or altered cognition. The risks of dysphagia are malnutrition, dehydration, and aspiration. Finding patients at risk is key to avoiding unnecessary complications. Dysphagia could be the first sign of a neuromuscular disease. Videoendoscopy, videofluoroscopy, manometric and electrophysiological studies are complementary tests and should be selected according to patient complaints and availability. In general, neuromuscular diseases tend to affect most phases of deglutition with variable expression and progression among patients. The association with old age of many degenerative conditions further impairs swallowing. Knowledge and awareness of neuromuscular diseases, the signs and symptoms that could affect speech and swallowing, along with familiarity performing a detailed neurological pharyngolaryngeal examination, is essential in understanding the mechanisms altering swallowing and in planning the best treatment. This chapter gives an overview of the physiopathology, the signs and symptoms, the evaluation, and the medical and surgical treatments of the most common neuromuscular conditions.

Recurrent Syncope upon Deglutition

A 67-year-old man presented to the department of otorhinolaryngology (ENT) with the complaint of recurrent syncope upon deglutition since several months. He reported symptoms ranging from light headedness to syncope triggered by deglutition. He suffered from end stage renal disease with no other relevant past medical history. Physical exam, carotid duplex ultrasound and electrocardiogram were unremarkable. No external compression of the larynx was noted during laryngoscopy. Before assuming that the patient actually suffered from deglutition syncope (DS) syndrome, a non-enhanced computed tomography (CT) of the neck was performed. It revealed right posterior tilting of the hyoid bone with its right greater horn abutting the distal right common carotid artery, just before its bifurcation (arrow in Figures A and B). Tilting of the hyoid bone and the thyroid cartilage was better demonstrated on three-dimensional image reconstruction (Figure C). Tawk, S, et al. Recurrent Syncope upon Deglutition. Journal of the Belgian Society of Radiology. 2018; 102(1): 55, pp. 1–2. DOI: https://doi. org/10.5334/jbsr.1584

International consensus (ICON) on basic voice assessment for unilateral vocal fold paralysis

There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts have been made to reach a consensus, including the Dejonckere protocol for the European Laryngological Society in 2001. This suggested to perform objective and quantifiable measures in the following domains: perception, acoustic, aerodynamic, self-evaluation by the patient and videolaryngostroboscopy. But in a PubMed® search with the keywords Voice Assessment and Voice Outcome since 2001 retrieving 452 articles, only 33 of them were using methods taking into account the first four dimensions proposed by Dejonckere. To elaborate a new and simpler protocol, we chose to focus on unilateral vocal fold paralyses (UVFP), which represents a homogeneous disease in terms of physiology. This protocol was elaborated on the basis of a review of the literature and of the database and experience of the IFOS panel members. In summary, our group recommends the use and implementation of the ELS basic protocol with some minor modifications. Voice audio recordings are an indispensable prerequisite, and may even have medico-legal implications. We recommend the systematic use of the Voice Handicap Index (VHI). Perceptual analysis must be performed by using Hiranos GRB scale and voice breathiness has to be prioritized. Currently, acoustic analysis remains optional given the lack of data to support clinical usefulness. Aerodynamic studies should include at a minimum an evaluation of the Maximum Phonation Time, calculated in seconds following multiple trials in order to obtain a recording representing the patients best possible glottis closure.

International consensus (ICON) on assessment of oropharyngeal dysphagia.

OBJECTIVEnTo present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation).nnnMETHODSnFollowing a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting.nnnRESULTSnFor the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.