Lise Crevier-Buchman

Reduced survival in patients with ALS with upper airway obstructive events on non-invasive ventilation

Introduction Non-invasive ventilation (NIV) is part of standard care in amyotrophic lateral sclerosis (ALS). Intolerance or unavailability of NIV, as well as the quality of correction of nocturnal hypoventilation, has a direct impact on prognosis. Objectives We describe the importance of NIV failure due to upper airway obstructive events, the clinical characteristics, as well as their impact on the prognosis of ALS. Methods Retrospective analysis of the data of 190 patients with ALS and NIV in a single centre for the period 2011–2014. 179 patients tolerating NIV for more than 4 h per night without leaks were analysed. Results Among the 179 patients, after correction of leaks, 73 remained inadequately ventilated at night (defined as more than 5% of the night spent at <90% of SpO2), as a result of obstructive events in 67% of cases (n=48). Patients who remained inadequately ventilated after optimal adjustment of ventilator settings presented with shorter survival than adequately ventilated patients. Unexpectedly, patients with upper airway obstructive events without nocturnal desaturation and in whom no adjustment of treatment was therefore performed also presented with shorter survival. On initiation of NIV, no difference was demonstrated between patients with and without upper airway obstructive events. In all patients, upper airway obstruction was concomitant with reduction of ventilatory drive. Conclusions This study shows that upper airway obstruction during NIV occurs in patients with ALS and is associated with poorer prognosis. Such events should be identified as they can be corrected by adjusting ventilator settings.

The French version of Speech Handicap Index: validation and comparison with the Voice Handicap Index

Objective: This study aimed to adapt the Speech Handicap Index (SHI) in French, to compare it with the Voice Handicap Index (VHI) and to study its relevance in dysarthric patients. Patients and Methods: Two hundred and twenty-nine subjects filled out the French versions of the SHI and VHI. SHI test-retest reliability was performed on 82 subjects. Psychometric properties were analyzed in 112 healthy controls and 89 patients with speech disorders. Mean scores of 89 speech-disordered and 28 dysphonic patients were obtained. Results: For SHI, internal consistency (Cronbach’s alpha >0.9) and test-retest reliability (Spearman’s r > 0.75) were high. Mean scores were significantly different between healthy subjects (8/120) and patients (52/120) (p < 0.0001). Scores were statistically different between dysphonic (40/120) and speech-disordered patients (52/120) (p < 0.05), and also between patients with oropharyngeal surgery (44/120) and dysarthric patients (57/120) (p < 0.05). Patients with speech difficulties had higher scores on the SHI than dysphonic patients (p < 0.05). Conclusion: The French SHI is a reliable and sensitive tool. It can be proposed to all patients with speech disorders. The contrasting results between the SHI and the VHI highlight the importance in giving the appropriate questionnaire tailored to the patient’s pathology.

A video-fiberscopic study of laryngopharyngeal behaviour in the human beatbox

Abstract The human beatbox is the art of reproducing all types of sounds with the mouth while ‘adapting’ them for better control. To understand how these ‘voice virtuosos’ juggle with so many different sounds—instrumental, rhythmic, and vocal—at the same time, we have performed a descriptive analysis of three beatboxers by observing their vocal tract behaviour by fiberscopic imaging using an OCM visual scale. From an anatomical-dynamic point of view, beatboxers mobilize all the structures of their laryngopharynx separately. With this first physiological study of the human beatbox, we could observe a well-developed laryngopharyngeal system with extreme articulatory configurations to perform their art.

Analogy between laryngeal gesture in Mongolian Long Song and supracricoid partial laryngectomy

This article reports the results of a multiparametrical analysis of Mongolian Long Song, characterised by multiple ornamentation and shows the similarities between the laryngeal behaviour observed during these ornamentations and the compensatory gesture produced by patients after supracricoid partial laryngectomy. This study includes (1) a physiological analysis of videofiberscopic laryngeal data from a healthy Mongolian singer and from three non-singer French-speaking clinical patients; and (2) an acoustical analysis (fundamental frequency and intensity). For the singer, the fiberoptic analysis showed two main laryngeal behaviours in producing ornamentations: (1) ‘lyrical’ vibratos mobilising the entire laryngeal block; (2) ‘Mongolian’ trills with essentially supraglottic movements, the arytenoids being mobilised independently of the rest of the laryngeal block. Patients demonstrated similar aryepiglottic trilling to fulfil a function of voicing. The acoustic analysis showed that the fundamental frequency and the intensity were in phase for vibrato, contrary to the ‘Mongolian’ trills which were in opposite phase, underlying a change of laryngeal vibratory mechanisms.