Dans le cadre de l’IFOS 2017, plusieurs conférences de consensus sont organisées. Parmi elles, le lundi 26 juin (15:00, salle 352b), signalons la conférence sur l”Evaluation Vocale.
ICON Vocal Assessment in Unilateral Vocal Fold Paralysis
Antoine Giovanni (Marseille, France)
Agricio Crespo (Sao Paolo, Brazil)
Gauthier Desuter (Brussels, Belgium)
Byung-Joo Lee (Seoul, Korea)
Alexia Mattei (Marseille, France)
Ekaterina Ocipenko (Moscow, Russia)
Babak Sadoughi (New-York, USA)
Berit Schneider-Sticker (Austria)
Since the 1980s, numerous publications in the scientific literature have focused on measures of patient satisfaction through questionnaires, more or less standardized perceptual measures, various acoustic measurements, and aerodynamic measurements. Several attempts have been made to combine different measures and several consensus meetings have been held without any real clarification of the situation. These include the consensus meeting organized by Ingo Titze in Denver in 1995 (1) and the ELS basic protocol. In 2000, Ph Dejonckere (2), on behalf of the Committee on Phoniatrics of the European Laryngological Society, presented a “basic” protocol recommending the combined use of acoustic (GRBAS-I scale) and aerodynamic perturbation measures (Maximum Phonatory Time, Oral Airflow).
But the clinical use of all these indicators remains uncertain because of a lack of reliability, sensitivity and specificity (3, 4). We therefore decided to reconsider the question at the request of IFOS to evaluate the possibilities of proposing a guideline in 2017. It is clear that the complexity of the problem will prevent us from achieving a consensus based on evidence and we will limit ourselves to proposing a kind of framework in which future clinical research could be carried out. We decided to refocus our work on the simplest pathophysiological model, which is that of unilateral laryngeal immobilizations (UVFP) outside a neurological context. Dysphonia is most often related mainly to glottal geometry with an audible air leak and its acoustic consequences. On the other hand the surgical treatment options in particular have the only objective of reducing this glottal leakage on the basis of a fairly simple model (medialization). Thus vocal assessment of patients pre / post medialization surgery could be beneficial of a potential common protocol.
A panel discussion will be held on what we really need as surgeons simply to assess and compare results of our surgeries between us. According to the survey of Desuter, the basic protocol will be a shortened version of the ELS protocol and probably include at least
– a perceptual judgement of the quality of the voice (on the basis of the recording of a sample of the voice)
– Analysis of the patient complaint with the VHI
- Max Phonatory Time
And optionally when available
-An aerodynamic measurement such as oral airflow
-An acoustic analysis based upon a spectrogram and or SNR (with caution)