Publications of Aude Lagier
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See detailIntérêt et limites des outils de dépistage de la dysphagie en gériatrie
DENUIT, Catherine ULiege; delcourt, sandrine; poncelet, mélanie et al

in Revue Médicale de Liège (in press)

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See detailEarly Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature
Marques, Joana; Marronnier, Adrien; Crampon, Frederic et al

in Journal of Voice (in press)

Background. Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is ... [more ▼]

Background. Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is still controversial. Published data suggest that early intracordal injection positively affects long-term outcomes. Objectives. To critically review current literature in order to determine if early treatment of acute UVFP influences clinical outcomes of the patients. Type of Review. Nonsystematic literature review. Methods. A literature review was performed, using the Pubmed database. All relevant articles published in English addressing the effect of early treatment in acute unilateral focal fold paralysis were analyzed. Twenty-six articles were included due to their scientific interest. Results. Published literature suggests that early intracordal injection in patients with UVFP reduces pulmonary infections, hospital length of stay and improves voice parameters. Also, patients who receive early intracordal injection seem to be less likely to undergo subsequent medialization thyroplasty. Conclusions. Early intracordal injection should be offered to patients with newly diagnosed UVFP since it promotes a satisfactory position of the vocal fold and seems to improve clinical outcomes. More investigation, with long-term follow up data and treatment randomization, is necessary to develop clinical consensus for these patients. [less ▲]

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See detailContact Pressure Between the Vocal Folds in Reinke’s Edema: Experimental Observations on an Excised Human Larynx
SILVA, FABRICE; LEGOU, THIERRY; CHAMPSAUR, PIERRE et al

in Journal of Voice (in press)

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 ... [more ▼]

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. [less ▲]

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See detailSwallowing in individuals with disorders of consciousness: A cohort study
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Annals of Physical and Rehabilitation Medicine (in press)

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with ... [more ▼]

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral feeding tube. However, the real impact of the level of consciousness on an individual’s swallowing ability remains poorly investigated. Objective. We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. Methods. We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. Univariate and multivariate logistic regression was used to analyse the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). Results. We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). Conclusion. Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC. [less ▲]

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See detailJournée des maladies rares 2021: "les dystonies laryngées"
Lagier, Aude ULiege; DEPIERREUX, Frédérique ULiege

Scientific conference (2021, February 26)

Overview sur les différentes formes de dystonies laryngées, précédée d'une introduction concernant les dystonies focales. Le traitement est également abordé.

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See detailSwallowing function after severe COVID-19: early videofluoroscopic findings
Lagier, Aude ULiege; Mélotte, Evelyne ULiege; PONCELET, Mélanie ULiege et al

in European Archives of Oto-Rhino-Laryngology (2021)

Introduction: The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS). Methods: The 21 first patients (14 men and 7 women) who recovered ... [more ▼]

Introduction: The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS). Methods: The 21 first patients (14 men and 7 women) who recovered from ARDS in context of COVID-19 were referred to VFS just before to maximum 14 days after their discharge from ICU. The swallowing impairments and the physiopathologic mechanism of them were prospectively analyzed by two swallowing experts: one radiologist, and one phoniatrician using penetration-aspiration scale (PAS) score. Results: Nineteen out of 21 presented impairment in their swallowing function. Sixteen patients presented direct penetration or inhalation. All but one were silent. Some stases were also observed in 13 patients. Five patients presented secondary penetration/aspiration, among these inhalations, and all were silent. The most frequent findings are the delayed pharyngeal phase, the reduced propulsion of the tongue root, the posterior oral leaks, the default of laryngeal closure, and the impaired pharyngeal peristaltism. Discussion: The very high prevalence of swallowing disorders with inhalation and the lack of protective reflexes are the main findings. This emphasizes the need of high caution with bedside screening in these patients with severely injured lungs. [less ▲]

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See detailPrevalence and characterisation of vocal fold motion impairment (VFMI) in patients with Multiple system atrophy compared with Parkinson’s disease
GRIMALDI, STEPHAN; RENAUD, MATHILDE; Lagier, Aude ULiege et al

in Revue Neurologique (2020), 176

Introduction. – Multiple system atrophy (MSA) is a neurodegenerative disorder in which vocal fold mobility can be affected, sometimes leading to life-threatening situations. Our aim was to know if ... [more ▼]

Introduction. – Multiple system atrophy (MSA) is a neurodegenerative disorder in which vocal fold mobility can be affected, sometimes leading to life-threatening situations. Our aim was to know if laryngeal examination could help differentiate MSA from Parkinson’s disease (PD). Materials and methods. – Between 2004 to 2014, all consecutive patients diagnosed with probable MSA were included in this retrospective, monocentric study. Flexible laryngoscopy was obtained in 51 MSA patients and compared with 27 patients with Parkinson’s disease (PD). Laryngeal muscles EMG was available in 6 MSA patients. Results. – Vocal fold motion impairments (VFMI) was found in 35 (68.6%) MSA patients: 15 (29.4%) had uni- or bilateral vocal fold abnormal movement (VFAM), 13 (25.5%) had uni- or bilateral vocal fold abductor paresis (VFABP), 4 (7.8%) had uni- or bilateral vocal fold adductor paresis (VFADP), 10 (19.6%) had bilateral vocal fold paralysis (BVFP). VFMI was found in 13 PD patients (48.1%) all of whom had VFADP. Presence of BVFP was found associated with stridor (P < 0.001) and dysphagia (P = 0.002). In all muscles examined in 6 MSA patients, the EMG showed neuropathic patterns. [less ▲]

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See detailGuidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic
MATTEI, ALEXIA; Amy de la Breteque, Benoit; CRESTANI, SABINE et al

in European Annals of Otorhinolaryngology, Head and Neck Diseases (2020), 137

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 ... [more ▼]

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 videofluoroscopic 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. [less ▲]

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See detailToute l’anatomie pour l’orthophonie
Lagier, Aude ULiege

Book published by DE BOECK SUPERIEUR (2019)

Il s'agit d'un ouvrage pédagogique visant à cibler l'anatomie dont la connaissance est nécessaire pour pratiquer la logopédie. L'objectif est de fournir un ouvrage illustré, et présentant également les ... [more ▼]

Il s'agit d'un ouvrage pédagogique visant à cibler l'anatomie dont la connaissance est nécessaire pour pratiquer la logopédie. L'objectif est de fournir un ouvrage illustré, et présentant également les applications cliniques des notions anatomiques développées. [less ▲]

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See detailDécouverte fortuite d’un neurofibrome laryngé lors d’une intubation chez une patiente atteinte de neurofibromatose de type 1
GRANDJEAN, ALEXANDRE; Lagier, Aude ULiege; POSPIECH, A et al

in Revue Médicale de Liège (2019), 74(12), 633-636

We report the unexpected discovery of a large laryngeal neurofibroma during a direct laryngoscopy for intubation in a 18-year old female with a medical history of neurofibromatosis type 1. The most ... [more ▼]

We report the unexpected discovery of a large laryngeal neurofibroma during a direct laryngoscopy for intubation in a 18-year old female with a medical history of neurofibromatosis type 1. The most striking feature of this case report is the discrepancy between the absence of clinical manifestations and the size and location of the neurofibroma. This case highlights the importance of a careful preoperative assessment, especially in the context of multisystemic disease. Knowledge of the disease, recognition of related complications and adequate preoperative evaluation are crucial to establish the safest anesthesia strategy. [less ▲]

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See detailAcoustic correlates of vocal effort: External factors and personality traits
MATTEI, ALEXIA; LEGOU, THIERRY; CARDEAU, ADELE et al

in European Annals of Otorhinolaryngology, Head and Neck Diseases (2019), 136

Objectives: To develop an experimental protocol to study the vocal effort generated by introducingbarriers to communication, and its relationship with certain personality traits.Material and methods: The ... [more ▼]

Objectives: To develop an experimental protocol to study the vocal effort generated by introducingbarriers to communication, and its relationship with certain personality traits.Material and methods: The experimental protocol consisted of an interactive game in which the sub-ject gave an investigator instructions to adopt various body positions (semi-directed communicationsituation). The Control situation included no constraints on communication. Then a Distance Constraint(increased distance between subject and investigator) and a Time Constraint (generation of performancestress by putting the subject in competition with others) were introduced. The vocal parameters studiedcomprised vocal intensity and fundamental frequency in the middle of the vowel of 3 target phonemes.Subjects also took the NEO FFI-R personality test.Results: The study included 41 women aged between 18 and 52 years. Vocal intensity and fundamentalfrequency increased significantly with the introduction of the constraints (P < 0.05), intensity passingfrom 75.5 dB to 81.8 dB and frequency from 249.4 Hz to 335.8 Hz. No correlations were found betweenthese changes and results for the various personality traits.Conclusions: This ecological protocol enables the impact of both physical and emotional obstacles tocommunication to be studied. No correlations between vocal effort and personality traits emerged. Alarger-scale study would be necessary to analyze the continuum between vocal effort and vocal forcing,to improve speech therapy for dysfunctional dysphonia. [less ▲]

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See detailCross-sectional swallowing study in patients with disorders of consciousness
MELOTTE, Evelyne ULiege; Delhalle, Sabrina; Gosseries, Olivia ULiege et al

Poster (2018, September 29)

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See detailTraitement des sténoses laryngées et trachéales de l'adulte
Lagier, Aude ULiege; Gorostidi, François; DEMEZ, Pierre ULiege et al

in EMC techniques chirurgicales Tête et cou (2018), (46-395),

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See detailSténoses laryngées de l'adulte
Lagier, Aude ULiege; Gorostidi, François; DEMEZ, Pierre ULiege et al

in EMC - Oto-Rhino-Laryngologie (2018), (20.735.A10),

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See detailControl of the glottal configuration in ex vivo human models: quantitative anatomy for clinical and experimental practices
Lagier, Aude ULiege; Guenoun, Daphne; Legou, Thierry et al

in Surgical and Radiologic Anatomy (2017), 39(3), 257-262

Introduction The objective of this paper was to identify the determining factors of the glottal prephonatory configuration from the point of view of the resulting muscular actions (i.e., arytenoids ... [more ▼]

Introduction The objective of this paper was to identify the determining factors of the glottal prephonatory configuration from the point of view of the resulting muscular actions (i.e., arytenoids adduction, membranous vocal fold adduction, and tension). Materials and methods 21 human non-embalmed excised larynges (12 females and 9 males) were studied. Experiment A (11 larynges) studied four conditions of adduction of the vocal folds and arytenoids. Experiment B (10 larynges) studied the effect of cricothyroid approximation on the vocal fold length and the cricothyroid angle. Results Experiment A: The mean glottal area significantly decreased from 41.2 mm2 mean with no adduction, to 10.2 mm2 mean with arytenoid adduction, to 9.2 mm2 with membranous vocal fold adduction, and down to 1.1 mm2 with the combination of arytenoid and membranous adduction. The effect of the task was statistically significant. Experiment B: The length of vocal folds increased from 13.61 mm median to 14.48 mm median, and the cricothyroid angle decreased of 10.05 median along with cricothyroid approximation. Discussion The results of experiment A emphasize the sub-division of adductor intrinsic muscles in arytenoids adductors (i.e., LCA and IA), and membranous vocal fold adductor (i.e., TA). The results of experiment B quantify the effect of cricothyroid approximation on the vocal folds length. The implications of these results can be useful in both clinical practice and experimental studies. [less ▲]

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See detailThe shouted voice: A pilot study of laryngeal physiology under extreme aerodynamic pressure
Lagier, Aude ULiege; LEGOU, THIERRY; GALANT, CAMILLE et al

in Logopedics, Phoniatrics, Vocology (2017), 42(4), 141-145

Introduction: The objective was to study the behavior of the larynx during shouted voice production, when the larynx is exposed to extremely high subglottic pressure. Materials and methods: The study ... [more ▼]

Introduction: The objective was to study the behavior of the larynx during shouted voice production, when the larynx is exposed to extremely high subglottic pressure. Materials and methods: The study involved electroglottographic, acoustic, and aerodynamic analyses of shouts produced at maximum effort by three male participants. Results and discussion: Under a normal speaking voice, the voice sound pressure level (SPL) is proportional to the subglottic pressure. However, when the subglottic pressure reached high levels, the voice SPL reached a maximum value and then decreased as subglottic pressure increased further. Furthermore, the electroglottographic signal sometimes lost its periodicity during the shout, suggesting irregular vocal fold vibration. [less ▲]

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See detailDystonia of the soft palate: Mutation of the THAP1 (DYT6) gene in a 42- year-old patient
GRIMALDI, STEPHAN; Lagier, Aude ULiege; ROBERT, DANIELE et al

in Revue Neurologique (2017)

Il s'agit d'un case report d'un patient de 42 ans présentant une dystonie négative du voile du palais, prouvée électromyographiquement, chez qui a été mise en évidence une mutation du gène THAP1 (DYT6)

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See detailAbout a case of laryngeal location of SAPHO
VATIN, LORAINE; JEAN, ESTELLE; RIVIERE, DAMIEN et al

in Revue de Médecine Interne (2017), 38

éIntroduction. – Synovite-acnée-pustulose-hyperostose-ostéite (SAPHO) désigne un syndrome associantdes atteintes inflammatoires osseuses, articulaires et dermatologiques. Les immobilités laryngées bila ... [more ▼]

éIntroduction. – Synovite-acnée-pustulose-hyperostose-ostéite (SAPHO) désigne un syndrome associantdes atteintes inflammatoires osseuses, articulaires et dermatologiques. Les immobilités laryngées bila-térales d’origine articulaire sont rares. Nous présentons un cas de blocage articulaire cricoaryténoïdienbilatéral en contexte de syndrome SAPHO.Observation. – Un patient de 53 ans présentait une dyspnée intermittente évoluant par crises depuis 2 ans.Un syndrome SAPHO avait été évoqué sur des scanners thoraciques répétés. Le lien entre la dyspnée et leslésions de syndrome SAPHO n’était pas fait immédiatement étant donné l’absence d’antériorité connue.Cependant, après avoir éliminé d’autres étiologies et avoir réalisé une trachéotomie après aggravationde la situation respiratoire, ce diagnostic était envisagé. Le traitement par corticothérapie et imunosup-presseurs permettait une amélioration clinique du patient.Conclusion. – Cette observation vise à sensibiliser d’autres équipes médicales qui seraient confrontées àcette même présentation clinique afin d’en accélérer le diagnostic et la prise en charge. [less ▲]

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