{"id":2839,"date":"2021-02-19T08:41:17","date_gmt":"2021-02-19T08:41:17","guid":{"rendered":"https:\/\/www.reseau-amylose.org\/jesuissoignant\/?page_id=2839"},"modified":"2026-08-26T10:28:56","modified_gmt":"2026-08-26T08:28:56","slug":"pour-lorl","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-lorl\/","title":{"rendered":"Pour l&rsquo;ORL"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2839\" class=\"elementor elementor-2839\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7c10aaff elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7c10aaff\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5514246b\" data-id=\"5514246b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-20925cb elementor-widget elementor-widget-heading\" data-id=\"20925cb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Pour l'ORL<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e43aa4c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"6e43aa4c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-38afafb elementor-widget elementor-widget-heading\" data-id=\"38afafb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">D\u00e9pister, diagnostiquer et prendre en charge les amylose cardiaques<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-efcd978 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"efcd978\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0a5f2e9\" data-id=\"0a5f2e9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-603cd54 elementor-widget elementor-widget-text-editor\" data-id=\"603cd54\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em>Les atteintes ORL (surdit\u00e9, dysphonie, dysphagie, macroglossie) surviennent fr\u00e9quemment avant les sympt\u00f4mes cardiologiques de l&rsquo;amylose \u2014 la surdit\u00e9 peut pr\u00e9c\u00e9der le diagnostic cardiaque jusqu&rsquo;\u00e0 120 mois. Un tableau audiom\u00e9trique atypique pour une presbyacousie, associ\u00e9 \u00e0 d&rsquo;autres \u00ab red flags \u00bb, doit conduire \u00e0 adresser rapidement le patient \u00e0 un centre expert.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fc4f006 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fc4f006\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-37e449e\" data-id=\"37e449e\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a444287 elementor-widget elementor-widget-heading\" data-id=\"a444287\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Points cl\u00e9s pour les professionnels de sant\u00e9<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ea794f7 elementor-widget elementor-widget-text-editor\" data-id=\"ea794f7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>La surdit\u00e9 amylo\u00efde diff\u00e8re de la presbyacousie : perte plus profonde, toutes fr\u00e9quences touch\u00e9es, ph\u00e9nom\u00e8ne de recrutement important ; elle peut pr\u00e9c\u00e9der le diagnostic cardiaque jusqu&rsquo;\u00e0 120 mois.<\/li><li>La dysphonie touche plus d&rsquo;un tiers des patients, avec 16 % d&rsquo;anomalies de mobilit\u00e9 laryng\u00e9e inexpliqu\u00e9es \u00e0 la nasofibroscopie.<\/li><li>La dysphagie concerne 17 % des patients, appara\u00eet 6 \u00e0 30 mois avant le diagnostic cardiologique, sans l\u00e9sion organique visible.<\/li><li>La macroglossie touche plus de 15 % des patients au diagnostic d&rsquo;amylose AL et r\u00e9gresse sous traitement de fond.<\/li><li>Devant un tableau ORL atypique, rechercher les autres \u00ab red flags \u00bb (canal carpien, canal lombaire, ecchymose p\u00e9riorbitaire, dyspn\u00e9e) et adresser rapidement \u00e0 un centre expert.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e70a90e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e70a90e\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e2b7143\" data-id=\"e2b7143\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-69f97dc elementor-widget elementor-widget-heading\" data-id=\"69f97dc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Les amyloses cardiaques<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9fb6df3 elementor-widget elementor-widget-text-editor\" data-id=\"9fb6df3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Physiopathologie : <\/strong>les amyloses sont des maladies o\u00f9 des prot\u00e9ines circulantes changent de conformation et deviennent fibrillaires. Ces fibrilles amylo\u00efdes sont stables et rigides et vont infiltrer la matrice extracellulaire des organes, alt\u00e9rant ainsi leur fonctionnement. La fibrillo-formation est un processus dynamique et donc \u00e9volutif.<\/p><p><strong>Les 3 types d&rsquo;amyloses cardiaques : <\/strong>la forme AL est li\u00e9e \u00e0 la surproduction de cha\u00eenes l\u00e9g\u00e8res libres Kappa ou Lambda. Les deux formes \u00e0 transthyr\u00e9tine (TTR) sont l&rsquo;ATTR sauvage (ATTRwt), acquise et apparaissant apr\u00e8s 50 ans, et l&rsquo;ATTR h\u00e9r\u00e9ditaire, li\u00e9e \u00e0 une mutation dans le g\u00e8ne de la transthyr\u00e9tine.<\/p><p>Les atteintes ORL et stomatologiques surviennent fr\u00e9quemment avec les sympt\u00f4mes cardiologiques.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-95ca6b0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"95ca6b0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-070c9ca\" data-id=\"070c9ca\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8c06777 elementor-widget elementor-widget-image\" data-id=\"8c06777\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"735\" height=\"437\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/3-types-damylosecardiaque-ORL-2.png\" class=\"attachment-2048x2048 size-2048x2048 wp-image-9038\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/3-types-damylosecardiaque-ORL-2.png 735w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/3-types-damylosecardiaque-ORL-2-300x178.png 300w\" sizes=\"(max-width: 735px) 100vw, 735px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a629a1f\" data-id=\"a629a1f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1c49857 elementor-widget elementor-widget-image\" data-id=\"1c49857\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"811\" height=\"555\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/Audiogramme-des-3-types-damylose.png\" class=\"attachment-1536x1536 size-1536x1536 wp-image-9039\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/Audiogramme-des-3-types-damylose.png 811w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/Audiogramme-des-3-types-damylose-300x205.png 300w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/08\/Audiogramme-des-3-types-damylose-768x526.png 768w\" sizes=\"(max-width: 811px) 100vw, 811px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2bca04a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2bca04a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-89a9c27\" data-id=\"89a9c27\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-20ab5f8 elementor-widget elementor-widget-heading\" data-id=\"20ab5f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">La surdit\u00e9 amylo\u00efde<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7ddc830 elementor-widget elementor-widget-text-editor\" data-id=\"7ddc830\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Signes \u00e9vocateurs : <\/strong>l&rsquo;amylose est responsable d&rsquo;une surdit\u00e9 par d\u00e9p\u00f4ts amylo\u00efdes aussi bien au niveau endocochl\u00e9aire, r\u00e9trocochl\u00e9aire que central. Il en r\u00e9sulte des tableaux de surdit\u00e9 de perception se diff\u00e9renciant des presbyacousies par une perte auditive plus profonde et surtout affectant toutes les fr\u00e9quences, pas seulement les fr\u00e9quences aigu\u00ebs. Un ph\u00e9nom\u00e8ne de recrutement important est \u00e9galement retrouv\u00e9 en faveur d&rsquo;une surdit\u00e9 d&rsquo;origine endocochl\u00e9aire. Les autres hypoth\u00e8ses seraient une atteinte r\u00e9trocochl\u00e9aire et centrale par neuropathie auditive amylo\u00efde li\u00e9e \u00e0 des d\u00e9p\u00f4ts endo\/p\u00e9rineuraux, mais aussi une vasculopathie.<\/p><p>L&rsquo;amylose cardiaque est responsable de tableaux de surdit\u00e9 mixte, uni ou bilat\u00e9rale, dans 1\/3 des cas, \u00e0 faible Rinne et \u00e0 tympan normal. Des cas de surdit\u00e9 de transmission pure ont \u00e9t\u00e9 d\u00e9crits avec abolition du r\u00e9flexe stap\u00e9dien (sans cause retrouv\u00e9e au scanner des rochers). L&rsquo;hypoth\u00e8se physiopathologique serait un d\u00e9p\u00f4t amylo\u00efde au niveau de la synoviale articulaire ossiculaire responsable d&rsquo;une ankylose, \u00e0 l&rsquo;image de ce qui est vu en cas de syndrome du canal carpien. Des d\u00e9p\u00f4ts amylo\u00efdes au niveau de la fen\u00eatre ovale ou de la membrane tympanique pourraient \u00e9galement expliquer ces surdit\u00e9s mixtes.<\/p><p><strong>Un signe pr\u00e9coce : <\/strong>les atteintes auditives semblent pr\u00e9c\u00e9der de plusieurs mois le d\u00e9but de la maladie cardiaque, jusqu&rsquo;\u00e0 120 mois avant le diagnostic, et pourraient donc \u00eatre un sympt\u00f4me pr\u00e9coce de la maladie. En cas de tableau audiom\u00e9trique atypique pour une presbyacousie, il convient de rechercher \u00e0 l&rsquo;interrogatoire d&rsquo;autres localisations de d\u00e9p\u00f4ts amylo\u00efdes : ant\u00e9c\u00e9dent de chirurgie du canal carpien, canal lombaire \u00e9troit, ecchymose p\u00e9riorbitaire, macroglossie, dyspn\u00e9e, etc., et d&rsquo;adresser rapidement le patient au cardiologue expert pour recherche d&rsquo;amylose.<\/p><p><strong>La prise en charge : <\/strong>\u00e0 l&rsquo;heure actuelle, la prise en charge th\u00e9rapeutique repose sur l&rsquo;appareillage auditif lorsque les crit\u00e8res sont pr\u00e9sents. Le b\u00e9n\u00e9fice auditif du traitement de fond de l&rsquo;amylose syst\u00e9mique par mol\u00e9cules anti-TTR (tafamidis) est \u00e0 \u00e9valuer.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-705cf4e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"705cf4e\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b40ed6b\" data-id=\"b40ed6b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4b8b8d2 elementor-widget elementor-widget-heading\" data-id=\"4b8b8d2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">La dysphonie amylo\u00efde<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f595226 elementor-widget elementor-widget-text-editor\" data-id=\"f595226\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>C&rsquo;est quoi : <\/strong>dans une \u00e9tude de cohorte, plus d&rsquo;un tiers des patients se plaignaient de dysphonie (VHI 10\/30 en moyenne). Cette dysphonie pr\u00e9existait au diagnostic d&rsquo;amylose cardiaque de plusieurs mois. Elle s&rsquo;expliquerait par des d\u00e9p\u00f4ts amylo\u00efdes au niveau des cartilages et de la musculature laryng\u00e9s, mais aussi par une neuropathie.<\/p><p><strong>Le diagnostic : <\/strong>l&rsquo;examen nasofibroscopique ne retrouve que peu d&rsquo;anomalies, contrairement aux amyloses localis\u00e9es ; il n&rsquo;existe pas de tumeur \u00e0 proprement parler. 40 % d&rsquo;anomalies ont \u00e9t\u00e9 retrouv\u00e9es, notamment 16 % d&rsquo;anomalies de la mobilit\u00e9 laryng\u00e9e inexpliqu\u00e9es (hypomobilit\u00e9 uni ou bilat\u00e9rale, fuite vocale). Dans 24 % des cas, des anomalies inflammatoires de la muqueuse vocale ont \u00e9t\u00e9 retrouv\u00e9es sans l\u00e9sion tumorale. Si possible, il est recommand\u00e9 de pratiquer un examen stroboscopique des cordes vocales.<\/p><p><strong>La prise en charge : <\/strong>le traitement des amyloses ORL localis\u00e9es (AL) repose essentiellement sur la chirurgie (traitement par radioth\u00e9rapie exceptionnel), mais il faut bien s\u00fbr \u00e9liminer une forme syst\u00e9mique en adressant pr\u00e9alablement le patient \u00e0 un centre expert. Le traitement des dysphonies fonctionnelles des amyloses ATTR est plus difficile car il n&rsquo;existe pas de l\u00e9sion organique : il est donc recommand\u00e9 d&rsquo;adresser le patient pour bilan \u00b1 r\u00e9\u00e9ducation orthophonique le plus pr\u00e9cocement possible. Le traitement sp\u00e9cifique de l&rsquo;amylose (ex. tafamidis) pourrait am\u00e9liorer les atteintes laryng\u00e9es.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3c91ad1 elementor-widget elementor-widget-text-editor\" data-id=\"3c91ad1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em>Un diagnostic pr\u00e9coce des amyloses est capital pour sauver des vies. Fr\u00e9quemment, les sympt\u00f4mes ORL ou stomatologiques sont les premiers \u00e0 appara\u00eetre. En cas d&rsquo;atteintes ORL ou stomatologiques \u00e9vocatrices d&rsquo;amylose, rechercher les \u00ab red flags \u00bb et adresser rapidement le patient \u00e0 un centre expert pour initier le traitement en fonction du type d&rsquo;amylose.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4d49969 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4d49969\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-aa2ba66\" data-id=\"aa2ba66\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0f78973 elementor-widget elementor-widget-heading\" data-id=\"0f78973\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">La dysphagie amylo\u00efde<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c7fa704 elementor-widget elementor-widget-text-editor\" data-id=\"c7fa704\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>C&rsquo;est quoi : <\/strong>17 % des patients avec amylose cardiaque se plaignent de dysphagie, \u00e0 l&rsquo;origine d&rsquo;une modification alimentaire (adaptation des textures) et d&rsquo;une perte de poids. Il s&rsquo;agit essentiellement de sympt\u00f4mes \u00e0 type de blocage alimentaire et de r\u00e9gurgitations, avec un allongement de la dur\u00e9e des repas. Comme les autres signes ORL, la dysphagie appara\u00eet pr\u00e9cocement dans l&rsquo;histoire de la maladie, en moyenne 6 \u00e0 30 mois avant le diagnostic cardiologique.<\/p><p><strong>Le diagnostic : <\/strong>la nasofibroscopie ne retrouve pas de l\u00e9sion organique (\u00e0 la diff\u00e9rence de l&rsquo;amylose localis\u00e9e). Des d\u00e9fauts de propulsion alimentaire et une stase salivaire sont retrouv\u00e9s. Il n&rsquo;existe pas de corr\u00e9lation entre la gravit\u00e9 de la dysphagie et la positivit\u00e9 de la biopsie des glandes salivaires accessoires. La physiopathologie serait li\u00e9e \u00e0 une neuropathie et \u00e0 des d\u00e9p\u00f4ts amylo\u00efdes ligamentaires, musculaires et articulaires. Une infiltration des glandes salivaires \u00e0 l&rsquo;origine d&rsquo;une x\u00e9rostomie pourrait expliquer une atteinte de la phase orale.<\/p><p><strong>La prise en charge : <\/strong>elle repose sur une adaptation alimentaire (textures, fractionnement des repas, compl\u00e9ments nutritionnels oraux) associ\u00e9e \u00e0 une r\u00e9\u00e9ducation orthophonique. Le traitement g\u00e9n\u00e9ral de l&rsquo;amylose pourrait potentiellement am\u00e9liorer les atteintes pharyng\u00e9es.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0d64853 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0d64853\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e19bbd2\" data-id=\"e19bbd2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5cc558b elementor-widget elementor-widget-heading\" data-id=\"5cc558b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">La macroglossie<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66f9471 elementor-widget elementor-widget-text-editor\" data-id=\"66f9471\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>C&rsquo;est quoi : <\/strong>une macroglossie est retrouv\u00e9e chez plus de 15 % des patients lors du diagnostic d&rsquo;amylose AL. Elle est due \u00e0 une infiltration locale amylo\u00efde et peut entra\u00eener une dysgueusie invalidante.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-804de3b elementor-widget elementor-widget-image\" data-id=\"804de3b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"277\" height=\"300\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/05\/Capture-de\u0301cran-2021-05-07-a\u0300-10.00.17-277x300.png\" class=\"attachment-medium size-medium wp-image-4018\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/05\/Capture-de\u0301cran-2021-05-07-a\u0300-10.00.17-277x300.png 277w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/05\/Capture-de\u0301cran-2021-05-07-a\u0300-10.00.17.png 634w\" sizes=\"(max-width: 277px) 100vw, 277px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6de22de elementor-widget elementor-widget-text-editor\" data-id=\"6de22de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Le diagnostic : <\/strong>la macroglossie ne pr\u00e9sente pas de caract\u00e8re sp\u00e9cifique : hypertrophie de la langue d\u00e9passant du plan d&rsquo;occlusion, avec langue cr\u00e9nel\u00e9e ou non.<\/p><p><strong>La prise en charge : <\/strong>la macroglossie dispara\u00eet g\u00e9n\u00e9ralement avec le traitement de fond de la maladie (chimioth\u00e9rapie pour les amyloses AL, tafamidis pour les amyloses \u00e0 TTR).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-84a4cf9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"84a4cf9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-d99f1f6\" data-id=\"d99f1f6\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-19b4948\" data-id=\"19b4948\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-09fbada elementor-align-center elementor-widget elementor-widget-button\" data-id=\"09fbada\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/triptyques-du-centre-de-reference-des-amyloses-cardiaques-chu-henri-mondor\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">T\u00e9l\u00e9chargez le Triptyque - Surdit\u00e9, Dysphonie, Dysphagie ou Macroglossie, et si c'\u00e9tait une amylose ? Ce que l'ORL doit savoir<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e2ab029 elementor-widget elementor-widget-text-editor\" data-id=\"e2ab029\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center\"><span style=\"color: #808080\"><em>Document r\u00e9dig\u00e9 par\u00a0Dr Sophie BARTIER, Dr \u00c9milie B\u00c9QUIGNON, Pr Andr\u00e9 COSTE<\/em><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-c640220\" data-id=\"c640220\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cf8d07f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cf8d07f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-67da89d\" data-id=\"67da89d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1635ce7 elementor-widget elementor-widget-text-editor\" data-id=\"1635ce7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>R\u00e9f\u00e9rences\u00a0:<\/p><p>&#8211; <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28598686\/\">How your ears can tell what is hidden in your heart: wild-type transthyretin amyloidosis as potential cause of sensorineural hearing loss inelderly<\/a>. B\u00e9quignon E et al.Amyloid. 2017.<\/p><p>&#8211; <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31364411\/\">Pharyngo-laryngeal involvement in systemic amyloidosis with cardiac involvement: a prospective observational study.<\/a> Bartier S,\u00a0 et al Amyloid. 2019.<\/p><p>&#8211; <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31502881\/\">Association between hearing loss and hereditary ATTR amyloidosis.<\/a>Bartier S et al, Amyloid. 2019.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b08e7d0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b08e7d0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fb1d122\" data-id=\"fb1d122\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2f02021 elementor-widget elementor-widget-heading\" data-id=\"2f02021\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">FAQ \u2014 Questions fr\u00e9quentes<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bf03fe9 elementor-widget elementor-widget-toggle\" data-id=\"bf03fe9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2001\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2001\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">En quoi la surdit\u00e9 amylo\u00efde diff\u00e8re-t-elle de la presbyacousie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2001\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2001\"><p>Elle est plus profonde et touche toutes les fr\u00e9quences, pas seulement les aigu\u00ebs, avec un ph\u00e9nom\u00e8ne de recrutement important orientant vers une origine endocochl\u00e9aire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2002\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2002\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Combien de temps la surdit\u00e9 peut-elle pr\u00e9c\u00e9der le diagnostic cardiaque ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2002\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2002\"><p>Jusqu&rsquo;\u00e0 120 mois (10 ans) avant le diagnostic, ce qui en fait un signe potentiellement tr\u00e8s pr\u00e9coce.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2003\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2003\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Que montre la nasofibroscopie en cas de dysphonie amylo\u00efde ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2003\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2003\"><p>Peu d&rsquo;anomalies dans la majorit\u00e9 des cas (60 %), mais 16 % d&rsquo;anomalies de mobilit\u00e9 laryng\u00e9e inexpliqu\u00e9es et 24 % d&rsquo;anomalies inflammatoires de la muqueuse sans l\u00e9sion tumorale, contrairement aux amyloses localis\u00e9es.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2004\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2004\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">La macroglossie r\u00e9gresse-t-elle sous traitement ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2004\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2004\"><p>Oui, g\u00e9n\u00e9ralement, avec le traitement de fond de la maladie : chimioth\u00e9rapie pour l&rsquo;amylose AL, tafamidis pour l&rsquo;amylose \u00e0 TTR.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-de87d42 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"de87d42\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6d9f7c6\" data-id=\"6d9f7c6\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fef2672 elementor-widget elementor-widget-text-editor\" data-id=\"fef2672\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Les atteintes ORL de l&rsquo;amylose cardiaque (surdit\u00e9, dysphonie, dysphagie, macroglossie) pr\u00e9c\u00e8dent souvent le diagnostic cardiaque, parfois de plusieurs ann\u00e9es. La surdit\u00e9, pr\u00e9sente sous forme mixte dans un tiers des cas, diff\u00e8re de la presbyacousie par une perte plus profonde touchant toutes les fr\u00e9quences, et peut pr\u00e9c\u00e9der le diagnostic jusqu&rsquo;\u00e0 120 mois. La dysphonie touche plus d&rsquo;un tiers des patients, avec des anomalies de mobilit\u00e9 laryng\u00e9e \u00e0 la nasofibroscopie dans 16 % des cas. La dysphagie concerne 17 % des patients, sans l\u00e9sion organique visible, 6 \u00e0 30 mois avant le diagnostic cardiologique. La macroglossie touche plus de 15 % des patients au diagnostic d&rsquo;amylose AL et r\u00e9gresse sous traitement de fond. Devant un tableau ORL atypique associ\u00e9 \u00e0 d&rsquo;autres signes \u00e9vocateurs (canal carpien, dyspn\u00e9e, ecchymose p\u00e9riorbitaire), il convient d&rsquo;adresser rapidement le patient \u00e0 un centre expert du R\u00e9seau Amylose.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7739a40 elementor-widget elementor-widget-text-editor\" data-id=\"7739a40\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>R\u00e9dig\u00e9 par<\/strong> : Contenu r\u00e9dig\u00e9 par l&rsquo;\u00e9quipe du Centre de r\u00e9f\u00e9rence des Amyloses Cardiaques<\/li><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>Relu \/ valid\u00e9 par<\/strong> : Pr Thibaud DAMY, cardiologue, Coordonateur du CRAC Centre de R\u00e9f\u00e9rence des Amyloses Cardiaques APHP &#8211; CHU Henri-Mondor<\/li><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>Date de derni\u00e8re mise \u00e0 jour<\/strong> 08\/2026<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Pour l&rsquo;ORL D\u00e9pister, diagnostiquer et prendre en charge les amylose cardiaques Les atteintes ORL (surdit\u00e9, dysphonie, dysphagie, macroglossie) surviennent fr\u00e9quemment avant les sympt\u00f4mes cardiologiques de l&rsquo;amylose \u2014 la surdit\u00e9 peut pr\u00e9c\u00e9der le diagnostic cardiaque jusqu&rsquo;\u00e0 120 mois. Un tableau audiom\u00e9trique atypique pour une presbyacousie, associ\u00e9 \u00e0 d&rsquo;autres \u00ab red flags \u00bb, doit conduire \u00e0 adresser [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-2839","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Amylose cardiaque \u2014 Ce que l&#039;ORL doit savoir - R\u00e9seau Amylose<\/title>\n<meta name=\"description\" content=\"Surdit\u00e9, dysphonie, dysphagie, macroglossie : physiopathologie, diagnostic et prise en charge des atteintes ORL de l&#039;amylose.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-lorl\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Amylose cardiaque \u2014 Ce que l&#039;ORL doit savoir - 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