Phoniatrics forms a separate medical specialty, which until 1993 was a subspecialty of otolaryngology (ENT). Phoniatrics deals with hearing, voice, and speech disorders, as well as swallowing difficulties, and carries strong interdisciplinary characteristics. Together with pediatric audiology, which deals primarily with problems in children’s voice and speech development and hearing perception, phoniatrics establishes an independent specialist field in Germany and Europe.
What is phoniatrics?
The medical specialty of phoniatrics is centered around hearing problems, disorders of voice and speech, and disorders of swallowing. The medical specialty of phoniatrics is centered around the topics of hearing problems, disorders of voice and speech, and disorders of swallowing. Phoniatrics is highly interdisciplinary because it deals not only with medical-physiological problems but also, to some extent, with non-medical problems. Therefore, other medical and non-medical specialties such as neurology, psychiatry, geriatrics, orthodontics, speech therapy and some others are included. In Germany, phoniatrics together with pedaudiology, which deals with corresponding child developmental and perceptual disorders, forms an independent specialty, which was renamed in 2004 from Facharzt für Phoniatrie und Pädaudiologie to Facharzt für Sprach-, Stimm- und Kindliche Hörstörungen. Additional specialist training includes 2 years of basic training in the field of otolaryngology and 3 years of specialized training in the fields of voice and speech disorders and the field of childhood hearing disorders. The origins of the medical specialty of phoniatrics can be traced back to Hermann Gutzmann Sr. who used the topic of speech disorders in his habilitation thesis in 1905.
Treatments and therapies
Diseases and symptoms that can be diagnosed and treated in phoniatrics are typically related to disorders of the voice, speech, and fluency (stuttering) or to swallowing or hearing problems. It does not matter whether the problems are of medical-physiological origin, e.g., due to injury, surgery, or illness, or whether the problems are based on social-psychological conditions. This also illustrates the holistic, interdisciplinary approach of phoniatrics, which is also evident in the treatment of voice disorders that can occur due to organic causes or are functionally based, such as those caused by overuse or, in rare cases, the effects of shock. Speech and language disorders (dysarthria and aphasia) of adults can occur due to voice disorders, but are usually based on neurological problems due to failure of certain brain areas after a stroke or due to a brain tumor. Speech flow disorders such as stuttering are also a clinical picture that falls within the treatment spectrum of phoniatrics. The swallowing process, which is also the subject of phoniatrics, involves the ingestion, comminution and transport of solid or liquid food and saliva from the mouth to the stomach, with transport through the esophagus occurring involuntarily through appropriate peristaltic movements of the esophagus. In addition to organic problems, there are a number of reasons why dysphagia may occur and require careful diagnosis and treatment. Hearing disorders in adulthood can also have a variety of causes in addition to organic changes due to injury, surgery or age, and therefore also fall within the treatment spectrum of phoniatrics. A special area of treatment with great challenges is offered by voice adjustment in gender reassignment surgery, in order for converted women or men to also adjust the pitch of their voice to their new gender as a woman or man.
Diagnosis and examination methods
Hearing disorders in adults usually manifest symptomatically as hearing loss. The causes can be very diverse and cover a wide spectrum, ranging from simple obstruction of the external auditory canal by earwax to ossifications in the middle ear or damage to the eardrum to sound conversion into nerve impulses in the inner ear or problems with the further processing of the nerve impulses in the brain.For diagnosis, in addition to otoscopy, several subjective and objective audiometric procedures are available to localize the causes of hearing problems. If the presence of a voice disorder is suspected, and a carefully conducted anamnesis, in order to be able to exclude certain causes for the possible voice disorder from the previous conditions and the course of the complaints. Further diagnostic procedures such as electromyography (EMG) of the laryngeal muscles and/or electroglottography may follow to identify or rule out organic problems. Electroglottography is a non-invasive procedure that records the function of both vocal folds, i.e., their vibration cycle, in an electroglottogram and allows conclusions to be drawn about the functioning of both vocal folds. Further diagnoses such as magnetic resonance imaging of the head to the upper chest cavity can provide conclusions about any infections present and the integrity of the laryngeal nerve. Depending on the diagnosis, therapy options include logopedic treatments, which can also be supplemented by logopedic therapy devices that the patient can use himself at home with ongoing monitoring of success. In some cases, various surgical treatment methods (phonosurgery) are also available. In the case of spasmodic dysphonia, where the vocal folds largely lose their function due to muscle spasms, the injection of botulinum toxin into the larynx can provide relief, at least for some time. In the case of voice and speech disorders without identifiable organic causes, there are a number of logopedic voice therapies that involve voice production, breathing, articulation, and the patient’s personality. In many cases, stimulation current therapy in the area of the larynx can accompany the therapy and promote and shorten the success of the treatment. In the case of existing swallowing problems, fiberendoscopic swallowing examination (FEES) is often used as a diagnostic procedure to visually assess the swallowing process with a flexible optic that is inserted through the nose. Therapies of choice include logopedic swallowing therapy or, in the presence of localizable organic damage, appropriate surgical measures.
