Speech, Voice, and Childhood Hearing Disorders: Phoniatrics and Pediatric Audiology

The origins of phoniatrics and pediatric audiology date back to the mid-19th century, when the first experiments were performed on larynxes and on the examination of the larynx in the living using external light sources. This was later followed by pioneering work in speech (A. Gutzmann, 1879) and stuttering (H. Gutzmann). After World War II, the subject gradually developed into an independent discipline in Europe. In the Anglo-Saxon countries (especially in the USA) this development took place under the generic term “speech pathology” and brought together representatives of different disciplines (psychologists, philosophers, linguists and pedagogues – medical doctors were rather the exception). In 1972, the first clinic for communication disorders was established in Mainz under the direction of Biesalsky.

Today, phoniatrics and pediatric audiology is firmly established in Germany and numerous European countries and deals with all disorders of voice, speech and language as well as childhood hearing disorders. The classification of childhood hearing disorders results from the fact that hearing loss in early childhood, if left untreated, inevitably leads to a speech development disorder, because the affected child cannot hear the speech of others and thus cannot develop it himself. If these children are not provided with hearing aids or inner ear implants in time, the so-called “speech-sensitive phase” (until the end of the 4th year of life) is lost, which is why early diagnosis is important. Voice disorders concern, in addition to organic diseases, the so-called “functional” voice disorders, where there are no diseases to be treated surgically, but the problem lies in an incorrect voice and breathing technique. Speech disorders include, for example, articulation disorders (diseases of the speech organs, such as in neurological diseases like nerve paralysis or after tumor operations) or disorders of the speech process (stuttering). Speech disorders, on the other hand, affect the patient’s linguistic competence, which can be severely restricted, for example, after an apoplexy (stroke), a craniocerebral trauma (TBI) or after brain surgery – language must be relearned. This also includes language development disorders in children, which also exist without underlying hearing disorders.

The main field of work of specialists in phoniatrics and pediatric audiology is the sometimes very extensive diagnosis of these diseases and the initiation of the necessary therapy, e.g. the prescription of speech therapy. In clinics or affiliated departments, phoniatrists also perform surgical procedures, e.g. ablation of tissue changes on vocal folds or to improve voice quality after paralysis or surgery (“phonosurgery”).

The numerous schools of speech-language pathology that train therapists to address these disorders are predominantly led by specialists in phoniatrics and pediatric audiology.

Although this is a rather “small” specialty (which refers exclusively to the number of recognized specialists in Germany!), its importance is constantly increasing because of the increasing frequency of speech development problems, especially in children. Too early television consumption and not child-appropriate adequate language offer in the domestic surrounding field are – among other things – causes for it. Voice disorders are also becoming increasingly common in our ever more hectic and noisy times.

This circumstance was taken into account a few years ago when the “Specialist in Phoniatrics and Pediatric Audiology” was recognized in the continuing medical education with its own curriculum.