Training Program Phoniatrics

Based on a first UEP-draft from 1983 and updated several times

Definition
Phoniatrics is the medical specialty for communication disorders, concerned with diseases and disorders of voice, speech, language, hearing (in so far as hearing impairment has its effects on any of the areas previously mentioned) and swallowing.

The specialty is based on the anatomical, physiological, diagnostic and therapeutic principles of otorhinolaryngology and also on other medical disciplines (e.g. neurology, psychiatrics, pediatrics, dentistry, orthodontics) and non-medical sciences (e.g. linguistics, phonetics, psychology, behavior sciences, pedagogics, acoustics, communication sciences).

These fundamentals guarantee that physical, developmental, functional and behavioral aspects of verbal communication can be taken care of in phoniatrics with competence.

As a consequence, a phoniatrician can be said to have a responsibility of his own, to have a coordinating task and to be competent as to the whole of prophylaxis, diagnostics, therapeutics, rehabilitation, medical report (also on fitness for special activities), teaching and research, with reference to the diseases and disorders previously mentioned.

"Common Trunk" in Training
Contents, structure and duration of phoniatric training programs have to be fixed in accordance with general national and European rules and regulations. For a common trunk, UEP recommends the following guidelines.

Theoretical, practical and medical-technical elements in the vocational training in phoniatrics

1. Enlargement of basic knowledge

The basic medical knowledge has to be enlarged and made more thorough primarily by the study in detail of the anatomy, physiology and pathological physiology of the functions of voice, speech, language, hearing, and swallowing.
Knowledge of the neurophysiological principles of the central encoding, decoding, memory and integration processes in speech, hearing, and swallowing.
Knowledge of genetic principles and the influence of the environment in the development of language, speech, hearing, and swallowing abilities.
Knowledge of developmental and aging processes as to voice, language, speech, hearing, and swallowing.
Knowledge of psychological and behavioral aspects of verbal communication.

2. Specific knowledge, competence and skill

One has to prove to have specific knowledge, competence, skill and experience in the epidemiology, etiology, pathogenesis, prophylaxis, clinical physiology, diagnostics, differential diagnostics, therapeutics and rehabilitation of the following disorders:

Congenital voice disorders
Developmental voice disorders
Dysphonia caused by hormones
Functional voice disorders with and without secondary organic lesions in the larynx, including occupational dysphonia and also singers’ voice
Dysphonia as a result of organic alterations in the larynx
Voice disorders due to neurological and psychiatric diseases, including vocal fold paralysis
Voice disorders after operation or trauma of the larynx
Nasality, including cleft palate
Delayed speech development
Disorders of reading, writing and calculating (dyslexia, dysgraphia)
Organic and functional articulation disorders
Dysfluency (stuttering and cluttering)
Dysphasia, aphasia
Other speech and language disorders in neurological and psychiatric diseases
- Central and peripheral hearing disorders in children
- Acoustic agnosia
- Dysphagias (structural lesions, movement disorders)

2.1. Specific knowledge of and experience in diagnostics, as to
- Examination of phonatory respiration
- Analysis of vocal fold vibration
- Direct and indirect micro-laryngoscopy
- Auditory and instrumental analysis of voice and speech sounds
- Examination of central and peripheral speech and language functions
including appropriate testing
- Subjective and objective methods for testing of the peripheral and central hearing functions
- Morphological and functional examination of the swallowing apparatus

2.2. Specific knowledge of and experience in therapy, as to
- Drug therapy in inflammatory, neurogenic and psychogenic disorders
in the domain of phoniatrics
- Surgical therapy in order to improve voice and speech functions
- Physical therapy in the treatment of voice, speech and language disorders
- Rehabilitation methods for speakers’ and singers’ voice
- Rehabilitation methods for nasality
- Rehabilitation of the laryngectomized
- Rehabilitation methods in delayed speech development
- Rehabilitation methods for the correction of articulation errors
- Rehabilitation methods for stutterers and clutterers
- Rehabilitation methods in dysphasia and aphasia
- Rehabilitation methods in dysphagias
- Procedures of behavior and psychotherapy
- Complete rehabilitation for hard of hearing children,
including auditory training, fitting and use of hearing aids and cochlear implants

3. Specific knowledge, competence and skill from other disciplines required for phoniatricians

Besides professional knowledge in the field of speech therapy, selected knowledge is required from the following disciplines:
acoustics, electronics, information theory, phonetics, linguistics, pedagogics, psychology and
behavior sciences.
This will form the starting point for the formation of a phoniatrician and also the basis for interdisciplinary cooperation.

4. On the basis of the knowledge, competence, and skill he has acquired during his training a phoniatrician must also be prepared to fulfill the following important tasks:
Examination on one’s own responsibility as to the fitness for so called voice professions,
medical report on vocational unfitness and disability
Medical care for voice professions
Collaboration in early detection of laryngeal malignancies
Organization and guidance of phoniatric institutes
Education of physicians and speech therapists

Conditions to be fulfilled with respect to training centers and supervisors
The training of phoniatricians takes place under the responsibility of authorized teachers and in recognized phoniatric training institutes.
The selection of the training institutes and the teachers in phoniatrics as well as the affirmation of having fulfilled the requirements to be recognized as a phoniatrician is done by an official council of phoniatricians. `

Number of Phoniatricans needed
On the basis of morbidity analyses and practical experience in countries provided relatively well with phoniatricians, it can be said that there has to be 1 phoniatrician in every 200,000 inhabitants for the medical care in public health.