Phoniatrics: Information & Phoniatrists

In 1966, the Working Group of German-Speaking Phoniatrists was founded. This later gave rise to the German Society for Phoniatrics and Pediatric Audiology (Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.). Nevertheless, phoniatrics and pediatric audiology remained an unspecified fringe area of medicine until 1978.

Starting in 1978, these subfields were gradually integrated into otolaryngology, where they functioned as specialized disciplines. Following a resolution by the German Medical Assembly in 1993, both fields became fully recognized medical specialties.

Today, physicians can complete a five-year residency to become board-certified specialists in phoniatrics and pediatric audiology.

Most speech development disorders occur in early childhood. Accordingly, phoniatrics focuses primarily on the neurological characteristics of early childhood brain functions.

In this context, the specialty strives for the early detection of speech or swallowing disorders. Subsequently, it focuses on their rehabilitation.

However, communication difficulties can also arise later in life, for example as a result of psychological trauma. In collaboration with psychology, phoniatrics investigates the causes of these speech disorders.

There are now a number of research projects in the field of phoniatrics. These include, among other things,

• experiments such as singing and playing wind instruments to assess articulatory function, as well as
• studies of tongue motor function in cases of suspected neurological system disorders.

The fields of application for phoniatrics include all malformations of the oral and pharyngeal cavities that result in articulation problems and swallowing disorders.

Within phoniatrics, a distinction is made between various disorders:

• swallowing disorders and organic malformations, and
• articulation problems associated with speech and language disorders.

Many disorders are the result of a genetic predisposition. Possible inherited disorders include:

• Pierre Robin syndrome
• Treacher-Collins syndrome
• Charge syndrome
• Down syndrome (trisomy 21)
• Trisomy 13 and Trisomy 18

Speech disorders are defined by a neurological impairment of the speech apparatus, for example in cases of

• speech development delays,
• the absence of synaptic connections, or
• selective mutism (affected individuals speak only to certain people).

Examples of speech disorders may include:

• Difficulty finding the right words
• Difficulty distinguishing between sounds
• Syntax errors (difficulty forming grammatically correct sentences)
• Semantic misnomers (e.g., “cloud” instead of “sky”)

Speech disorders, on the other hand, refer to abnormalities in speech fluency and linguistic performance. Facial nerve paralysis is also classified as a speech disorder. Examples of speech disorders include:

• Stuttering (disjointed articulation)
• Mutism (silence)
• Cluttering (hasty articulation)
• Dyslalia (difficulty articulating sounds)
• Dysarthria (unclear, slurred speech)
• Dysglossia (caused by organic changes)

Speech-language
pathologists also work in phoniatrics © nellas | AdobeStock

In addition to the subcategories listed, the voice is also examined in detail to document changes or abnormalities and incorporate them into an overall picture. Possible causes of dysphonia (voice disorders):

• organic abnormalities (reflux, vocal cord nodules, paralysis)
• Polyps in the ENT area
• Chemical burns and injuries
• Respiratory tract infections

First, phoniatrists take the patient’s medical history (anamnesis) and examine the symptoms. They formulate an initial diagnosis, which they verify by seeking second opinions from other medical specialties.

Identifying the underlying cause is fundamental in cases of communication disorders. Do the symptoms stem from organic or neurological causes? Is there a psychological reason for the symptoms? Or might they be the result of a lingering infection?

Neurological tests are used to monitor brain activity and specific brain regions. With the help of diagnostic methods such as

• MRI,
• CT, and
• EEG

, damage or abnormalities in brain function can be identified.

Tests such as X-rays or acoustic speech tests are used to assess the function of the affected organs.

For swallowing difficulties, minimally invasive examinations can be performed through the nose and via the mouth. If a diagnosis is still difficult to make, a psychological cause is likely. In this case, psychologists or (speech) therapists are consulted.

The number of possible treatment methods is as wide-ranging as the spectrum of underlying causes themselves.

In cases of speech development disorders, such as disabilities or delays, speech therapy is often used.

If this type of therapy fails to resolve the communication difficulties and the problem potentially worsens, a form of so-called “augmentative and alternative communication” is often considered. With the help of special devices, it can contribute to improving communication abilities.

However, there are also surgical procedures in phoniatrics, such as adenotomy. This routine removal of the adenoids is typically initiated by an ear, nose, and throat (ENT) specialist. Phoniatrists also refer their patients for surgery if an organic obstruction is found to be the cause of swallowing and speech difficulties.