Paper on Basic Phoniatric Education in the frame of ENT-Training Programs Accepted by the General Assembly of IFOS at the ORL World Congress in Istanbul 1993, Published in IFOS Newsletter, Autumn 1993 1. Preamble Phoniatrics is the medical specialty for communication disorders in terms of diseases and dysfunctions of voice, speech, language and hearing (in so far as hearing impairment has its effects on any of the areas previously mentioned). The speciality is based on the anatomical, physiological, diagnostic, therapeutic, habilitative and rehabilitative principles of otorhinolaryngology, and also on other medical disciplines (e.g., neurology, psychiatrics, paediatrics, dentistry, orthodontics) and non-medical sciences (e.g. logopedics, speech pathology, linguistics, phonetics, psychology, behaviour sciences, pedagogics, acoustics, communication sciences). These fundamentals guarantee that physical, development, functional and behavioral aspects of communication are being taken care of by competent physicians. 2. Premises At the XIII World Congress of Otorhinolaryngology & Head and Neck Surgery in Miami, 1985, the Executive Committee and the General Assembly of IFOS adopted the following recommendation: „Phoniatrics, a medical specialty dealing with communication disorders, should be recognized as a subspecialty of otorhinolaryngology and should be included in the primary training of ear, nose, and throat specialists“. Mean-time, different developments have taken place in different parts of the world. In some more countries, phoniatrics has reached the status of an independent specialty of its own standing, in others, even the name of this special field is, still, unknown. But, there is generally no doubt that communication disorders are closely related to the traditional area of otorhinolaryngology and that the general ENT doctor urgently needs a basic phoniatric education in the frame of his/her postgraduate training program. In spite of being a subspecialty of otorhinolaryngology, phoniatrics is, in most of the countries, under-represented or even non-represented in the basic training program for ENT specialists. Thus, in accordance with the position of WHO concerning „Medical Specialization in Relation to Health Needs“ (1985) and concerning the IFOS statement of 1985 mentioned above, IFOS adopts the following, more specified recommendation as a basis document in relation to ENT training. 3. Training programs ENT training programs shall, obligatorily, include basic education in phoniatrics. This basic program should contain: Enlarged knowledge of physiology of voice, speech, language, hearing, and swallowing Basic knowledge of acoustics, phonetics, phonology, linguistics, psychology and behaviour sciences Basic knowledge, competence, skill and experience in the epidemiology, etiology, pathogenesis, prophylaxis, clinical physiology of organic and functional voice disorders, organic and functional articulation disorders including nasality, disfluency disorders (stuttering and cluttering), central and peripheral hearing disorders in children, delayed and deviant language development, dysphasia - aphasia, dysarthria, dyspraxia, dysphagia Basic knowledge of and experience in diagnostics as to: examinations of phonatory respiration, analysis of vocal folds’ vibration (stroboscopy, aerodynamics, glottography etc. ...), perceptual and instrumental analysis of voice and speech sounds (voice range profiles, spectrograms, etc. ...), examination of central and peripheral speech and language functions, subjective and objective methods of the peripheral and central hearing testing, examination of swallowing disorders Basic knowledge and experience in therapy, as to medical therapies and rehabilitation methods for voice, speech, language disorders, hearing impaired children, swallowing problems. 4. General considerations The training program should include theoretical as well as clinical and basic skill training in phoniatrics. Not only physical, but also developmental, functional, and behavioral aspects of verbal communication should be represented. Further aspects are being considered to be highly desirable, even if they may not be applicable in many countries for the time being: To spread the training program over different years: a first introduction of phoniatrics, including physiology and pathophysiology of voice, speech, language, hearing and swallowing, at the beginning of the 2nd year, a more detailed and extensive program in the 3rd or 4th year A period of clinical phoniatric practicum following the theoretical part of the training In case of an examination at the end of the ENT training, basics of phoniatrics shall be an obligatory part of it. A competent phoniatrician shall be a full member of the Central Board of Examiners. Depending on national situations, the training program can be organized at a local, regional or national level by those competent in phoniatrics or by National Associations for Phoniatrics. In case there are no phoniatricians and no corresponding medical associations existing in an area given, The Standing IFOS Committee on Phoniatrics & Voice Care is ready to offer courses in close cooperation with the Committee on Educational Affairs of the International Association of Logopedics and Phoniatrics on a non-profit basis to the National ORL Societies. 5. Conclusion Considering extended discussions in the framework of national and international phoniatric societies and among many members of IFOS, our basis is, now as before, a philosophy which promotes phoniatrics as a special medical field for communication disorders which is closely related to the area of ORL. In this connection, IFOS, as an international organization, respects that the official status of phoniatrics varies to a high degree with regard to different countries. Being fully aware that IFOS is not entitled to control the system of medical education or that of medical practice in any country, IFOS, nevertheless, considers a systematically organized and officially recognized basic training program in phoniatrics to be an essential and integrated part of every ENT training program. IFOS recommends that all countries shall aim at this goal. References 1. Medical specialization in relation to health needs. WHO Regional Office for Europe, Copenhagen 1985 2. Paper for the admission of phoniatrics as a subspeciality in otorhinolaryngology (also in French, German, and Russian). Ann. Bull. UEP 1 (1983): 27-44 3. Paper on basic phoniatric education in the frame of ENT-training programs in Europe Ann. Bull. UEP 5 (1987): 59-62 4. Phoniatrics, a subspeciality of otolaryngology. IFOS Newsletter, December 1986 5. Wellens, W., Wendler, J.: Phoniatrics in the general frame of otorhinolaryngology. Arch. Otorhinolaryngol. 246 (1989): 392-394 6. Wendler, J., Wellens, W.: Professional aspects of phoniatrics: definition and training. Otorhinolaryngology, Head and Neck Surgery. Proc. XIV. World Congr., Madrid, September 1989, Kugler & Ghedini Publ., Amsterdam/Milano/New York 1991, pp.2071-2078