Brazil Paulo Pontes (Sao Paulo) - IFOS Regional Secretariat for South and Central America FAX #(+5511) 539.5013 / e-mail: ppontes@mandic.com.br In 1964, during the first most important meeting on phoniatry and basic logopedy in Rio de Janeiro, a group of doctors organized by Dr. Pedro Bloch has defined the statements to create a Specialty of Phoniatry in Brazil. Resulting from the work of this group, in November, 1973, the Medical Brazilian Association (Associaco Medica Brasileira - AMB) approved the inclusion of phoniatry as a medical specialty. In 1974, it was created the Brazilian Association of Phoniatry and Audiology (Associacao Brasileira de Foniatria e Audiologia - ABRAFA) associated to the Latin American Federation of Phoniatry Logopedy and Audiology Societies. (Federacao Latino-Americana das Sociedades de Foniatria Logopedia e Audiologia - FLASFLA), which has actuated until 1983. Mauro Spinelli, Paulo Pontes, Irene Abramovich and Alfredo Tabith were the presidents of this association. In 1996, the AMB has unfortunately decided not continue conferring the title of phoniatrician specialist due to the lacking number of physicians involved. However, with the developing interest in the field of communication disorders, the physicians who has focused their work in this area, are now trying to reorganize the Brazilian Society of Phoniatry with a scientific purpose, yet not having the authority to confer the specialist degree. Nowadays, the field of communication disorders and the specific area of voice and speech problems, have being assessed by both otolaryngologists (ORL) and speech-language pathologists (SLP). The responsibilities of the formers are the medical diagnosis and treatment, including surgical procedures, while the lasts are responsible for functional diagnosis and rehabilitation treatment. Besides the otolaryngologists, a few number of neurologists has being working with speech and language disorders, as phoniatricians. The national society that assumes the nearest role of phoniatry is the Brazilian Otolaryngology Society (Sociedade Brasileira de Otorrinolaringologia - SBORL) through the Brazilian Society of Laryngology and Voice (Sociedade Brasileira de Laringologia e Voz - SBLV), that results from the intersection with Brazilian Society of Speech-Language Pathology (Sociedade Brasileira de Fonoaudiologia - SBFa). These institutions has their own websites and each one of them includes many indications of interesting links (attached). Today, we count on approximately 78 medical universities and 60 speech-language pathology bachelor courses. Even without specific departments for phoniatry, some medical universities count on departments for communication disorders. Some courses for speech-language pathology are independent and characterize a college, while others belong to public and private universities. The minimum program for graduation on medicine is 6 years of undergraduate program plus 3 years of medical residence. The SBORL have one ORL department for each Brazilian State and annually applies a theoretical and a practical examinations for physicians who have concluded the 3 years of medical residence, in order to confer the ORL specialist degree. The SLP bachelor course requires a minimum of 4 years of undergraduate program. The Federal Council of Speech-Language Pathology (Concelho Federal de Fonoaudiologia - CFFa) has implemented the specialty degree in the voice field in 1995, for which it is required 2 years of a specialization course, in any institution recognized by the Council. Research has being performed mostly in the governmental education institutions. However, there are many non governmental centers, which has decisively contributed to this area. The most representative governmental institutions for research in voice speech and language field in Brazil are: * Universidade Federal de Sao Paulo (UNIFESP- EPM), Sao Paulo - SP * Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo - SP * Universidade Estadual de Campinas (UNICAMP), Campinas - SP * Universidade Federal de Santa Maria (UFSM), Santa Maria - RS * Universidade Federal do Rio de Janeiro (UFRJ), Rio de janeiro - RJ Some of the most important non-governmental centers that has contributed in education and research and directors are: * Instituto da Laringe (INLAR), Sao Paulo - SP: Paulo Pontes, MD * Centro de Estudos da Voz (CEV), Sao Paulo - SP: Mara Behlau, PhD * Instituto de Foniatria e Fonoaudiologia (IFF), Campinas - SP: Evaldo Rodrigues, MD * Pontificia Universidade Catolica (PUC), Depto. de Educacao e Reabilitacao em Disturbios da Comunicacao (DERDIC), Sao Paulo - SP: Mauro Spinelli, MD Instituto de Voz e Fala, Belo Horizonte - MG: Elisio Nascimento Batista, MD * Centro de Especializacao em Fonoaudiologia Clinica (CEFAC), Sao Paulo - SP: Irene Marchesan, PhD In Brazil, there are around 15000 Speech Language Pathologists, with more than 600 working in the field of voice and approximately 5000 ORLs, being 400 laryngologists in voice field. The most important personalities in Brazil are certainly Dr. Pedro Bloch, who was the first phoniatrician of the country, Dr. Mauro Spinelli , who has developed an important work, promoting the school for Phoniatry of PUC-SP, Dr. Elisio Nascimento Batista, who has organized the first governmental clinic center for phoniatry not associated with any university and Dr. Paulo Pontes who has implemented and developed the school for phonosurgical procedures in the last decades. Their inestimable contribution has empowered and strengthened the field, being widely recognized. Dr. Pedro Bloch who has intensively actuated at IALP, founded the Department of Phoniatry at the Otolaryngology Society of Rio de Janeiro (Sociedade de Otorrinolaringologia do Rio de Janeiro - SORJ) in the end of the 50's. He has ministered courses of phoniatry and logopedy in the 60's, at the School of Rehabilitation of Rio de Janeiro (Escola de Reabilitacao do Rio de Janeiro), from where many physicians got their specialist degree. Since this time we have experienced a large period of gradual progress and many realizations. The main contribution of Dr. Bloch and his group is the holistic analysis of the human's voice problems, considering the progresses of the anatomo-physiologic studies applied to the methods of evaluation, diagnosis and treatment. Dr. Mauro Spinelli is the full professor of PUC-SP, actuating mostly at the post-graduation programs. He has developed basic studies and research systems in post-graduation and specialization programs specifically related to voice, hearing, language and speech pathology. He has studied with Professor Julio Bernaldo Quiros, in Buenos Aires in 1964, as well as Paulo Americo Morganti, who was the first phoniatrician in Sao Paulo. Mauro Spinelli has contributed to the specialization of many eminent Brazilians phoniatricians as: Alfredo Tabith Jr., Fernando Carvalho Silva, Evaldo Rodrigues, Maria Helena Ermel, Maria Estala Figueiredo, Sulene Pirana e Heloisa de Nubia. Dr. Elisio Nascimento Batista was full professor of the Department for Phoniatry of the Speech-Language Pathology course at the Isabela Hendrix Institute (Instituto Metodista Isabella Hendrix). He has created the Minas Rehabilitation Association (Associacao Mineira de Reabilitacao), a non profit organization that provides free assistance to children with communication disorders. In 1969, he founded the Institute for Voice and Speech (Instituto da Voz e da Fala), a private center in the area of phoniatry. Dr. Paulo Pontes studied with Professor Hans Von Leden in Los Angeles, 1970. He introduced and standardized the laryngeal microsurgical procedures, as well as the basis for the post phonosurgery rehabilitation process, including the implementation of the voice laboratory in Brazil. Is full professor at the Department of Otolaryngology and Communication Disorders at the UNIFESP-PM. At this institution, he has decisively actuated in the development of the post graduation programs in the field of laryngology and voice. Arnaldo Guilherme and Orlando Armelin are phoniatricians specialized at this school. He is the director of the INLAR, being responsible for many international scientific publications. From the Neurology, there are some important phoniatrics that are contribution to the language disorders as: Irene Abramovich, from Sao Paulo University (Universidade de Sao Paulo - USP) was assistant of the Antonio B. Lefevre. Other phoniatricians who has developed an expressive work, are: Gisela de Almeida Batista, José Carlos Lassi Caldeira, Ismael Gomes, Evaldo J. B. Rodrigues, Ariovaldo Silva. Otolaryngologists that has given an important contribution to the phoniatry are: OsÌris CamponÍs do Brasil, Henrique O. Costa, Agricio Crespo, Claudia Eckley, Ivo Khul, Marcos Nemetz, Geraldo Druck Sant'Anna, Marcos Sarvat, Nedio Steffen and Domingos Tsuji. General contribution from Brazil to the voice field may be found in several articles in international publications such as: -de ANGELIS EC; MOURAO LF; FERRAZ HB; BEHLAU MS; PONTES PA; ANDRADE LA - Effect of voice rehabilitation on oral communication of Parkinson's disease patients. Acta Neurol Scand 1997 Oct;96(4):199-205 - CAMPONES DO BRASIL OO; PONTES PA; SPECK FILHO J; COSTA HO - Partial vertical laryngectomies and reconstruction with plathysma myocutaneous flap. Rev Laryngol Otol Rhinol (Bord) 1991;112(1):45-53 [Article in French] - CERNEA CR; FERRAZ AR; FURLANI J; MONTEIRO S; NISHIO S; HOJAIJ FC; DUTRA JUNIOR A; MARQUES LA; PONTES PA; BEVILACQUA RG - Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Am J Surg 1992 Dec;164(6):634-9 - KOWALSKI LP; FRANCO EL; DE ANDRADE SOBRINHO J; OLIVEIRA BV; PONTES PL - Prognostic factors in laryngeal cancer patients submitted to surgical treatment. J Surg Oncol 1991 Oct;48(2):87-95 - PINHO SM; PONTES PA; GADELHA ME; BIASI N - Vestibular vocal fold behavior during phonation in unilateral vocal fold paralysis. J Voice 1999 Mar;13(1):36-42 - PINHO SM; TSUJI DH; SENNES L; MENEZES M - Paradoxical vocal fold movement: a case report. J Voice; 11(3):368-72, 1997 Sep. -PONTES P & BEHLAU M - Treatment of sulcus vocalis: auditory perceptual and acoustical analysis of the slicing mucosa surgical technique. J Voice 1993 Dec;7(4):365-76 - PONTES PAL; BIASE NG; BEHLAU, M - Vascular characteristics of the vocal fold cover in control larynges and larynges with benign lesions. Phonoscope 1999, 2(3):129-35 - PONTES PAL; BIASE N; GADELHA ME - Clinical evolution of laryngeal granulomas treatment and prognosis. Laryngoscope 1999, 109(2):289-94 - PONTES PA; GADELHA ME; GREGORIO LC - Pathologic quiz case 2. Laryngeal syngamosis. Arch Otolaryngol Head Neck Surg 1993 May;119(5):570-1, 573-4 - VASSALLO J; ALTEMANI AM; CARDINALLI IA; CRESPO AN; LIMA CS; EID KA; SOUZA CA - Granulocytic sarcoma of the larynx preceding chronic myeloid leukemia. Pathol Res Pract; 189(9):1084-6; discussion 1086-9, 1993 Nov. Interesting links may be found at: English version available - EPM-UNIFESP - http://www.epm.br - PUC - http://www.pucsp.br - SBORL and SBLV - http://www.sborl.com.br Portuguese version only - FMUSP - http://www.usp.br/medicina - IFF - http://www.bestway.com.br/foniatria - UFRJ - http://www.ufrj.br - UFSM- http://www.ufsm.br - UNICAMP - http://www.unicamp.br