| Canada Murray Morrison (Vancouver) Professional state Indendependent specialty of its own standing? in Canada, phoniatrics is not an independent specialty of its own standing. Equivalent services to persons with communication disorders are provided by a combination of individuals including otolaryngologists, speech pathologists, audiologists and probably others as well. I believe that the situation in Canada is very similar to that of the United States. . Official subspecialty to ENT Laryngology may be considered a subspecialty of ENT, but in this country a laryngologist does not receive the broad training in communication that would be expected within a phoniatrics program in Europe. As multi-disciplinary voice clinics evolve, laryngologists within them share skills and expertise with others on the team, particularly speech pathologists, to the point where the otolaryngologist members acquire a much wider range of knowledge and skills. This means that the laryngologist may be able to provide services to patients in a manner more closely resembling the European phoniatrist. . Official subspecialty to others? . Unofficial specialization as to voice? speech? language? hearing? Most individuals that develop special interest in voice, speech, language and hearing do so from a background in speech pathology or audiology, rather than Otolaryngology. . Number of university departments There are 13 Otolaryngology training programs in Canada, 10 anglophone andthree francophone. . Number of doctors working in the field There are approximately 700 otolaryngologists practicing in Canada. One, (MM) has a practice totally dedicated to laryngology and voice disorders. Within most of the major centers in Canada there is an otolaryngologist with a voice care interest who works in cooperation with a speech pathologist to care for voice disordered patients. There are a number of Otolaryngologists in Canada with added experience and training in laryngology and voice. The list includes: Halifax: Dr Elhami Attia Quebec: Dr Guy Parent Montreal: Dr Karen Kost, Dr Francoise Chagnon Toronto: Dr Peter Alberti, Dr Jonathan Irish, Dr Jennifer Anderson My current fellow, Dr Simon Gagnon, will be returning to Quebec next year. Vancouver is the only site in Canada with a laryngology fellowship. . relevant web sites for links http://www.pvcrp.com (Pacific Voice Clinic in Vancouver) Canadian Society of Otolaryngology - Head and Neck surgery: http://www.csohns.com Education and training . program and examination for specialization Otolaryngologists who wish to sub-specialize in laryngology and voice disorders take a fellowship, usually one year in length, some time after completion of their residency. The fellowships will usually consist of a combination of clinical and research experience. Similarly, graduate speech pathologists wishing to pursue a career in voice will receive extra training within a multi-disciplinary academic voice clinic, usually as part of a Ph.D. program. I enclose here a copy of our own fellowship description. . University of British Columbia/Pacific Voice Clinic Fellowship Laryngology is a subspecialty of Otolaryngology-Head & Neck Surgery that encompasses the diagnosis and treatment of those laryngo-pharyngo-esophageal disorders that cause problems with voice production, swallowing, and the laryngeal airway. A broad spectrum of benign and malignant disease affects this part of the aerodigestive tract and a rapidly enlarging armamentarium of technological advances permits a clearer understanding of the complexity of interconnected processes. New treatments such as botulinum toxin injections for laryngeal dystonia, thyroplasty techniques for altering position or tension of the vocal folds, and microscopic and laser procedures for managing laryngotrachael stenosis and laryngeal malignancies have become common, but are not familiar to a large proportion of practicing otolaryngologists. The goals of this training program are 1) to provide the fellow with advanced experience in diagnosis and treatment of laryngeal disorders, 2) to provide basic clinical research experience with a specific focus on neurolaryngology, and 3) to create an environment that will stimulate the participant to pursue a career in academic Otolaryngology. This one year fellowship will provide broad clinical experience in laryngology and voice disorders, basic and clinical research in laryngology, and didactic teaching. The fellow will take an active role in all multidisciplinary voice assessments including regular interaction with the Pacific Voice Clinic staff including laryngologist Dr Murray Morrison and speech pathologist Dr Linda Rammage; and frequent interaction with psychiatrist Dr. Hamish Nichol and singing teacher Bruce Pullan. The fellow will have ample opportunity to act in the role of primary care giver, but always with advice and support close at hand. In order to satisfactorily complete this fellowship the fellow will: - acquire competence in the diagnosis of laryngeal and related disorders and in a variety of surgical procedures including use of botulinum toxin for laryngeal and craniocervical dystonias; thyroplasty techniques for the management of laryngeal paralysis; and microscopic, laser, and open techniques for management of benign and malignant diseases of the larynx - develop a firm understanding of laryngeal anatomy and physiology, necessary for high quality clinical practice and as a platform for investigative ideas, acquire an in-depth knowledge of the principles and practice of voice therapy and rehabilitation - become familiar with the basics of vocal pedagogy to the level required for effective communication with the community of singing teachers and singer patients - develop skill in basic laryngological research techniques such as acoustic analysis, phonatory airflow and pressure studies, esophageal manometry/pH testing, laryngeal EMG, and EGG among others - become a highly skillful video-laryngo-stroboscopist - attend weekly conferences including Otolaryngology Grand Rounds, BCCA, tumor conferences and coordinate the weekly difficult-case-of-the-week conference - Teaching and resident training: The laryngology fellow will not negatively impact on the training of UBC residents in Otolaryngology. Rather s/he will augment the training of residents since the increased volume of laryngeal cases will result in more exposure to, and discussion of, laryngeal disorders for residents and other students. The fellow will be expected to play a „casual“ teaching role as a part of all activities. - Research project The fellow will be required to participate in basic science and/or clinical research. The basic science research will focus on neurolaryngology and may include studies on coordination of laryngeal muscle systems, sensory-motor reactions of the aero-digestive tract or laryngeal EMG and muscle stimulation studies. The clinical research project may be in any of a wide range of disorders seen in the daily voice clinics, and will make use of a video-tape library of more than 10,000 laryngoscopies all of which are indexed in a dBase data bank. The fellow will present updates on his/her research at monthly research meetings and is expected to complete the research project and submit to a national meeting for presentation and publication. Phoniatrics in the frame of ENT, program and examination - postgraduate programs Described above - there is no examination as yet. Research, main topics Morrison - Irritable Larynx Syndrome, recurrent papilloma, spasmodic dysphonia, laryngeal breathing disorders, laryngeal maninfestations of reflux, vocal paralysis. Rammage - Occupational voice disorders, group approaches to voice therapy, parkinsons disease and voice. H Nichol - psychiatric and psychological aspects of voice disorders. B Pullan - singing in children, the singing teacher in the voice clinic. Associations . Canadian society of Otolaryngology Head & Neck Surgery. . Canadian Voice Care Foundation Based in Calgary, Alberta. Director is Katharine Ardo. Literature Morrison and Rammage: The management of voice disorders. Singular Press 1994 - second edition in preparation. Koschkee and Rammage: Voice care in the medical setting. Singular Press 1997 Rammage: Vocalizing with ease: a self improvement guide - see the pvcrp website (http://www.pvcrp.com) for details. |