ABSTRACT
Communication disorders represent a major and growing problem worldwide. In Europe, the specialty of phoniatrics has developed partly in response to this important issue. This article reviews training and workforce issues in phoniatrics and raises key questions and issues that need resolution in the future.
Subject(s)
Communication Disorders/therapy , Speech Acoustics , Speech-Language Pathology/methods , Education, Medical, Graduate , Europe , Forecasting , Health Services Accessibility , Humans , Speech-Language Pathology/education , Speech-Language Pathology/trendsABSTRACT
A 46-year-old woman with Shy-Drager syndrome is presented. She has impaired vocal fold abduction during sleep, but has no laryngeal dysfunction while she is awake. In order to reduce laryngeal obstruction during sleep, she initially underwent laterofixation of 1 vocal fold (Ejnell's method) with little lasting success because of accidental slipping of the ligature. Later, she successively underwent arytenoidectomy with the use of CO2 laser. Her noctural breathing improved markedly after arytenoidectomy.
Subject(s)
Airway Obstruction/physiopathology , Airway Obstruction/surgery , Shy-Drager Syndrome , Sleep , Vocal Cords/physiopathology , Vocal Cords/surgery , Airway Obstruction/diagnosis , Electromyography , Female , Humans , Laryngoscopy , Middle Aged , Otorhinolaryngologic Surgical Procedures , PolysomnographyABSTRACT
Proper assessment of patients with velopharyngeal valve incompetence is a mandatory prerequisite for optimal management. The protocol of assessment of Ain Shams University, Phoniatric Department, uses three levels of assessment of velopharyngeal valve incompetence according to the complexity of the armamentarium used. This allows application of those parts of the protocol that suit the needs of the different socioeconomic levels and geographical locations. Firstly, the elementary diagnostic procedures, which are rather simple, noninvasive, but essentially subjective. Despite the clinical feasibility of these procedures, documentation of the data is made utilizing the tools at the second level of assessment in that protocol (clinical diagnostic aids). This level comprises video-nasofiberscopy and high fidelity voice recording. An attempt to extract quasi-quantitative measures from the hitherto qualitative video-nasofiberscopy is made. The third level of assessment, namely additional instrumental measures, comprises CT scanning of the velopharyngeal port, aerodynamics, and acoustic analysis. The results of the three levels of the protocol are presented. Their significance and clinical efficacy are discussed. Some community-related problems that have faced the cleft palate team are outlined. Their sociocultural significance in a developing country is discussed.
