Introduction to Phoniatrics

Dr./ Ahmed Nabil Khattab

Assistant Professor of Phoniatrics
Phoniatrics unit
ENT department
Ain Shams Faculty of Medicine
 Phoniatrics

Is a speciality of Oto-rhino-laryngology.
It deals with disorders of communication,
which include disorders of voice, speech
and language.
Physiology of communication:

The process of communication entails four

physiological processes which are:

*Respiration which gives the effector energy that sets

the vocal folds into vibration

*Phonation is the process of vibrations of the vocal

folds to produce voice which is a primary laryngeal
sound.
* Articulation: is the process in which the primary
laryngeal sound is modified, amplified, reformed
and resonated to produce speech, which is the
specific sound units of spoken language.
* Symbolization which refers to the central
representation of language in the left cerebral
hemisphere.
 Symbolization

Language

Articulation
Speech

Phonation
Voice

Respiration Effector energy

• Accordingly disorders of communication
include disorders of:

• voice
• speech
• Language
• Swallowing
• Learning disabilities
Voice Disorders
• Usual presenting symptoms in voice disorders:
[a] Dysphonia: change of the voice any person from his habitual
one.
[b]Dysodia: change of singing voice while the speaking voice is
kept normal.
[c] Phonasthenia :is a subjective complaint of dryness, tightness,
globus feeling and voice fatigues, while the patient's voice is
normal.
[d] Aphonia: loss of voice (functional and organic).
• Dysphonia may be organic or functional or
functional leading to organic.
Pathophysiological model of dysphonia:

The cause of the unagreeable tunes may be due to

defect in:
1- The instrument – Organic factors.
2- The player – Non-organic factors.
Speech Disorders
I.Dyslalia: It means persistence of
isolated phonological errors after late
childhood.
• Types:
/s/ defect ----> Sigmatism
/r/ defect ----> Rotacism
/k/,/g/ defect ---->Lack of distinction
between backward and forward
plosives.
II-Stuttering: means misting of speech. The flow of
speech is abnormally interrupted by sound and
syllable repetitions, sound prolongations and blocks.
III. Rhinolalia = nasality: This is a disorder in the
resonance of speech. It means faulty contamination of the
speech signal by the addition of nasal noise.
• 1.Open nasality: there is increased nasal
resonance.
It may be organic:
Or it may be functional as in:
• 2.Closed nasality:
Organic as:
Functional as:
• 3.Mixed nasality: In which elements of open
and closed nasality are present in the same
patient.
IV. Dysarthria: It means difficulty of articulation of
neurological origin.

• Types:
1. Spastic dysarthria: as in pseudobulbar
palsy.
2. Flaccid dysarthria: as in bulbar palsy.
3. Ataxic: results from cerebellar lesion.
4. Extrapyramidal:
Hypokinetic: e.g. Parkinsonism:
Hyperkinetic (e.g. dystonia):
Language Disorders
• Delayed Language Development
• Dysphasia
Structural domains of language:
• Semantics: meaning
• Phonology: articulation
• Syntax: grammar

• Stages of normal language development

• Birth till 2 months: Meaningless cry.
• 2 month till 4 months: Meaningful cry.
• 6 month: Babbling.
• 1 year: 1st word.
• 1-½ years: two- word sentences.
• 2 years 6 month: 3 word sentence.
• 4 years: Starting to tell a story and conversation.
• 5 to 7 years: Full maturation of all language
modalities
Etiology of delayed language development:

> Brain damage:

>Sensory deprivation:
Hearing impairment:
• Visual impairment.
> Psychiatric illnesses:
> Environmental deprivation.
> Idiopathic.
 Dysphasia
• Def: Deterioration of language after its full
development.

• Types of dysphasia:
– Expressive dysphasia
– Receptive dysphasia
– Mixed dysphasia
– Amnestic dysphasia
 Learning disabilities
• It is a generic term that refers to a
heterogenous group of disorders,
characterized by significant difficulties
in acquisition and use of listening,
speaking, reading , writing, reasoning
or mathematical abilities, in spite of
normal intellectual , auditory and
visual abilities, and given opportunity
 Swallowing
Swallowing difficulties can exert a profound
effect on the quality of life and may result in
reduced nutritional intake and place the
individual in the risk of aspiration.