What Should Be the Working Relationship between Otolaryngologists and Speech Language Pathologists?

抄録

What should be the working relationship between laryngologists and speech language pathologists?
An explosion in diagnosis and treatment options in laryngology, logopedics and phoniatrics has become available. In part this is due to technology, but an even greater contribution has been due to application of multidisciplinary approach to the patient with voice and swallows complaints. The multi-disciplinary clinic approach to patients with voice and swallowing disorders brings in contributions from basic scientists, speech language pathologists and laryngologists. In their own right each specialty brings contributions based on professional training and clinical pathways to care for voice and swallow disorders. In aggregate, the contribution to team care of the patient is greater than the separate parts. We will explore in this paper some of the added benefits to care of professional and non-professional voice users by such a team approach.
While the physician (phonosurgeons or phoniatricians) is primarily the medical specialist invested with the authority and responsibility for medical care of the patient with voice and swallow complaints, they also carry the mandate from society for co-ordination of care once the medical issues are no longer relevant. In this regard, management of functional deficits in voice and swallow are to be championed primarily by someone with medical training (i.e., physician) . A physician must be involved in the therapy and rehabilitation of voice and swallow to provide a comprehensive approach to achieve optimum results. The model used in laryngology and voice care specialty is modeled after other established relationships between disciplines such as orthopedic surgery and physical therapy and pulmonary medicine and respiratory therapy. Speech language patholo-gists interested in providing voice therapy should achieve: a) defined professional stan-dards, b) understand their scope of practice, and c) demonstrated area of clinical expertise. Patient safety, increased efficiency, and value to patient care must be demonstrated. Training must be based on systems practice using didactic and clinical patient based teaching.
In our voice center we use speech language therapists extensively in a variety of ways in counseling and direct care. Our clinicians are primarily responsible for a) objective and perceptual evaluation of promontory function before and after interventional treatment, b) pre-operative counseling in pre and post operative voice use surrounding phono-surgery, management of functionally based benign lesions of the larynx (nodules, contact granuloma, muscle tension dysphonia, presbyphonia, puberphonia, and voice enhancement), c) evaluation and management of functional voice disorders such as psychogenic dysphonia, dysphonia for secondary gain and conversion voice disorders and d) optimizing the power, source, and filter system to improve phonatory function by voice rehabilitation. The swallow therapists' primary role is to do functional assessment of swallow, assist in performing fiberoptic evaluation of swallow function, administer modified barium swallow, perform swallow therapy and alaryngeal speech, and evaluate for electro stimulation. The physician is the primary diagnostician, medical and surgical treatment specialist and co-coordinator of overall care while the therapist functions as specialists in rehabilitation, diagnosis of functional deficit, and treatment of functional loss.
The optimum model of care for patients with voice and swallow disorders is a multi-disciplinary approach that addresses both functional and medical aspects of care.