Central Annals of Otolaryngology and Rhinology

Cite this article: McNeilly LG, Robinson TL (2018) Communication Disorders: An Overview for Ear, Nose and Throat Surgeons. Ann Otolaryngol Rhinol 5(3): 1212.

*Corresponding author

Lemmietta G. McNeilly, American Speech-Language-Hearing Association, Rockville, USA, Email:

Submitted: 06 June 2018

Accepted: 25 July 2018

Published: 26 July 2018

ISSN: 2379-948X

Copyright© 2018 McNeilly et al.

OPEN ACCESS

Keywords•Communication disorders•Speech language pathology•Dysphagia•Collaborative practice•Functional outcomes

Abstract

Ear, Nose and Throat Surgeons (ENTs) diagnose a number of health conditions in children and adults that result in communication disorders or co-exist with communication disorders.

Speech-Language Pathologists/Phoniatricians/Logopedists assess and treat a variety of communication disorders including dysphagia, voice disorders, and velopharyngeal insufficiency.

KEY POINTS1. Communication disorders are associated with several

health conditions and disorders identified by Ear, Nose and Throat Surgeons.

2. Children and adults present with communication disorders of speech, voice, resonance and dysphagia.

3. Enhanced understanding of the role of speech-language pathologists will enhance the efficiency of ENT referrals to SLPs

INTRODUCTIONSpeech-language pathologists/Phoniatricians/Logopedists

work with individuals across the life cycle from newborns through geriatrics that present with communication disorders and or feeding and swallowing problems. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific and credentialing association for 198,000 members and affiliates who are audiologists; speech-language pathologists (SLPs); speech, language, and hearing scientists; audiology and speech-language pathology support personnel and students. Speech-language pathologists have the knowledge, skills, and expertise to provide high quality clinical services and actively pursue professional development to maintain current certification. SLPs work collaborative with other professionals to address the functional needs of individuals that present with challenges communicating with others or safely swallowing a variety of foods and liquids.

Definition of Communication Disorder

A communication disorder is impairment in the ability to

receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be developmental or acquired and range in severity from mild to profound. An individual may present with one or any combination of communication disorders. A communication disorder may result in a primary disability or it may be secondary to other disabilities [1]. However, a person that exhibits language differences based on speaking English as a second language or a nonstandard dialect i.e., southern dialect, Black English does not present with a communication disorder.

Role of Speech-Language Pathologists

In most English speaking countries, a speech-language pathologist (SLP) is a professional that practices in the areas of communication and swallowing across the life span. Communication includes speech production, fluency, language, cognition, voice, resonance, and hearing. Swallowing includes all aspects of swallowing, including related feeding behaviors [2]. Speech language pathologists work in hospitals, schools, private practice, serve on interdisciplinary teams, and engage in collaborative practice. In the United States SLPs possess the nationally recognized professional credential, the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) is awarded by The Council for Clinical Certification in Speech-Language Pathology (CFCC) to individuals that have successfully and have completed a minimum a master’s degree, clinical fellowship and passed a national praxis examination. Professionals, educated and qualified to provide services to individuals with communication disorders, have different titles in different countries and different educational models. For example, Italy is one country that employs Phoniatricians, physicians that

Review Article

Communication Disorders: An Overview for Ear, Nose and Throat SurgeonsLemmietta G. McNeilly1* and Tommie L Robinson2

1American Speech-Language-Hearing Association, Rockville, USA2Children’s National Health System, Scottish Rite Center for Childhood Language Disorders, George Washington University School of Medicine and Health Sciences, USA

Central

McNeilly et al. (2018)Email: lmcneilly@asha.org

Ann Otolaryngol Rhinol 5(3): 1212 (2018) 2/4

specialize in speech, voice and swallowing disorders, as well as Germany and Switzerland educate and employ Logopedists that specialize in speech and language disorders and complete a baccalaureate degree [3].

Speech Language Services

Areas of service delivery address all aspects of communication, swallowing and related areas that impact communication and swallowing, specifically, speech production, fluency, language, cognition, voice, resonance, feeding, swallowing, and hearing. The practice of speech-language pathology continually evolves. SLPs play critical roles in health literacy, intervention plans Autism Spectrum Disorder (ASD) and technological advances to enhance communication. Patients are overwhelmed at the time of discharge and often nod their heads in agreement with understanding instructions; therefore, it is important to state in plain language using print and illustrations to convey instructions. Individuals with ASD typically have difficulty communicating their wants and needs to others and following the cultural norms for interacting with others across settings. Technological advances are making intervention planning executive more effective and user friendly. The use of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) [4] to develop functional goals and collaborative practice can facilitate targeting of appropriate functional goals [2].

The domains of speech-language pathology service delivery complement the ICF, the WHO’s multipurpose health classification system [4]. The classification system provides a standard language and framework for the description of functioning and health. The ICF framework is useful in describing the breadth of the role of the SLP in the prevention, assessment, and habilitation/rehabilitation of communication and swallowing disorders and the enhancement and scientific investigation of those functions. The framework consists of two components: health conditions and contextual factors. The framework in speech-language pathology encompasses these health conditions and contextual factors across individuals and populations [2]. The ICF framework facilitates targeting of functional goals that address the individual’s needs in the home, school and/or community. For example, a person with difficulty swallowing thin liquids may need strategies to improve their swallow or the liquids may need to be thickened to maintain adequate hydration.

Health Conditions

Body Functions and Structures: These involve the anatomy and physiology of the human body. Students take courses in anatomy and address the relevant structures in other courses that target specific communication disorders associated with physical functioning. Relevant examples in speech-language pathology include craniofacial anomaly, vocal fold paralysis, cerebral palsy, stuttering, and language impairment.

Activity and Participation: Activity refers to the execution of a task or action. Participation is the involvement in a life situation. Relevant examples in speech-language pathology include difficulties with swallowing safely for independent feeding, participating actively in class, understanding a medical prescription, and accessing the general education curriculum.

Contextual Factors

Environmental Factors: These make up the physical, social, and attitudinal environments in which people live and conduct their lives. Relevant examples in speech-language pathology include the role of the communication partner in augmentative and alternative communication (AAC), the influence of classroom acoustics on communication, and the impact of institutional dining environments on individuals’ ability to safely maintain nutrition and hydration. University training programs may use interprofessional educational models to provide instruction in this area.

Personal Factors: These are the internal influences on an individual’s functioning and disability and are not part of the health condition. Personal factors may include, but are not limited to, age, gender, ethnicity, educational level, social background, and profession. Relevant examples in speech-language pathology might include an individual’s background or culture, if one or both influence his or her reaction to communication or swallowing.

Domains of Speech-language Pathology Service Delivery

The eight domains of speech-language pathology service delivery are collaboration; counseling; prevention and wellness; screening; assessment; treatment; modalities, technology, and instrumentation; and population and systems [2]. Two areas of focus for this article are assessment and treatment.

ASSESSMENTSpeech-language pathologists have expertise in the

differential diagnosis of disorders of communication and swallowing. Communication, speech, language, communication, and swallowing disorders can occur developmentally, as part of a medical condition, or in isolation, without an apparent underlying medical condition. Competent SLPs can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions [2].SLPs conduct evaluations that include administering standardized assessment tools and informal observations of behaviors and interviews of patients and/or family members. In some countries this includes FEES and stroboscopy. In some European countries, only physicians such as Phoniatrists or ENTs are permitted to perform endoscopy not Logopedics.

TREATMENTSpeech-language services are designed to optimize

individuals’ ability to communicate and swallow, thereby improving quality of life. SLPs develop and implement treatment to address the presenting symptoms or concerns of a communication or swallowing problem or related functional issue. Treatment establishes a new skill or ability or remediates or restores an impaired skill or ability. The ultimate goal of therapy is to improve an individual’s functional outcomes [2].

Clinical Practice

The areas of clinical practice identified by ASHA in Table are examples and not a comprehensive list. Health conditions that are appropriate for speech- language intervention vary from

Central

McNeilly et al. (2018)Email: lmcneilly@asha.org

Ann Otolaryngol Rhinol 5(3): 1212 (2018) 3/4

country to country. The Standing Liaison Committee of E.U. Speech and Language Therapists and Logopedists define Speech and Language Therapy as “the intersection of medical, linguistic, educational and psychological sciences and provides evaluation, treatment, support, prevention and counseling for children and adults” [5]. In the United States, some current areas of practice include literacy, whereas other new areas of practice such as applying artificial intelligence to speech production are emerging [2] (Table).

Social Communication

Pragmatics or social communication involves the branch of

linguistics dealing with language in use and the contexts in which it is used. This includes the skills of turn-taking, maintaining topic of conversation, changing topics appropriately, introducing new topics and closing conversations.

Nonverbal communication involves communication without the use of spoken language. It includes gestures, facial expressions, and body positions (known collectively as “body language”), as well as unspoken understandings and presuppositions, and cultural and environmental conditions that may affect any encounter between people. It deals with understanding rules for proximity and context communication.

Table: Areas of clinical practice and examples are not a comprehensive list (ASHA, 2016).

COMMUNICATION DISORDERS

FLU-ENCY SPEECH PRODUCTION LANGUAGE COGNI-

TION VOICE RESO-NANCE

FEEDING & SWALLOW-

ING

AUDITORY HABILI-TATION& REHABILI-

TATION

Stut-tering Motor planning and execution

Spoken and written language (listening, processing, speak-ing, reading, writing, and prag-matics). Ability to understand or comprehend language heard or read.

Delayed language-failure to develop language abilities at the usual age appropriate for developmental timetable.

Atten-tion

Phona-tion Quality

Hyperna-sality Oral Phase

Speech, language, com-munication, and listen-ing skills impacted by hearing loss, deafness

Clut-tering

Motor speech disorders - a class of speech disorder that disturbs the body’s natural ability to speak.

Varied etiology based on the integrity and integration of cognitive, neuromuscular, and musculoskeletal activities.

Phonology - branch of lin-guistics that deals with sound systems

Memory Pitch Hypona-sality

Pharyngeal Phase Auditory Processing

Articulation-The movement of the tongue, lips, jaw, and other speech organs to produce speech sounds.

Morphology (Morphemes-smallest units of meaning)

Problem Solving

Loud-ness

Cul-de-sac Reso-nance

Esophageal Phase

Phonological Syntax/Grammar

Ex-ecutive Func-tioning

Alaryn-geal Voice

Forward Focus

Atypical Eat-ing (e.g., food selectiv-ity/refusal, negative physiologic response)

SemanticsPragmatics (Language Use and Social Aspects of Communica-tion)Prelinguistic Communication (e.g., Joint Attention, Intention-ality, Communicative Signal-ing)Paralinguistic Communication (e.g., Gestures, Signs, Body Language)Literacy (Reading, Writing and Spelling)

Central

McNeilly et al. (2018)Email: lmcneilly@asha.org

Ann Otolaryngol Rhinol 5(3): 1212 (2018) 4/4

McNeilly LG, Robinson TL (2018) Communication Disorders: An Overview for Ear, Nose and Throat Surgeons. Ann Otolaryngol Rhinol 5(3): 1212.

Cite this article

Other Areas of Communication

Speech-language pathologists/Logopedists also have roles and responsibilities in literacy, working with children that are bilingual and have a communication disorder in their primary language. It is important for SLPs to be knowledgeable about the role of culture in language and to provide culturally appropriate services themselves are using an interpreter or cultural broker. Some individuals need augmentative or alternative devices to facilitate their communication and SLPs are integral in determining the appropriate devices and mechanisms for choosing an appropriate device.

Collaborative Practice

Speech language pathologists working in health care settings serve as collaborative members on a variety of teams and clinics including ENT, Center for Autism Spectrum Disorder, Craniofacial, Voice, Velopharyngeal Incompetence, Aerodigestive and Cochlear Implant.

Communication Health/Health Literacy

The current operational definition of health literacy used in Healthy People 2010 is: “the degrees to which individuals have the capacity to receive process and understand basic health information and services for appropriate health decisions” [6]. Health literacy is the means by which holders of knowledge can make that knowledge understandable and usable for the receiver. Health literacy is not restricted to only a person’s ability to read and write, however, and does not apply only to the written word. Other factors that play a role in how well someone understands health information that they are told, see, hear, or read include:

• experience with the health care system

• cultural and linguistic factors

• the format of materials

• how information is communicated

Individuals with a communication disorder may have increased difficulties processing and using health information. It may be helpful to use plain language, as defined by the U.S. Office of Disease Prevention and Health Promotion “in which people can find what they need, understand what they find, and act appropriately on that understanding “[7].

As human communication specialists, SLPs are excellent resources for provide insight into how to clearly communicate complex messages to individuals that possess limited literacy skills or understanding. It is important use strategies in health literacy and techniques to develop plain language messages.

SUMMARYENTs diagnose, and treat a number of conditions that result in

communication disorders or feeding and swallowing disorders. Working collaboratively with speech-language pathologists/Phoniatrists/logopedists to develop functional outcomes using the ICF framework is an effective best practice strategy. When teaming is not an option, at the minimum making referrals to the SLP to determine if there are options to intervene and maximize the individual’s ability to communicate or swallow safely and effectively as an enhancement of the patient’s quality of life is best practice. Communicating with patients and family members using plain language is essential to appropriate follow through with discharge instructions and therapy recommendations. Technological advances are making intervention planning executive more effective and user friendly. The SLP can provide information and strategies to the team. ENTs and SLPs each want good patient functional outcomes and working collaboratively is the best approach to achieve the desired outcomes.

REFERENCES1. American Speech-Language-Hearing Association. Definitions of

communication disorders and variations [Relevant Paper]. 1993.

2. American Speech-Language-Hearing Association. Scope of practice in speech-language pathology [Scope of Practice]. 2016.

3. International Association of Logopedics and Phoniatrics. 2018.

4. World Health Organization. International Classification of Functioning, Disability and Health. 2014.

5. Comite Permanent de Liaison des Orthophonistes/Logopedes de I’Union Europeenne. 2018.

6. Healthy people 2010. 2nd Ed. Washington (DC): Department of Health and Human Services (US); 2000 Nov. 2 Vols.

7. Communicating With Patients and Families: Developing Clear Written Information. 2018.