Phoniatrists do not exist in the United States, but they provide voice care in many European countries. The phoniatrist is a physician who is in some ways a hybrid of the laryngologist and speech-language pathologist. Phoniatrists receive medical training in diagnosis and treatment of voice, swallowing, and language disorders, including voice therapy; but they do not perform surgery. In countries with phoniatrists, surgery is performed by otolaryngologists. In many cases, the phoniatrist and otolaryngologist collaborate as a team, just as otolaryngologists and speech-language pathologists do in the United States and elsewhere. A physician who has completed training in phoniatry is generally well-qualified to diagnose voice disorders and provide non-surgical medical care, as well as voice therapy.
Nurses are important members of the voice team in many centers. Nurses who work closely with a laryngologist generally have vast experience in the diagnosis and treatment of voice disorders. They are wonderful information resources for patients and frequently provide much of the patient education in busy clinical settings. Such nurses are usually members of the Society of Otolaryngology-Head and Neck Nurses (SOHN). Nurses with advanced knowledge and skills may be certified (by SOHN) as otolaryngology nurses, and are identified as such by the initials “CORLN” (certified otolaryngologic nurse) after their names.
Education and Training Track
Nurse practitioners are advanced practice nurses with master’s degrees who are licensed to provide independent care for patients with selected medical problems. They are identified by the initials “CRNP” (certified registered nurse practitioner). They work in conjunction with a physician, but they can examine, diagnose, and treat selected problems relatively independently. A few nurse practitioners specialize in otolaryngology and work with voice teams. They ordinarily receive special training “on the job” with the otolaryngologist, and they provide care within their scope of practice. Nurse practitioners can also become members of SOHN, become certified through examination by SOHN, and upon certification will also use the certification CORLN after their names.
Physician Assistants and Medical Assistants
Physician assistants, like nurse practitioners discussed above, function in association with a physician. Physician assistants graduate from a training program that usually lasts four years and teaches them various aspects of medical diagnosis and physical examination. They use the initials “PA” (physician assistant) after their names. They practice in conjunction with physicians but can perform examinations and treat patients independently. They are licensed in many states to write prescriptions. A few physician assistants specialize in otolaryngology, and a smaller number have had extensive training and experience in voice care. In collaboration with their laryngologist and voice teams, these PAs are qualified to evaluate and treat patients with voice disorders.
Physician assistants should be distinguished from “medical assistants” who have less training and are qualified to assist in medical care and patient education, but generally not to diagnose and treat patients independently. Medical assistants generally are trained to perform tasks such as phlebotomy (drawing blood) and perform electrocardiograms. In a laryngology office, a good medical assistant can be trained to perform many other tasks such as taking histories, assisting with strobovideolaryngoscopy, assisting during the performance of surgical procedures in the office, participating in research, and other tasks.
Consultant Medical Professionals
Otolaryngologists often refer voice patients for consultation with other medical professionals. Other specialists consulted commonly include:
- Neurologist: specializes in brain and nerve disorders
- Pulmonologist: lungs and respiratory system disorders
- Gastroenterologist: stomach and intestinal system
- Psychiatrist: mental health
- However, physicians, in virtually any medical specialty, may be called upon to care for voice patients.
- Consultant Non-medical Professionals
Other professional specialists who may also be involved in voice care are:
- Physical therapists