Fascination Phoniatrics

As phoniatrician I deal with the voice and the swallowing process and with the corresponding dysfunctions (dysphonia and dysphagia). The fascination of this area lies on one hand in the fact that these are two functions that are so incredibly important to us living beings, on the other hand it always amazes me to wonder what solution nature has found, to combine breathing, voice and swallowing.

The voice is important for communication, to interact, and for many people, the voice is also an important “working tool” that they depend on. In contrast with the past, with increased manual labour, more and more people are now practising professions in the service sector, where communication plays a major role. A typical example are call centre agents, consultants and coaches.
But the voice is much more than just a “working tool”. It is a real instrument that can be played, an artistic form of expression. An instrument that always amazes me with its versatility and possibilities. And it is part of our personality, it characterises us. It is unbelievable, how quickly one recognises someone on the phone, just because of their voice. And if you listen closely, you very often and quickly recognise how the person you are talking to feels and their present emotions, no matter what that person is saying in words. It’s harder to lie with your voice than with words, because the voice is a mirror of the soul.

Eating and swallowing is not just about providing yourself with fluid and nourishment, it also involves pleasure and enjoyment, it means savouring with all your senses. If we pick a sun-warmed fruit directly from the tree, we first look at it, maybe we smell it, in the mouth we feel its temperature, we taste it, we feel its consistency and hear our chewing sounds. Perhaps all these sensory impressions will find central connections and memories will awake of a similarly beautiful summers and if the fruit is eaten, then this contented feeling of satiation will remain. It’s especially nice to eat in a group, in a cosy get-together, when the atmosphere is pleasant before and after the meal.
Eating keeps body and soul together, says a German proverb.

The core subjects of phoniatry, voice formation and swallowing, are therefore only the basis of human experience such as communication, inner and outer sensory experience and social connection and that makes my field of expertise so exciting. These basic functions are performed through a complex interplay of anatomical structures and physiological processes, at the centre of which stands the larynx, a fascinating “organ,” almost a piece of art. There is a widespread belief that the larynx is primarily responsible for the voice, but its main function is to protect the lungs from food during swallowing (aspiration). Only secondarily is it responsible for the voice. In the area of the larynx air and food paths intersect and it is short of a miracle that normally breathing and swallowing work together without any problems. The act of swallowing is extraordinarily complex. More than 50 muscles and more than half of all cranial nerves are involved and we swallow about 600–2,000 times a day, because we do not only swallow to nourish ourselves with food and liquid, but also to remove saliva and nasal secretions.
But the genesis of the voice also always amazes me. The airflow from the lungs causes the delicate structures of the vocal folds to vibrate, similar to the reeds of a wooden instrument, so that a sound (primary sound) can be formed, which is then shaped by the resonance chambers in the nose, mouth and throat and thus to become the individual and characteristic voice of a human and through articulation can turn into language.

As phoniatrician, I have acquired an in-depth understanding of these complex processes, which are prerequisites for the diagnosis and treatment of voice and swallowing disorders. I like being able to use medical-technical aids such as stroboscopy, light-intense endoscopes and video documentation, which adds another level of quality to my field of expertise.
And last but not least, swallowing and voice disorders are often not limited to my own area of expertise and thus open up the wonderful opportunity for me to work together with other conventional medical and alternative medicine disciplines.

I know that illnesses that affect the voice and swallowing not only burden people physically, but often also mentally and often hinder their social relationships. As a phoniatrician, I have the rewarding opportunity to accompany these patients and, at best, help them.

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