Hungary

1. Developing of the organisational frames of the voice and speech therapy in Hungary

The earliest efforts aiming for the improvement of the quality of life and the betterment of the handicapped people date back to the 1790-es in Hungary, through András Jólészi Cházár’s life work. The first Hungarian special pedagogic institution, the “Educational House of Deafs” opened its doors in 1809 in Vác (1).
After some sporadic initiations, it was dealing with the matter of speech disorders on physiological and didactic basis. Since the end of the nineteenth century, the collaboration of physicians and pedagogues greatly enhanced the Hungarian Institutions. The first Hungarian Orthophonic Institute was established in 1891 in Arad under the direction of the laryngologist I.Székely and J.Roboz, special teacher for the deaf, for the treatment of stutterers and stammerers. The institute already functioned in 1894 in Budapest, led by Roboz, who also started the education of logopedists with the aid of courses. In 1898 A.Sarbó, professor of neurology, continued Roboz’s duties after a study-tour abroad. Following in his predecessor’s footsteps, he raised the level of the treatment of speech disorders by means of his excellent organisational, research, scientific and educational activity so high in Hungary, that his teacher, H.Gutzmann in Berlin wrote about him with the greatest appreciation: “Especially abroad, some people do such good work with a wide intellectual horizon and with the energetic support of the authorities that the foreign countries have surpassed us. First of all the centralised institutions of Denmark and Hungary are so admirable that we cannot do better than imitate this example” (Die soziale Bedeutung der Sprachstörungen. Jena: 1904, p. 58.). Sarbó made a nation-wide survey and he found speech disorders in 3.6% of the students (the national census in 1890 estimated the number of people with stuttering and stammering as 60.000). On the basis of these data, he established special classes in several towns and suggested preventive arrangements (26). In his capacity as a university professor, his lectures about the pathology and therapy of speech disorders for the medical superintendents of schools and health-teachers were well known. He directed the logopedists’ education for 20 years. In the initial period, Sarbó was very active in the pedagogical-logopedic fields and on the therapeutical courses established by him. Subsequently teachers of the Institute of the Deaf collaborated and worked with him. Among his co-workers especially K.Istenes had outstanding knowledge, later he became the successor of Sarbó in the Logopedic Institute in Budapest (1918-25), and director of the Teachers College (1940-42) founded in 1928. Istenes was succeeded in the leadership of this College by A.Sulyomi-Schulmann. The physicians of the institute were then G.Bárczi, ENT specialist and L.Szondi, neurologist; the latter was in the same time the chief of the State Pathological and Therapeutical Laboratory for Special Pedagogy. At the beginning of the twentieth century, the Special Pedagogical - Psychological Institute, organised and directed by the neurologist P.Ranschburg in Budapest (1902-1926) had an excellent reputation in Europe, where physicians, psychologists and logopedists collaborated with Sarbó, representing the complex view of the special pedagogy and of speech pathology.

The immense prosperity in the field of speech research and management of individuals with speech disorders observed in the first two decades of the century were halted in the difficult years of the World War. The well-known developing logopedic institutional system regressed, the education of special pedagogists and logopedists came to a crisis. In 1927 the courses for correcting the different speech disorders were reorganised in Budapest. The number of the patients at that time was approx. 500-600 in a year. Physicians worked at some university clinics in very modest financial circumstances in poorly equipped institutions, mostly separated from speech therapists. The representatives of logopedics in Hungary provided the management and care of individuals with speech disorders at this time. The first phoniatric outpatient clinic was established in 1932 in the University ENT Clinic in Budapest headed by Z.Lénárt, later by T.Germán where mostly the voice problems of singers were treated. L.Dénes (1932-36), T.Polyánszky (1936-54), V.Imre (1934-36), and later in 1943, L. Kenessey worked here. Shortly after his activity in Budapest, V. Imre moved to Vienna, Austria.
After the Second World War, thanks to G.Bárczi’s and D.Kanizsai’s initiative, the education of special pedagogists and logopedists prospered. According to the available data, the Hungarian education of speech therapists (logopedists) was first established in 1900 (among the firsts all over the world), as a two-year course. Since 1928 it has been qualified as a four-year program in a Teachers College (traditionally as a part of the training of the special-education teachers, i.e. teachers of the mentally retarded, deaf, blind, later on motorically handicapped). These branches were all mandatory, beside speech therapy. From the sixties, to raise the training to a higher standard, the mandatory branches were reduced to three-years, then to two-year training, which is still the method today. In the period of five and three levels of education the branch of speech therapy was compulsory. From 1992 a reformed education system started. According to the new concept all lines are optional (e.g. logopedics-surdopedagogics, logopedics-somatopedagogics). Now two kinds of speech therapists are educated: the so-called “teacher logopedists” and the “clinical logopedists”. The former ones are working in kindergartens, schools, centers for speech and learning disorders. The clinical logopedists beside the mentioned fields work in hospitals. The phoniatricians take part more and more in their education. After the Second World War the name of the earlier Teachers College became “College for Special Education”, named after Bárczi Gusztáv since 1975. The special-pedagogic institution system differentiates gradually; the logopedic network develops continuously. In 1946 only four logopedists functioned in the country, in 1968 twenty-two, in 1978 three hundred and twenty (131), at present time the number of the logopedists is about one thousand (the exact number is not available).
The research of the voice and speech disorders, the treatment of the patients became again a multidisciplinary task and phoniatricians take part in this work more and more intensively. The number of phoniatricians increases year by year. In the sixties only 4 phoniatricians have been working, in 1980 there were ten colleagues (44) and now the number of specialists in phoniatrics is 42 among 900 ENT specialists in Hungary with ten million inhabitants (mostly in the frame of ENT university clinics and ENT departments, usually in part-time position). In the organisation of the Phoniatric Department (chief: T.Frint, later K.Mészáros) of the Haynal Imre Medical University, phoniatric further education courses have been held every two years for ENT specialists. The topic is: “Main features of phoniatrics”. The practical education of the candidates before ENT and phoniatric examinees happens in the same place and in some other departments (St.János Hospital, Heim Pál, and Madarász Children’s Hospital). Since 1978 the Ministry of Health has acknowledged phoniatrics as an independent discipline: the candidate may pass an examination two years after the basic ENT education. After a successful examination the candidate gets the title: “specialist in phoniatrics”. A phoniatric textbook was published, edited by L.Surján and T.Frint in 1969. The second edition came out in 1982 (authors: T.Frint, L.Bacsa, J.Hirschberg, I.Meixner, G.Palotás) and the 3rd one is in preparation. This book’s subject matter is also instruction for the logopedists. J.Hirschberg founded the first Station of Phoniatrics and Pedaudiology in the Heim Pál Children’s Hospital in 1977, where phoniatricians, audiologists, orthodontists, neurologist, and paediatrician had been working together with logopedists, surdopedagogists, and psychologists. J.Hirschberg also established a Cleft Palate Center in Madarász Children’s Hospital in Budapest in 1994 with a team representing all specialisation necessary in the multidisciplinary treatment and care of children with cleft lip/palate and/or velopharyngeal insufficiency. Phoniatricians also take part in the education of medical students, otolaryngologists, paediatricians, logopedists, audiological assistants, and nurses. They contribute in the medical examination of actors and singers and in the work of several committees of the Hungarian Academy of Sciences.

2. Scientific and research work

The scientific-research work dealing with speech and voice disorders began to develop at the end of the nineteenth century in Hungary. We have, however, some data about the observation, description and correction of speech disorders already from the time preceding the close of that century, by way of the activity, and notices of preachers, doctors, linguists, jurists, schoolmasters and teachers educating deaf people (26).

One can regard W.von Kempelen (1734-1804) as one of the most significant pioneers of the scientific phonetics. He discussed in his work: “Mechanismus der menschlichen Sprache” (75) the sound-doctrine of the German and Hungarian speech intensively and published at the same time the exact description of his speech machine. Kempelen brought great care upon the investigation and improvement of the speech disorders, too.

J.Czermak, professor of physiology at the University of Budapest, made the first experimental investigation on the function of the palate measuring the elevation of the velum during formation of different vowels with a wire probe. His tiny apparatus, by aid of a mirror turned upwards, demonstrated indirectly the movements of the soft palate in 1859. (Czermak’s original mirror can be seen in the Semmelweis Museum of Medical History, Budapest.)

The earliest logopedic works come from the co-workers of the Institute of Deafs in Vác. A.Simon was the first who published a general work on the Hungarian speech in 1808. Besides A.Schwartzer and J.Meszlényi-Molnár, especially the activity of J.Szilágyi should be emphasised from that time. He published in Hungarian his dissertation written about “Sigmatism” in 1835.

The Hungarian phonetic research-work was closely connected with linguistic and phoniatric topics from the very beginning; a good example for this is the life-work of J.Balassa who not only dealt with the elements of phonetics, the physiological analysis of the speech production, and the Hungarian name of the speech disorders, but also with the education of deaf people and - as first in Hungary - with the oesophagus speech of laryngectomizeds (2).

Besides Roboz, who published articles about the disorders of the articulation and education of deafs and stutterers (111), the literary and research work of A. Sarbó has to be mentioned at the turn of the century. His book about Speech (112) - written in 1906 - can be regarded as an outstanding work also today and a significant publication. Sarbó discussed and analysed first of all the questions of the stuttering, stammering and aphasia. The scientific results of Ranschburg (100) cannot be left out of consideration. He elaborated the pathology of dyslexia, dysgraphia, and dyscalculia and also dealt with special pedagogic and psychological problems.

In the first years of the twentieth century, A.Ónody worked in the field of the research with voice disorders. He studied the anatomical variants and the innervation of the larynx. The most important works of J.Némai are related to the physiology of singing voice and singing art and to the structure and function of the larynx, as well. G.Kelemen (later professor in the USA) enriched the special literature with his research about the comparative anatomy of the larynx.

In the thirties of this century G.Bárczi made his name recognised internationally, with the description of the cortical deafness (5), and with his method suggested to hearing improvement and speech education of severely hard-of-hearing individuals. In this time L.Szondi (125) dealt with the analysis of the stutterers’ constitution, and the beginning of D.Kanizsai’s activity - also in this period - was above all the psychology and special pedagogy of handicapped children due to speech or hearing disorders (73). Besides D.Kanizsai, the work of K.Istenes, A.Sulyomi-Schulmann and A.Murányi should be mentioned - among others - in the field of logopedical literature in the time between the two world wars.

The publications with phonetic topics of Z.Gombocz, the most significant Hungarian linguist of the first half of the twentieth century, searched the regularities of speech, determinated physiologically (25). In the third decade of this century, a unified and that time up-to-date conception has already been developed about the whole mechanism of voice production (Horger 1929), which was reformed and became complete by the monography of G.Laziczius with enforcement of phonological viewpoints in narrower sense (84). Today the new edition of this volume (1963) is the basis of the Hungarian researches.

The first initiatives of the phoniatric literature in proper sense derive from the thirties of this century. Some articles of L.Dénes (8), T.Polyánszky (99), L.Kenessey (76) and a significant part of A.Réthi’s life work generated from this period. V.Imre already published at this time in Vienna.

The scientific-research work reached new heights in the last four decades after the stagnation of the war-years. And the integrative and interdisciplinary initiations found scope and sense in this period of the specialisation.

The accomplishment of A.Réthi’s life-work falls also into this time-period, not only regarding the reorganisation of the scientific society’s life but also in the field of research. The scientific work of Réthi is well known and acknowledged all over the world. His 150 publications deal with four main topics: 1. Disorders of the laryngeal innervation. 2. Stenoses of the larynx and their therapy. 3. Laryngeal tumors and their surgical management. 4. Cosmetic surgery of the face. Réthi may be regarded as one of pioneers of phonosurgery; he dealt, however, not only with the surgical improvement of voice disorders (106), and the operative ceasing of the hyperrhinophony (107), but also - among others - with the conservative treatment of stuttering and dysphonia spastica (108,109). Undoubtedly, Réthi can be considered as one of the founders and greatest personalities of Hungarian phoniatrics.

The research and scientific works of phoniatricians alive today or dead in the recent past, have been published in the last 40 years (some of these specialists got education, experiences and inspiration in the Phoniatric Clinic in Prague from M.Seeman and E.Sedlácková). During these four decades, many scientific books, book-sections, university lecture notes, congress proceedings, popular editions, articles in international journals were published. Seven PhD. dissertations and one academic dissertation (D.Sc.) were written and accepted. In this chapter only some of them can be listed.
T.Frint summarised the results of his scientific work first of all in the Phoniatric Textbook (21) edited together with L.Surján and in his PhD. thesis in which he deals with the functional disorders of the voice production mechanism (19). Besides these, T.Frint wrote about the following topics: acoustic analysis of voice disorders and of hoarseness (18), results gained with the electric pneumograph constructed by him (17), the prevention of voice disorders, some aspects of the dysphonia spastica and the dichrotic voice (16), the data gained by the measurements of the intraoesophageal pressure in patients without larynx (15), phoniatric therapy in cases with recurrent nerve paralysis (22), the surgical methods which make easier the oesophagus speech, the role of relaxants (especially Seduxen) in the treatment of functional voice disorders, the morphological basis of Reinke’s oedema (in co-operation with E.Remenár and J. Élõ, 104), the connections of myasthenia gravis, recurrent nerve paralysis, and the voice disorders respectively (23). In recent past he published important guiding principles for treatment of the functional dysphonia and a review about the practical phoniatric management and rehabilitation of several voice disorders (20,24).

The research field and scientific interest of J.Hirschberg contain first of all: the investigation of pathological sound phenomena in infancy, several aspects of new-born and childhood dysphonia and hoarseness and of velopharyngeal insufficiency, the complex, multidisciplinary and - stressed - the phoniatric, phonosurgical and logopedic treatment and care of individuals with cleft lip/palate (CLP), the speech improving surgical methods, some questions of stuttering, paediatric hearing disorders and the delayed speech. He wrote chapters about rhinophony and stuttering in the Hungarian phoniatric textbook (21). From his 254 scientific publications (many of them with phoniatric topic) written in 11 languages one can firstly mention here his two theses. The PhD. thesis deals with the “Acoustic analysis of pathological cry, stridor and cough in infants” (39). This work - beginning in the early sixties (37) - was later published together with T.Szende in an English and German book as well, including sound records (47,50). Several aspects of the topic: dysphonia in infants and children were detailed in many publications (18,38,45,49,59,60,67). The theme of his D.Sc. dissertation is the “Etiology, diagnosis and phonosurgery of velopharyngeal insufficiency” (55). The topic of J.Hirschberg’s main report on the XXth World Congress of the International Association of Logopedics and Phoniatrics (IALP) in Tokyo was also the “Velopharyngeal insufficiency” published in Folia Phoniatrica (52), and he summarised his experiences concerning this field in a book, too (51). The author dealt with many aspects of the same theme (VPI) at several congresses of the Union of the European Phoniatricians (UEP), International Associations of Phonosurgeons (IAP), International Federation of Oto-rhino-laryngological Societies (IFOS), European Society of Paediatric Otorhinolaryngology (ESPO) and on many national and international meetings and conferences which were published in books, proceedings and journals (43,46,48,54,56,57). J.Hirschberg detailed the possibilities of phonosurgery in children (57,61,62) summarised the value of the electroacoustic techniques (40,41), the use of the different pedaudiological methods, e.g. the application of synthetic speech in the phoniatric practice (27). He took part in the elaboration of a new speech audiometric test for young children (11), investigated with his co-workers the meteoropathological effects on the speech of stutterers (36), the value of Melleril in the therapy of stuttering (42) and accomplished a speech intelligibility (understandibility) test (53). With the members of the IALP Cleft Palate Committee he compiled the parameters for the evaluation of speech and hearing disorders of patients with cleft lip/palate or velopharyngeal insufficiency (65) and the fundamental principles of the therapy and care of children with different facial clefts (68). With representatives of human genetics, orthodontics, logopedics and phonetics Hirschberg investigated also the genetic relations, the possible primary prevention of the facial clefts (7) and the effect of velopharyngoplasty on the development of the maxillofacial complex (66). He emphasised the importance of teamwork in the diagnostics and treatment of voice, speech, hearing, and swallowing disorders (58,63,64).

After getting the phoniatrician title, T.Hacki began his practical and scientific work in Hungary with the investigation of voice load tests (33), the role of the glottis at the genesis of hoarseness (34) and with the development of voice range profile measurement system (35) which functions today at about 150 ENT and phoniatric clinics in several European countries. T.Hacki was nominated in 1990 to private docent at the University Phoniatric and Pedaudiological Clinic in Hannover and he was elected in 1992 as chief and professor at the Phoniatric Department of the University ENT Clinic in Regensburg. Since the late eigthies Hacki has been published his research results in Germany.

A.Sáfrán investigated in his scientific publications and also in his thesis several aspects of the speech without larynx and published data about the comparative acoustic analysis of normal, whispering, oesophagus speech and of speech with voice prosthesis (113,114,115,116).

The research field of L.Rendi was the pathology and special pedagogic aspects of speech disorders in children (105).

G.Palotás analysed the pathomechanism and therapy of communication disorders due to CNS lesions, he dealt with experimental investigation of psychotherapeutical methods used in the treatment of stuttering (93) and wrote - together with G. Simonyi (120) - about tactile alexia.

M.Stepper gave account of phoniatric screening of school children; she deals intensively with aphasia (121).

The scientific topic and the title of the thesis of U.Pap is “Measurement of voice field, fundamental frequency and sound pressure level of voice and speech in physiological and pathological states (94). U.Pap wrote also a chapter about phoniatrics in the textbook Otorhinolaryngology, Head and Neck Surgery (95).

Á.Götze was one of the most outstanding organisers of the care of the patients with hearing impairments. He elaborated the speech audiometric tests for adults and children, usable in the Hungarian language area (32).

V.Göllesz made examinations regarding the lip articulation of blind and deaf-blind individuals and performed analyses of speech movements (31).

L.Pataki dealt with childhood dysphonia and with the neurophoniatric aspects of hyperrhinophony (96,97,98) also together with the neurologist Sz.Horváth (72).

Zs.Farkas’s main topic is the pedaudiology (10,11,12,27,110), but he took part with foreign researchers - in international collaboration - in investigation of other phoniatric questions, too (78,132). The theme of his thesis is: “Some research and clinical experiences in paediatric audiology” (9).

B.Balázs works first of all with the improvement of voice disorders in singers, with the rehabilitation of laryngectomizeds, and with the theory and practice, focusing on the interrelations of hearing and phonetics (3,4).

K.Mészáros deals with voice problems after surgery of the vocal cords (23) and with endocrine voice disorders.

The topic of E.Horváth is the evaluation of the functional results (swalloving and voice analysis) after partial vertical laryngectomy and subtotal pharyngectomy (69,70,71).

G.Kiefer published a book about “Hoarseness”. In his book he details the etiology, the diagnosis and the treatment methods of the voice disorders (77).

The works and articles of the borderline disciplines (speech therapy, linguistics, phonetics, psychology, and orthodontics) often touch upon themes referring also to phoniatrics. Logopedic literature - in the last years - deals with historical and organisational questions, too, sometimes in the form of co- publication with phoniatricians.

E.Kovács investigated the connection between dyslalia and orthodontic anomalies (79). The title of her Ph.D. dissertation is “Experimental phonetic research of oral sigmatisms” (80). Besides these she dealt with the prevention of dyslexia (81), together with the linguist researcher I.Kassai (74) with the phonetic investigation of cluttering and she summarised together with Zs.Fehér also the past, present and future of the training of logopedists in Hungary (82).

The main fields of V.Mérei are the stuttering and the speech disorders of oligophren children (88).

I.Meixner made investigations first of all in the scope of psychological aspects of speech disorders and made her name well-known with the research and practical recommendations regarding learning and reading disabilities (85,87).

The title of her thesis is “Children with language disorder and dyslexia” (86).

S.Szabó dealt with the dysphony and hyperrhinophony of children and she took part in many team-works together with phoniatricians (36,42,123).

I.Montágh, who recently died, was one of the most excellent practical logopedists in Hungary. With great competence, he dealt with the speech education of actors (92).

J.Mohr, the director of the Logopedic Institute in Kõszeg for many years, organised several scientific meetings and congresses with international participation and he raised to high level the institutional treatment of stutterers and some other severe speech disorders (89).

E.Simon-Nagy, well versed in the logopedical treatment of voice, speech, language and swallowing disorders, made her name well known also with her scientific activity. She deals above all with the speech therapy of cleft patients (53,117,118), and published articles about dysphonia and dysarthria (58,119) and took part in pedaudiological investigation (10).

The research field of L.Vékássy is the psychological approach to the stuttering. He summarised his work in a book and in his D.Sc. thesis (128,129).

E.Vincze-Bíró studied the situation and the tasks of the logopedics in Hungary (131).

The investigations of P.Lajos aimed at the application of R.I.T. method in the treatment of stuttering children. In his thesis he summarised the effectiveness of this method (83).

G.Rehák, orthodontist, has worked closely for many years with the multidisciplinary team established for treatment of children with CLP/VPI. The main topic of her scientific works and thesis is the importance of cephalometric investigations in the diagnostics and treatment of children with facial clefts and the follow-up of the maxillofacial development after flap surgery (101,102,103).

Among the recently edited publications of Hungarian linguist-phoneticians we can also find a great number of topics related to phoniatrics.
O.A.Vértes analysed the disorders of the sound production and the forms of sound substitutions in the child language (130).

I.Fónagy searched and defined the physiological background and the regularities of the lingual idioms, melody, accent, and emotion in an internationally accepted and valid form (13,14). I.Fónagy has been working since 1970 in France.

The activity of I.Subosits includes the instrumental-phonetic analysis of speech disorders (122).
The other line of the phonetic researches, the works of J.Molnár and K.Bolla, resp. resulted in an atlas-like elaboration of the speech sounds’ articulatory signs (6,91).

T.Szende tried to interpret the many-sided aspects of speech as a uniform process summing up the new knowledge (124). He took part, together with physicians, in the phonetic-acoustic analysis of the new-born and infant phonation, of voice and speech disorders and of the oesophagus speech (47,50,116).

M.Gósy was also co-worker and co-author of many common publications with phoniatricians. Her main themes are the following: speech perception and comprehension disorders of children, dysphasia: theories and practice, voice analysis of laryngectomized patients (28), and prevention of dyslexia (30) The title of her D.Sc. dissertation is” Speech perception and comprehension process: theories and application” (29). She participated in the development of the speech audiometry with synthesised speech together with J.Hirschberg, Zs.Farkas and G.Olaszy (27) and in the compilation of the Hungarian understandability test (53).

T.Tarnóczy is an outstanding and also internationally recognised representative of the Hungarian acoustic researches and physico-phonetics. His main work is the “Physics of the sound doctrine” (126). His numerous publications, which join the speech-research and which also promoted the investigation methods of phoniatrics, the so-called speech chor method (recommended for acoustic analysis) should be mentioned here (127). The recently rapid development of electroacoustical instruments and procedures gave possibility to T.Tarnóczy for the critical re-evaluation of the myoelastique-aerodynamic theory of voice production, too.

The present list wouldn’t be complete without mentioning the name of the excellent representative of Hungarian singing teachers, particularly I.Molnár, who died some years ago. He consolidated physiological-anatomical viewpoints in teaching singers. His main work: “Euphonetics” represents this contemplation (90).

3. Life of the scientific societies

The first scientific society for voice and speech research was founded in 1933 in Budapest under the name of “Phonetic Association”. The first president was G.Farkas, professor of physiology. Two years later Z.Lénárt, professor of laryngology assumed his presidency. Subsequent presidents were A.Sarbó, neuropsychiatrician and then T.Bajkay, laryngologist.
The VIth International IALP Congress was organised in 1934 in Budapest. The main reports and the biggest part of the altogether 30 presentations dealt with the theme of stuttering. The proceedings of the congress were published on 172 pages in Vienna.

After the war-years, The Hungarian Phonetic Association was reorganised in 1947. Honorary president was T.Germán, president A.Réthi, secretary T.Tarnóczy. This society existed, however, only for 3-4 years.
The Hungarian Association of Phonetics, Phoniatrics and Logopedics was founded in 1964 with 26 members. In the first two years it functioned as a Section of the Hungarian Society of Oto-rhino-laryngologists. From 1966 it has been an independent medical association. The first president (from 1964 to 1974) was A.Réthi, the Secretary General J.Hirschberg. After Réthi’s retirement the successors in presidency were T.Frint, O.A.Vértes, J.Hirschberg and L.Pataki.

The number of the Association is at present 300 members. Congresses have been organised every year. Outstanding international congresses were: Semmelweis Festive Week (Budapest, 1968), Speech Symposium (Szeged, 1971), 8th Congress of the Union of the European Phoniatricians - UEP (Kõszeg, 1979), World Congress of Paediatric Oto-rhino-laryngology with Phoniatric Section (Eger, 1986), Cleft Palate Symposium (Budapest, 1989), Int. Congress on Infant Cry Research (Visegrád, 1995), 20th UEP Congress (Budapest, 1997), Int. Conference on ththe Complex Care of Children with Cleft Lip/Palate or Velopharyngeal Insufficiency (Visegrád, 1997).

In 1967, the Kempelen medal was founded and has been given annually for specialists, advancing Hungarian voice and speech research. L.Pataki edits the journal Beszédgyógyítás (Speech therapy) twice a year. Until now 23 outstanding representatives in the field of communication disorders from all over the world were elected as honorary members.

The Hungarian Association is a member of UEP since its foundation (first secretary, later president, then member of the General Secretary’s Office and now J.Hirschberg is honorary member; board members were also T.Frint and M.Stepper), and of the IALP. T.Frint and J.Hirschberg were IALP board members, the latter representing Hungary also on the board of the International Association of Phonosurgeons, in the Standing Committee of Phoniatrics and Voice Care of IFOS and acting as chairman of the Cleft Palate Committee of IALP. In 1980, T.Frint and J.Hirschberg were honoured in Berlin with the Gutzmann medal for their merits in developing the Hungarian and general phoniatrics. Hungarian specialists (T.Frint, J.Hirschberg, M.Stepper, E.Simon-Nagy, L.Pataki, Zs.Farkas) are (were) members or chairs of several committees of UEP and IALP and participated as invited speakers, moderators, main lecturers, leaders of instructional sessions of many international congresses.