The road to efficient and effective stuttering management: information for physicians.

Physicians are often the first point of contact when children's speech begins to be disrupted by stuttering behaviors such as sound repetitions and prolongations. For this reason, we feel it is important that they are accurately informed with regards to the nature of stuttering and the available treatment options before making referrals to speech-language pathologists. Stuttering is by definition, an involuntary disorder and remains that way throughout life. Its cause is still unknown and the only true form of remission appears to be the natural, spontaneous recovery that occurs in up to 80% of those children afflicted. No therapeutic course has seemed to change this figure and the prevalence of stuttering in the general population has remained stable, suggesting that speech therapy has never 'cured' stuttering. Therefore, we suggest that therapeutic intervention for stuttering should be best directed towards 'efficient' and 'effective' symptom reduction. Until recently, intervention options for children and adults who stutter have generally been limited consist of countless hours of speech retraining (teaching people 'how to talk again'), while attempting to bring the disorder under voluntary control. The common end-results of these procedures include unnatural speech patterns that are difficult to maintain in all situations and highly prone to relapse, thus, reinforcing the notion that stuttering is highly resistant to treatment. However, miniaturized digital technology now allows those who stutter to take advantage of auditory effects that 'inhibit' stuttering. 'Choral speech' or speaking in unison has long been known to make those who stutter immediately fluent without compromising speech naturalness. All in-the-ear devices can emulate choral speech effects by altering auditory feedback. Therapeutic protocols using these devices can be quickly and efficiently implemented. Furthermore, they are showing high levels of long-term effectiveness with regards to reducing stuttering frequency and maintaining speech naturalness.