Teachers are susceptible to voice problems due to the phonatory effort they make in the school environment. When a teacher uses his/her voice inappropriately and resorts to a poor phonatory technique, this may result in voice overexertion; as a result, dysfunctional alterations may be sustained over time and become chronic. "In order to establish how the mechanism of phonatory overexertion operates, it is necessary to ask what triggers and promoting factors may influence the onset of voice strain. These factors may not be exclusively functional and organic, but also psychological and sociological, and may occur in isolation or in interaction," said Dr Ana Apellaniz.

A study conducted at the UPV/EHU by Dr Apellaniz on a sample of 76 teachers with voice problems (with the presence of vocal nodules) explored the influence exerted by emotional aspects on the aetiology of vocal problems, studied the way in which the emotional aspect directly influences the patient's perception of his or her own voice, and explored the importance of vocal rehabilitation to improve the patient's state of mind as the therapy progresses, during which greater confidence is acquired in vocal functioning in both daily and professional life.

Besides assessing the possible epidemiological factors that may influence the onset of the vocal problem, the study included a complete clinical history with the physical and instrumental examination of the patients. The patients also completed a global questionnaire, underwent a vocal disability test and a test to determine whether there was any link between the onset of voice problems and the existence of a state of anxiety or emotional problems when the voice problem began; the existence of a link with any type of anxiety-prone trait was also assessed.

What was found was that personal medical history and a higher level of anxiety observed in the vocal disability test in the emotional domain are statistically significant in accounting for the probability of suffering from moderate or severe functional vocal problems. The researcher pointed out that "64.47 % of the teachers in the study identified specific situations of stress or anxiety coinciding with the onset of the vocal problem, and 73.6 % of the patients had results indicating a high degree of anxiety at the time when the voice problem was triggered".

The study also shows that phoniatric rehabilitation brings about an improvement in vocal functionality, "since 84.20% of the teachers displayed total vocal disability that was moderate, severe or acute before rehabilitation, and the disability decreased to 24.99% after rehabilitation". What is more, no cases of acute total vocal disability were found after speech therapy. When statistically correlating the total number of rehabilitation sessions given with the degree of severity of total vocal disability, "no clear linear relationship was observed. This fact coincides with the clinical picture seen in the surgery, where it is observed that the degree of greater or lesser vocal disability does not determine whether the number of sessions to be carried out are higher or lower, given the degree of variability in each patient’s response and the particular circumstances of each one". She added that "after analysing the sample, it is possible to suggest that younger teachers display higher values of physical and functional vocal disability than the subgroup of senior teachers".

Additional information

This research is part of the PhD thesis within the PhD in Medicine and Surgery programme run by the UPV/EHU and recently read by the new PhD holder Ana Apellaniz-González, entitled "Análisis de correlación de la influencia del factor emocional en la etiología, eficacia y evolución del tratamiento rehabilitador mediante foniatría en la disfonía profesional del docente" (Correlation analysis of the influence of the emotional factor on the aetiology, efficacy and evolution of rehabilitation treatment by means of phoniatrics in professional dysphonia in teachers). The doctor carried out this work under the supervision of Professor Dr Ana Sánchez del Rey of the Department of Dermatology, Ophthalmology and Otorhinolaryngology.

Dr Ana Apellaniz has a degree in Medicine and Surgery from the UPV/EHU, and has trained as a speech therapist at the Hôpital Tripode in Bordeaux. She also graduated as a speech therapist at the University of Salamanca and has been working in Bilbao and Vitoria-Gasteiz for over three decades.