From the minute Caroline came into the office of the Speech-Language Pathologist, she appeared anxious and worried. A newly graduated elementary school teacher, she works in a little school in her neighbourhood. "I love my job, but it is increasingly difficult to teach and I often lose my voice", she stated during the evaluation. Caroline's voice sounded hoarse and muffled; an ENT physician (ear-nose-throat) had just diagnosed her with vocal fold nodules (small growths orther vocal cords).

Caroline is, unfortunately, not alone suffering from a voice problem. Six percent of all children between the ages of 0 and 14 years present with such problems, One percent of the people between ages 15 and 44 years, and 6.5% of people aged 45 to 65. Even though these problems are frequently reported by teachers, many other children, as well as receptionists, athletes, singers, people suffering from asthma, etc., could have similar problems. These reported difficluties can be intermittent and can be manifested in different ways: hoarseness, inablility to raise one's voice, voice fatigue after prolonged use, the feeling of pain burning or contraction in the throat while speaking, or a need to frequently clear the throat, etc.

There are many causes of voice problems. Amongs the most frequent we find : overuse of the vocal muscles (vocal cords) during speech, and a lesion or inflammation of the vocal cords.

The following measures can help in preventing or minimizing the symptoms : mentioned above before you see a doctor :

• avoid forcing your voice in order to speak or sing; as soon as your voice weakens and you start feeling pain, stop talking.
• Avoid clearing your throat too frequently.
• Stop smoking or smoke less, and if you consume alcohol, do it in moderation.
• In the case of laryngitis, rest your voice and speak as little as possible. Do not whispher! instead.
• If you need to talk for long periods of time, drink a lot of water and plan rest periods for your voice.
• Learn how to relax and exrecise regularly.

If, despite everything, the symptoms persist, the next step is to make an appointment with an ENT doctor, who will, if needed, examine the vocal cords and refer you to a Speech-Language Pathologist (a medical referral is neccessary). The Speech-Language Pathologist trained in the voice disorders, will evaluate the problem using specialized techniques and will make specific recommendations individually to the weekly treatment sessions may be recommended with the goal of eliminating discomfort in the throat and regaining the best quality of voice possible.

After 10 sessions with the speech-language pathologist, Caroline has learned how to speak without abusing or tiring her voice. Her voice is now stable and her nodules have disappeared without surgery. What success!