speech clinic and good vocal hygiene.

Jessica, a voice major, decided to pledge a sorority in the fall semester of her sophomore year. A talented vocal performer, Jessica had aspirations to teach singing and to perform professionally. During the fall semester, her course work was demanding, requiring several vocal performances and long hours of rehearsal. Pledging turned out to be demanding vocally also. Jessica was talking excessively all day long and well into the night, in addition to shouting loudly at sorority events. During the fifth week of the semester, Jessica noted that her voice fatigued easily, she sounded hoarse, and she could not reach some of the high notes required in her singing. Her voice teacher suggested that she be evaluated at the university’s speech and hearing clinic, in an effort to determine the cause of her diminished vocal capacity. A perceptual and instrumental evaluation of Jessica’s voice was performed by two graduate students enrolled in the university’s communication sciences and disorders program. The findings of this evaluation suggested the possibility of vocal nodules. During the consultation after the evaluation, the supervising professor and the two graduate students explained their findings to Jessica and told her that she needed to be examined by an otolaryngologist before they could proceed further. Otolaryngologic examination is required to confirm or disconfirm the presence of nodules, and SLPs are required ethically to ensure that such an examination has been performed before they initiate treatment. The otolaryngologic examination confirmed the presence of newly formed bilateral vocal nodules. Her physician prescribed complete vocal rest for a week, followed by voice intervention. Jessica enrolled in voice treatment at the university for 6 weeks. Vocal hygiene was stressed during treatment sessions. Jessica was examined by her otolaryngologist at the end of week 6 of treatment. Her vocal nodules were significantly reduced in size and were no longer adversely affecting her voice. Jessica completed her academic semester and sorority pledging successfully, graduated 2 years later, and went on to graduate school at the Juilliard School of Music in New York City. She maintains contact with the university’s speech clinic and reports that she continues to practice good vocal hygiene.

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