Music teacher Sarah Brady, 31, was born with a melodious voice, but last year suddenly began having trouble hitting certain notes and suffered frequent bouts of laryngitis.
She tried drinking lots of water, sucking on cough drops and resting her voice, all to no avail.
An ear, nose and throat specialist sent her to the Johns Hopkins Voice Center, where doctors quickly figured out what was wrong.
Doctors at the center, housed at Greater Baltimore Medical Center in Towson, used a flexible scope they eased down her throat to look at her vocal cords, which both had developed calluses.
"They weren't able to touch and air was escaping and that is why high and soft notes became hard to sing," said Brady, who lives in Boonsboro and teaches elementary students.
Brady is among the one in three people afflicted with voice problems. Many try to soothe the symptoms themselves, only to realize it's not that easily treated and that they may need to see a specialist.
"Voice problems are one of those things everybody takes for granted," said Dr. Kenneth Charles Fletcher, a laryngologist for the Hopkins voice center at GBMC. "No one thinks about it like an injury, to say, the knee."
The voice center recently underwent a $1.6 million, 5,000-square-foot expansion to treat more patients. The upgrades include a studio with $20,000 worth of audio equipment and guitars, drums and other musical instruments where people can do voice therapy. Fender Musical Instruments Corp. provided the instruments.
People who use their voices a lot — professional singers, teachers, doctors, broadcasters — are more likely to suffer from voice problems. For those people, treatment can prevent a career from ending.
But anyone can strain or damage their vocal cords, doctors said. For instance, the vocal cords can endure too much friction if they vibrate aggressively for long periods. Talking too much and loudly can also irritate the cords. Acid reflux, infection, age, trauma, chemical exposure, cancer or a neurological pathology can also all cause voice injuries.
Symptoms such as hoarseness, a scratchy throat or short-term voice loss may seem mild, but can be a sign of a serious condition.
Doctors at the Hopkins voice center use a combination of physical therapy and surgery to treat patients.
"If we remove the lump and don't find out what caused it, it will come back," Fletcher said. "It is a concerted effort to treat everything."
Breathing exercises and voice training are as important to recovery as removing calluses, doctors said.
"If you teach people to breathe more economically and more efficiently, there is not as much pressure put on the vocal cords," said Daniel Sherwood, senior speech pathologist at the voice center. "If we take the work out of it, then those cords get a break."
Elementary school teacher Theresa Wenck has been getting treated at the voice center after suffering bouts of laryngitis. Doctors said she had a vocal hemorrhage that wasn't getting better by resting the voice. They performed laser surgery to fix the problem.
One recent morning, Wenck tried to match notes played on a piano. Her voice still sometimes gets tired, but she said the surgery has helped and she is glad to be able to work again as a music teacher.
"It's good to get back to my students," she said.
Brady has also seen improvement with voice therapy. She felt she was letting her students down when her voice was injured and she couldn't model proper technique. She has learned how to conserve her voice and use new singing techniques so there is less wear on the vocal cords and she doesn't get injured again.
"They were able to give me ways to bring my voice back in healthy way," she said. "I am finally starting to sound like I used to."
Sherwood said sometimes voices just need a fine tuning and repair, just like a trumpet, flute or other musical instrument.
"It's all about taking care of the instrument," Sherwood said. "Because you can't take it back to the music store and get a new one."