ABSTRACT
Marie is a 35-year-old professional singer who has good health with the exception of her recent problems with voice. She sought help some years ago when she had a less severe voice problem, and felt that she had overcome any inadequacy in her singing technique. Since then she has tried to follow all the advice given to her and has progressed well until one year ago, when she experienced a period of extreme stress following a marital breakdown. During that time she began to notice changes in her voice quality and difficulties in her performance as she struggled to sing songs that had been part of her repertoire for years. She had difficulties in the quality and power of her voice, as well as with her upper pitch range. She realised that she was worrying about the possibility of a voice crash and was apprehensive before every performance. This resulted in physical tension and anxiety, which inhibited her performance in many respects. She usually sings in clubs and at weddings and may have several hours of singing as she is the main singer with her own band. These environments can be very hot and smoky, with little ventilation. She has small, soft vocal nodules at the anterior third and posterior two-thirds of her vocal folds.
