Case study (multiple photos): A female elementary school music teacher in her 40s notes two years of loss of singing capabilities for five months after school starts. She has definate improvement over the summer when she uses her voice less. She has had problems with high soft singing for a longer period. She has voice fatigue. On a previous ENT exam, a physician told her that she had nodules and recommended Speech therapy. This did not help according to patient. Medical history Soprano 10 years vocal training tobacco - none alcohol - none caffeine - none Medications - muscle relaxants She reports average talkativeness: 4/7 and average loudness: 4/7 vocal commitments: 6 hours talking at work choir practice 3 hours per week choir perfomance 1 hour per week Vocal capabilities testing Reading voice: clear sounding Anchor pitch (F0) - F3# Low pitch - F3# High pitch - A5 pianissimo mucosal ceiling (onset delays and breathiness) - C5 onset delay, F5 loss of entrainment diplophonia - no Her Stroboscopic Examination of the larynx is pictured above: before, during and after surgery In the initial picture she has broad based swellings along both vibratory margins with a hemorrhage on left noted during open phase of strobe and an ectasia on right. The swellings are clear and translucent.