Like breathing, we don't even think about it unless there's a problem. But by the time our vocal cords become so damaged they don't work right, it's often far worse than an inconvenience.

For some it can be a crisis, and that goes for more than just professional singers and actors. What good would coaches be if they couldn't shout? How about the voice of authority required by teachers, attorneys, broadcasters, clergy or parents?

Who are we if we don't have a voice?

"It can almost feel like you're not yourself," says Leda Scearce, a speech pathologist with the Duke Voice Care Center, "whether it's a rock star who comes in here or a grandmother who just wants to be able to talk to her grandchildren on the phone so they recognize her voice."

Duke started the voice center in July 2006, and within six months had so many patients who were performers that Scearce limited her practice to treating only voice professionals. The center's three surgeons and three speech pathologists treat a wide variety of voice ailments by combining the expertise of both disciplines with the newest technology.

Only a few places in the country do that in the same clinic. The UNC School of Medicine's voice center is one, and it also has a speech pathologist who specializes in singing-voice disorders.

The Duke center is singing a slightly different tune by forming partnerships with the N.C. Symphony, N.C. Theatre and Long Leaf Opera Company and with other medical providers to offer a comprehensive approach to treatment and education. Duke has also been spreading the word about voice health around the Triangle. On Sunday, the center will hold its second World Voice Day event in cooperation with the symphony.

Driven especially by the influx of performers, the Duke voice center's practice has been so busy that it expanded to a Raleigh office in December. Dr. David Witsell, director and founder of the center, sees an opportunity to explore what he calls the field of performing arts medicine.

"It's a very exciting time to have all these collaborations here in Raleigh," Witsell said. "I'd love to see 'Raleigh, the city of arts medicine.' "

Helping performers

The center has already rescued singers and actors who might otherwise be unable to perform on local stages. Last year, Broadway actress Lois Markle arrived with acute laryngitis facing 14 performances of a Theater Previews at Duke play that would not be amplified. Scearce, who was an opera singer before becoming a speech pathologist, gave Markle voice-saving instructions but also persuaded the play's director to hide a microphone in the actress' costume.

Duke's voice center also treats people who have less dramatic lives but suffer from problems just as disruptive.

Melissa Fitzpatrick is a nurse and vice president of a medical technologies firm who gives motivational speeches on health issues around the country. In 2006, when she was also coaching her young son's basketball team, she noticed that she was constantly clearing her throat and her voice sounded hoarse. She told herself it was a cold, although it had gone on for months.

After delivering a talk in Virginia, a speech pathologist who had been in the audience was introduced to her.

"She said, 'You have injured your vocal cords,'" Fitzpatrick recounted. "I had never seen this person before and she says, 'I don't want to scare you but you need to go get seen. I can hear it in your voice.' It scared the daylights out of me because I speak for a living."

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