"Treatment post-surgically must address the specific forms of vocal abuse, misuse and overuse that the patient engages in, in order for vocal rehabilitation to occur," said Daniel Martin, director of the University of Chicago Voice Center. "Examples of bad vocal habits include loud talking, talking over noise, shouting or yelling, excessive talking, improper singing technique."
But speaking optimally can be at odds with the vocal demands of some professions where projecting, speaking loudly, and varying tone and cadence often is important.
Singers, teachers and people who appear regularly on television are a few of the groups often at risk for vocal injury.
The goal of vocal therapy is to learn to use both breath and the vocal cords efficiently.
Like a balloon, the lungs can hold a certain amount of air that can be used to create sound. The more the vocal cords can control the airstream from the lungs, the better the voice sound and quality for the same amount of effort.
Ray's familiar rasp is the sound of excess air escaping, unregulated, from the vocal cords.
But Franco said the biggest difference therapy can make for those with injured vocal cords is the ease with which they can produce voice, with less effort and less fatigue.
"[Ray] still works with a vocal therapist on ways to use her voice better," Dougiello said. "If there's a difference, it's not noticeable to anyone else and she hasn't lost her voice since [her surgery]."