Durham, N.C. — Most people can abuse their voice with straining or shouting. Some people even have allergies or reflux that can cause voice problems. Many people turn to medical help and even surgery at places like Duke's Voice Care Center.

Noel Barefoot, a 20-year-old student at East Carolina University, wants to be a country music star.

"I love it. I'd rather sing than talk,"  she said.

But last summer, Barefoot noticed that she had a problem.

"I couldn't sing high anymore. I was staying hoarse all the time," she said.

Barefoot learned she had a lesion or polyp that keeps her vocal cords from closing completely. Dr. Seth Cohen at Duke's Voice Care Center tried all conservative approaches to help Barefoot, but she wanted her voice back to 100 percent. For her, surgery was the only answer.

"We do it with the microscope and we have very fine instruments -- small scissors and small knives -- and we remove the diseased portion of that layer of the vocal cord, preserving everything that is normal," Cohen said.

It is a delicate procedure because unlike some body tissue, the vocal cords can not regenerate.

After three months of healing, rest and rehabilitation, Barefoot's vocal cords are back to normal. The edges of the vocal cords are completely straight, though she said her voice is only at about 80 percent of what it should be. Barefoot and Cohen said it will improve with time and care.

A team of specialists helped Noel learn ways to use her voice more efficiently, protect it and prevent future injury. Special assessments, using computerized models of the voice, help her to identify ways to better use for her voice.

"Water intake is so very important. I have to constantly drink water throughout the day. I avoid caffeine and stuff that can dehydrate you," Barefoot said.

Cohen and his team at the Duke Voice Care Center also treat people who do not use their voice as their livelihood, but they may have problems that make simple communication difficult.