Treatment in most cases includes the following: Voice evaluation by a speech pathologist or experienced physician, including, when available, use of a computer-assisted program to assess pitch and intensity and to determine parameters of vocal acoustics Behavioral treatment (decreasing musculoskeletal laryngeal tension when speaking) using a computer program for visual and auditory biofeedback A vocal hygiene program to eliminate vocally abusive behaviors, such as excessive loudness, long duration (continuous speech for > 1 hour), vocal tension (excessive muscular strain during phonation), and habitual throat clearing An antireflux regimen, when appropriate Adequate hydration to promote an adequate glottal mucosal wave Diet and behavioral modification before vocal performances, which may include avoidance of alcohol, caffeine, and ambient tobacco smoke and other inhaled irritants