Lauren Alaina, 16, of Rossville, Ga., required medical treatment for a vocal cord injury suffered during rehearsals for Tuesday's performance show. She soldiered on with three tunes, drawing high praise from the Fox TV show's judges.
"This is a very tight race tonight, but Lauren, with that song, you may have just won," Jennifer Lopez said after Alaina sang an emotional "Like My Mother Does," the last of her trio of tunes.
But it's up to viewers to choose between Alaina and Scotty McCreery, 17, of Garner, N.C., an equally fresh-faced performer but one with a strikingly mature voice.
The results will be announced on Wednesday's finale, airing 8-10:07 p.m. EDT.
Randy Jackson said backstage he thought Alaina's performance, not her vocal problem, would count in the voting.
"I think she sang brilliantly tonight," said Jackson, who thought she outsang McCreery on two songs.
But the judge stopped short of predicting her victory.
"Going into tonight, Scotty definitely had an edge and he may still have a slight edge," Jackson said. But Alaina "was the best tonight."
Both are impressive singers for the show's "first-ever, all-country final," he said. "These kids are so young ... I just go, 'Wow.' They embody what this whole show is about."
Alaina's other tunes were Carrie Underwood's "Flat on the Floor" and Pam Tillis' "Maybe It was Memphis," which was selected by former "Idol" winner Underwood.
McCreery sang his own possible future single, "I Love You This Big," Montgomery Gentry's "Gone" and George Strait's "Check Yes or No," Strait's pick for the teenager.
After the show, Alaina gave reporters the silent treatment to protect her voice, with McCreery offering his services as spokesman while she scribbled answers on a memo pad or whispered to him.
When Alaina was asked if her finale performance had been at risk, he replied, "She says, 'Yes.'"
Judge Steven Tyler said it's not unusual for steroids to be used for a vocal cord injury.
"You pay for it dearly the next day," he said, adding that Alaina shouldn't be affected because she was on stage briefly Tuesday.
The show started with host Ryan Seacrest bringing Dr. Shawn Nasseri on stage to explain that Alaina blew out one of her vocal cords but had been given "a lot of medicine" to be able to sing during the finale.
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