The long read: More and more singers are cancelling big shows and turning to surgery to fix their damaged vocal cords. But is the problem actually down to the way they sing?
I dont even know how to start this, Adele wrote in an online letter to fans on 30 June. The previous night, she had played the second show of a sold-out, four-night residency at Wembley Stadium. These dates, in front of audiences of 98,000, were supposed to be the triumphant conclusion of her record-setting, 123-date world tour. But on stage, something had just felt wrong.
Ive struggled vocally both nights, she wrote. I had to push a lot harder than I normally do. I felt like I constantly had to clear my throat. After the second show, Adele went to see her doctor, who told her she had damaged her vocal cords and had no option but to cancel her remaining shows. The most powerful young voice in the music business had fallen silent. To say Im heart broken would be a complete understatement, she wrote.
Though only 29, Adele had been here before. Six years earlier, she had suffered a haemorrhage to her vocal cords after singing live on a French radio program. In order to repair the injury, she underwent an incredibly delicate, high-risk medical intervention: vocal cord microsurgery. In this operation, the surgeon wields miniature scalpels and forceps attached to foot-long poles that are guided down the throat to excise whatever damaged tissue is robbing the vocal cords of their elasticity, and depriving the voice of its natural timbre, range and clarity.
Adeles surgeon, Dr Steven Zeitels, was after a nasty polyp that had formed under her epithelium, the thin outer layer of the vocal cord. Zeitels carefully snipped the layer with a scalpel, and then, with a forcep, pulled back the tissue like a flap, exposing the polyp below. With a second forcep he pulled out the gooey, infected mass, and zapped the remaining haemorrhaged surface with a laser to stop the bleeding and prevent scarring.
The margin for error in such surgeries is measured in fractions of a millimetre. You cant let the instruments touch any healthy tissue. Dig too deep, Zeitels knew, and he would risk damaging the superficial lamina propria, the soft, pliable underlayer of Adeles vocal cords. If he pierced that, he told me, there would be no way to preserve the power and suppleness of her voice.
On 12 February 2012, three months after her surgery, Adele swept up six awards at the Grammys, including album of the year and song of the year. In her acceptance speech for best pop solo performance, she thanked Zeitels for restoring her voice. To most observers, it was a cheering comeback story, but for a handful of medical specialists it was a watershed moment. For years, vocal cord microsurgery had been considered risky. (In 1997, an unsuccessful surgical procedure left Julie Andrews already damaged voice beyond repair.) More than the physical risk, though, singers feared the damage to their careers that could follow if word got out. In the world of showbusiness, it was safer to be seen as a singer with a healthy young voice than as a one-time great with surgically repaired cords.
Now, Adele had suddenly swept away the stigma. In the years since, Zeitels business has boomed, along with those of many of his peers. They have no shortage of patients: there is an epidemic of serious vocal cord injuries in the performing arts. In addition to his work on Adele, Zeitels, who directs the Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, has repaired the cords of more than 700 performing artists, including Sam Smith, Lionel Richie, Bono and Cher. Michael Bubl, Keith Urban, Meghan Trainor and Celine Dion have also had to quit touring to get their cords surgically repaired. In a mark of how attitudes to surgery have changed, both Smith and Bubl broke the news of their surgeries to their fans via Instagram.
There is no precise data on the number of performers who have gone under the knife over the years. But several surgeons told me they estimate that vocal cord surgery has been performed on thousands of pop, rock and classical singers, as well as on theatre and stage musical stars. Cancelled shows reverberate across social media and hit a struggling music industry hard. When Adele pulled out of her remaining two Wembley shows this summer, nearly 200,000 tickets had to be refunded. Its unclear if she will ever tour again.
After Adeles 2011 surgery, Zeitels became something of a celebrity. Occasionally, a reporter asked him if Adele was cured for good. He made no assurances, but told Channel 4s Jon Snow that her surgically repaired voice sounds smoother now than before.
While the media was celebrating this miracle surgery, one woman in the music industry raised a dissenting voice. According to Lisa Paglin, a former opera singer turned voice coach, Zeitels had simply found a temporary fix; in the not too distant future, Adele would once again be forced off the stage and back into the operating theatre. It was a prediction that Paglin and Marianna Brilla, her coaching partner, were willing to stake their reputations on. The rash of vocal injuries silencing our most promising young talents, they argued, is too big a problem to be solved by microsurgery.
How many surgeries would Dr Zeitels consider performing on Adele? Or on anyone? After surgery, unless a singer makes major changes, return to performing means a return to the vocal abuse that put her/him on the operating table in the first place, Paglin wrote, in the small trade publication Intermezzo. Concerts injury surgery rest concerts injury surgery. Is this the life of a professional singer?
When Adele cancelled the final nights of her recent tour, Brilla and Paglin felt saddened but vindicated. For more than a decade, they have been pushing for a revolution in the way that almost every modern performer has been taught to use their voice. After years of painstaking research in musical archives, early scientific journals and the classroom, Brilla and Paglin say they can deliver what medical science has failed to: a permanent fix for vocal burnout.
Their solution requires the revival of an all-but-vanished singing method that is not just beautiful to the ear, but also easy on the throat. Some of their ageing and beleaguered clients described it to me as a kind of fountain of youth. But their cure is not without controversy. It is based on a provocative theory that has been gaining ground among a small cadre of international talents: that we have all been singing completely wrong even Adele.
Singing is a rough business. Every vocal performance involves hundreds of thousands of micro-collisions in the throat. The vocal cords also known as vocal folds are a pair of thin, reed-like, muscular strips located inside the larynx, or voice box, in the throat. They are shaped like a wishbone, and contain the densest concentration of nerve tissue in the body.
When we are silent, the cords remain apart to facilitate breathing. When we sing or speak, air is pushed up from the lungs, and the edges of the cords come together in a rapid chopping motion. The air causes the cords to vibrate, creating sound. The greater the vibration, the higher the pitch. By the time a soprano hits those lush high notes, her vocal cords are thwacking together 1,000 times per second, transforming a burst of air from her lungs into music powerful enough to shatter glass.
Beautiful singing requires lithe cords, but all that slapping together can wear down their fine, spongy surface and lead to tiny contusions. Over years of heavy use, nodules, polyps or cysts form on the vocal folds, distorting the sound they create. For a singer, the first sign of trouble is often the wobble. His pitch fluctuates on and off key because his ragged cords have lost their natural vibrato their ability to resonate properly. Then theres the hole, a point on the scale where a singers vibrating vocal cords fail to produce the proper tone. Try as he might, those notes will exit his mouth flat or, worse, as a barely audible gasp.