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Why do stars like Adele keep losing their voice?

Why do stars like Adele keep losing their voice?

"I don't 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. "I've 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 I'm 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. Adele's 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 can't 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 Adele's 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 Bublé, 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 Bublé 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. It's unclear if she will ever tour again. After Adele's 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 4's 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 there's the "hole", a point on the scale where a singer's 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. It was once unheard-of for a singer to perform with a faulty voice, but the opera world has recently been shaken by a trio of incidents in which the stars Rolando Villazón, Aleksandrs Antonenko and Robert Alagno walked off stage mid-performance, unable to go on. Some opera singers complain of year-round cold symptoms, and legal steroid injections and other drugs are often used to get a struggling singer through a performance. But singing through the wear and tear can cause the lesions to burst and bleed, creating voice-ruining scars, which is what happened to Adele in 2011. Voice specialists liken the physical toll on singers and stage performers to what athletes endure. Surgery to the professional singer's vocal cords is what ligament reconstruction has become to the football player's knee. Dusty theatres, stuffy airplane cabins, erratic eating and sleeping patterns, the stress of living off stingy contracts - all affect the vocal cords. Add to it the occupational hazard, at least in opera and classical music, of taking on roles that require you to sing above your natural range, and the cords become extremely susceptible to injury. In 1986, the conductor, vocal coach and New York Times music critic Will Crutchfield lamented that vocal burnout was cutting short careers and diminishing the power of opera, "as audiences, by necessity, accustom themselves to hearing voices in poor condition". Back then, Crutchfield saw that singers peaked in their 30s and then began to decline. But Adele, Trainor and Smith all underwent career-saving surgery in their 20s. Vocal burnout is afflicting amateurs, too. One veteran teacher in Italy told me that female students in their early 20s who want to sing like Adele or a young Whitney Houston are the ones who come down with vocal nodules. Another music teacher told me she recently had to instruct one of her 10-year-old students to stop singing and get his damaged cords checked by a specialist. The rise in vocal injuries is linked to a change in what we consider good singing. Across all genres, it has become normal to believe that louder is better. (One reason that Adele is such a big star is because her voice is so big.) As a result, singers are pushing their cords like never before, which leads to vocal breakdown. New waves of medical research into the causes of dysphonia, or the inability to properly produce voice, bear this out. In the west, vocal abuse is surprisingly common in all professions that rely on the voice , from schoolteachers to opera singers. Awareness of the problem is growing, but as Adele's case demonstrated, and separate studies conclude, surgery is not necessarily a lasting fix. Brilla and Paglin have been saying this for years. "You cannot solve the problem by simply relieving the symptom," Brilla said. "It's a motor problem. The singer has to understand it's the way you're running your engine" - the techniques they're using to sing. "If you don't fix the engine, it's going to happen again." Teatro La Nuova Fenice, a 19th-century opera house built in the neoclassical style, sits at the top of the small hill town of Osimo in central Italy, just inland of the Adriatic Sea. In the grand lobby of the building is a marble plaque commemorating the night in 1927 when the Italian tenor Beniamino Gigli, one of the greatest talents of his era, performed here. Gigli packed concert halls across Europe and the Americas in a career that spanned five decades. (To be continued)

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