The singer Adele's voice takes a hit

After a string of cancelled concerts, the performer is now facing surgery to help heal damage to her vocal cords - a sign of overwork in a music industry that continually demands more from its artists.

The singer Adele.

It doesn't take much for a female musician to be branded a diva. Show the slightest hint of self-assertiveness as a woman in the public eye and you risk getting lumbered with the tag, so when British soul singer Adele started cancelling concerts earlier this year, it's not surprising that some commentators were quick to label her a temperamental prima donna. Despite her reputation as one of the most down-to-earth stars in show business, some claimed that after the massive success of her album 21, which reached number one in 19 countries, Adele was simply getting too posh to push.

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The truth turns out to be the opposite - Adele has, in fact, been pushing herself too far. With a gruelling tour marathon taking its toll, the 23-year-old Londoner's voice has moved to near total collapse this year, with concert after concert cancelled. Last week, a representative for the singer finally announced that Adele had suffered a vocal haemorrhage. Having cancelled all her engagements for the rest of 2011, she would have surgery to rescue her vocal cords. Without immediate intervention, one of the most distinctive voices to emerge in recent years risks being permanently damaged.

Adele herself admitted that she had been "sick as a dog", and there have even been rumours flying around that she has throat cancer - which were swiftly denied by a spokesman. So how was one of the great musical hopes of the decade reduced to a state where her greatest asset was almost ruined?

Adele's troubles started in January, when she so damaged an already flu-weakened voice by overstraining on a European promotional tour that she contracted laryngitis. After the infection was more or less tamed, the singer never gave herself enough time off to get the full rest she needed for her voice and body to recover. Finally, her voice "went out like a light", as she described it herself in a heartfelt blog post, forcing her to give up all hope of performing in 2011. Explaining her haemorrhage as being "like a black eye on the vocal cord", the singer now needs surgical intervention and an open-ended period of complete rest before venturing to speak normally, let alone sing.

While problems like Adele's are rare in the population at large, haemorrhages in the vocal folds (the proper medical term for the vocal cords) are all too common in singers and regular public speakers. Frank Sinatra was forced to take a month-long vow of silence in 1952 after his voice came close to failing, while Elton John and Aerosmith's Steve Tyler have required surgery for similar problems. The Sound of Music star Julie Andrews was especially unlucky in 1997 when surgery for vocal damage almost destroyed her voice completely, an accident that gained her $12 million (Dh44m) in compensation for damage to her career.

And while careful techniques, such as relaxing the jaw when singing, can lessen potential vocal damage, strict voice training in itself is no protection. Natalie Dessay, star soprano at New York's Metropolitan Opera, required two vocal operations to rescue her voice 10 years ago.

What actually happens to singers like these, say doctors, is that they rupture tiny blood vessels on the vocal folds through straining and overuse, or even tear the soft tissue on the fold's vibrating edge. Normally, a good long rest and a strict policy of minimum communication is all the body needs to repair this problem, but in cases like Adele's, where problems have gone much further, surgical intervention is needed. Given the apparent seriousness of her condition, it is possible Adele has developed either a nodule - a hard, callus-like patch - or even a polyp, a (usually non-cancerous) blister-like lesion on the vocal fold. While leaving scars like this untreated can lead to permanent damage to the voice, either of them can thankfully be removed without cutting into the vocal fold itself.

With some swift work, it's perfectly possible that the singer of albums 19 and 21 will be back onstage singing her best next year. Her voice will probably recover, but the fact that it took a career-threatening illness to demand the rest she needs speaks volumes about the music industry's blind greed. A constant whirl of promotion and performance will hardly help the musicianship of a songwriter whose music is famous for the recognisable, everyday situations she sings about.

Let's hope Adele and other performers develop enough so-called "diva" attitude to ensure they get the breaks they need to protect their gifts and their craft.

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