Oct. 5, 2011 -- Once again, British singer Adele has been forced to cancel a number of sold-out U.S. shows because of throat problems.
The award-winning singer-songwriter of such hits as "Rolling in the Deep" says on her blog that for the second time this year, she has a vocal cord hemorrhage. She's been told she must rest or risk damaging her voice permanently.
The singer blogs that she is "heartbroken." Adele was planning to kick off her 10-city U.S. tour this Friday in Atlantic City.
Adele has had a number of health problems in the past year. She's had flu, laryngitis, a respiratory and chest infection, and now her second vocal cord hemorrhage.
British throat specialist Gerald Brookes, MD, works with singers. He's the man the British version of the show The X Factor has turned to for the past four years whenever any of its contestants has had a throat problem.
He says a vocal hemorrhage is the only situation, in terms of acute voice problems, where the show doesn't go on.
What Is a Vocal Hemorrhage?
Adele describes it as like a black eye on the vocal cord.
Brookes says: "It's a situation where bleeding occurs from some of the small blood vessels associated with the vocal cords. They bleed into the tissues of the vocal cords and they cause some slight swelling. Sometimes they may form small blood blisters on the vocal folds or they may just bleed under the surface tissues, just as you might bleed under the skin, for example.
"The problem is that the blood can organize and form scar tissue, and in forming scar tissue it can interfere with the way that the vocal cord functions.
"The surface of the vocal cord is rather like the fronds of a sea anemone. It's a very fragile membrane. It actually oscillates as we talk and sing. It's that undulatory motion that gives the voice its musical quality.
"With vocal cord hemorrhages, if there's excessive scarring it can interfere with the vibratory pattern of the vocal cord and give the patient a permanently husky voice."
Change in Voice
Could Adele's voice change?
"It could," Brookes says. "There are quite a lot of professional singers out there who have a slightly husky voice. They've probably overused the voice. Maybe they've battled on singing when they've had viral laryngitis or something like that. They've got up and performed and overdone it."
The slight husky quality, he says, may be one of the characteristics that make people like their singing style. For other people who have a more pure singing voice, he says, they may not have the full range they had before.
Treatment for Vocal Cord Hemorrhage
Rest is the only real treatment as Adele herself has acknowledged online: "I have absolutely no choice but to recuperate properly and fully, or I risk damaging my voice forever."
She writes, "My voice is weak and I need to build it back up. I'm gonna be starting up vocal rehab as soon as [I can], and start building my overall stamina in my voice, body and mind. I will be back and I'm gonna smash the ball out the park once I'm touring again."
Brookes says a singing ban is the only way for Adele: "You have to tell the performer they cannot perform, they cannot sing. They have to stop there and then.
"It doesn't happen very often, most of the rest of the time when you see people with problems affecting the vocal cords you can treat them with antibiotics, anti-inflammatory drugs and improve them enough so they can still do that important event.
"For people with vocal cord hemorrhages, they have to stop because if they keep singing, they can aggravate it, get more bleeding and more scarring."
Resting the Voice
How long should a person with a vocal cord hemorrhage rest his or her voice?
"I would say the person normally has to stop for a week and then be reviewed," Brookes says. "What you can't let them do is go back before it's settled down.
"It doesn't happen that often in professional singers, but when it does, it's not just missing the odd performance. It's often a week or couple of weeks they need to miss. It depends on the severity."
Recovery From a Vocal Cord Hemorrhage
Can Adele make a full recovery?
That depends, Brookes says. There may be a reason for a patient's bleeding: "The person may have had some injection in the vocal cord for laryngitis. Maybe they've had some acid reflux issues causing local inflammation. Or perhaps they've just been overusing the voice, overdoing it, particularly singers who project their voice and sing very loudly.
"If patients stop singing, rest the voice, for the majority of them it should settle down and recover back to normal. There are some people who get recurrent hemorrhages and it is possible to have a weakness of certain blood vessels in the vocal cords."
Adele will be doing her best to help in her own recovery, writing that she follows -- to the best of her ability -- all the advice she's given. She says she sticks to regimes, rules, and practices that can help, describing them as "very necessary but insanely grim."