Idon’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.