For some of today's most powerful young singers, vocal cord issues have them "rolling in the deep."
The health of singing sensation Adele's raspy voice, which propelled her into superstardom and has made her a favorite to sweep the Grammys next month, was threatened last year. Weeks after her Sept. 22 concert at Albert Hall in London, the singer/songwriter had surgery to repair her vocal cords and save her career. She hasn't sung publically since her surgery.
But the 23-year-old isn't the only young singer to go under the knife to help save her voice. John Mayer, 34, was operated on last year, as was 44-year-old country star Keith Urban.
Singers are suffering from polyps, nodules and even hemorrhaging in their throats, the kind of severe damage that can shut down any booming voice, according to Dr. Shawn Nasseri, an otolaryngologist in Beverly Hills who treats many of the biggest money-making singers in the music business today.
It takes the coordination of the lungs, diaphragm, neck, voice box, throat and mouth to produce a voice, but it's when the vocal cords are brought together and vibrate that a pitch and tone are produced. Nasseri said for a singer suffering from a hemorrhaging polyp on their vocal cords, similar to what Adele had, the polyp can keep the two vocal cords from meeting and give the person "absolutely no voice."
"It's devastating," Nasseri said. "These are people used to being in the limelight, used to being on the radio, used to being on TV, suddenly they have to be behind a closed door and for them, it's devastating."
Nasseri said these kinds of injuries are not attributed to genetics, but happen because of a specific vocal technique that singers are doing wrong -- forcing or straining their voice when they should be resting it.
"It's like if you have a bruised, swollen ankle and you want to go run 10 miles, that's exactly when you're going to have trouble," he said.
Problems are easily developed when high demands are placed on popular singers by the new realities of the music business, which is now so dependent on touring, traveling and keeping an active public profile.
"The age where a singer can go sing two to three shows a week, rest in between, not do any press, not stay up at night tweeting about it, not keep their fans informed and be famous, those days are over," Nasseri said.
And it's not just the career demands that can take its toll on singers, but also lifestyle choices -- cigarettes, alcohol and even acid reflux can cause long-term voice problems.
"For a lot of young singers, what happens is they get overwhelmed by just the grind of the schedule," Nasseri said. "I tell singers, 'you are a Lamborghini, you are not a Ford Taurus, going out on the road and going 55 miles per hour, 65, on a freeway, you are going 110 miles per hour on the autobahn."
Soul singer John Legend, 33, said he has grown mindful of the importance of looking after his voice.
"I've certainly been no stranger to having issues with my voice," he said. "My first year performing was the worst year because I didn't know how to pace myself, and once I started to understand how it worked, I started to pace myself better."
And he is not alone. In his biopic, "Never Say Never," pop sensation Justin Bieber was shown with a vocal coach to help him monitor the strain his demanding schedule was having on his voice.