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.
When the vocal cords are damaged, Nasseri said minimally invasive surgery, the type Adele underwent, heals wounds with minimal risk.
"But we always use surgery as a last option, because everyone knows about Julie Andrews' voice," he said.
Andrews, the star of the original "The Sound of Music" and "Mary Poppins" films, lost her singing voice after a 1997 surgery. Her story remains a cautionary tale to other musicians. Recording artist Celeste Prince is slowly making a comeback after, she said, vocal problems and subsequent surgery ruined her signature raspy sound and threatened her career.
"It's a strange thing as a singer to know that you're signed and you're loved for a particular quality in your voice that then gets taken out of your own body," Prince said.
Since her recovery Prince said she was "relieved" to get her voice back.
"I was sexy again," she said.
Vocal coach Roger Love, who has worked with almost everyone in the music business from Gwen Stefani to Def Leppard, said he prefers to heal damaged vocal cords without surgery.
"Why would anyone want surgery?" Love said. "If I tell the artist that I can eliminate those calluses that are on their cords by teaching them how to sing better, who's going to take the knife? In my view the vocal cords are never better after surgery."
Love said he will lay down the law of good vocal practice with his top-tier singing clients, starting with proper vocal warm-up exercises before shows.
"If you went back stage to see any of my artists you would hear sounds like, 'goog goog goog goog,'" he said. "You would think that somebody was either having a small seizure or that they were warming up their voices."
Singers with raspy voices, such as Rod Stewart or Joe Cocker, have that unique throaty gurgle because their "vocal cords are not perfect," Love said.
"There are other ways of creating that sound without damaging your vocal cords," he said.
Even superstar music legends like Paul Stanley of KISS believe it's never too late to look after your voice. With thousands of performances and over four decades of touring, Stanley said those years of hitting screeching notes and high-octane stage raps can take their toll.
"As soon as you hit the stage, you are a complete idiot," he said. "People are cheering for you, so you do the impossible and when you don't have enough time to recuperate afterwards, it just catches up with you. Literally speaking my voice was cracking. It was cracking quite a bit on stage."
Those years of strain are why the Kiss vocalist had surgery on his vocal cords this year by the noted Dr. Steven Zietels, an otolaryngologist at the Massachusetts General Hospital Voice Center, who also operated on Adele.
"[Zietels] said my cords actually looked great for somebody who actually worked as much as I did and he did some minor things to mine," Stanley said. "It sounds way, way, way, way better."
It's good news for a nearly 60-year-old recording artist who is working on producing a new Kiss album.
"I lead a pretty good healthy life and I think at some point that really plays into it. That whole cartoon lifestyle that some people think is key to being a rock star is your demise," Stanley said. "Treat your voice like an instrument. We take pretty good care of our guitars our violins and our pianos but we kind of take our voice for granted. You know, warm it up, warm it down and give it a chance to rest."
ABC News' Lauren Effron contributed to this report