Why Are So Many Singers Suffering From Vocal-Cord Injuries? A Leading Surgeon Explains

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Meghan Trainor. Photo: Taylor Hill/FilmMagic

Last week, “Dear Future Husband” singer Meghan Trainor canceled her tour for health reasons related to her vocal cords. “I was being careful and taking precautions, but I have hemorrhaged my vocal cord again,” she wrote to her fans on Instagram. “I will need to cancel the remainder of my tour and get surgery to finally fix this once and for all.” Of course, Trainor isn’t the only singer who has had to cancel tour dates because of fragile pipes. Between Adele, John Mayer, R. Kelly, and Sam Smith, artists canceling tours to treat their vocal cords appears to be happening more and more these days. But why, exactly? To get some answers, Vulture reached out to Steven M. Zeitels, the famed surgeon and director of the Massachusetts General Hospital Voice Center who has treated everyone from Adele and Sam Smith to Steven Tyler and Julie Andrews. He walked us through the future of voice management.

There aren’t necessarily more vocal cord injuries — just greater awareness of when they have occurred.
Vocal-cord issues have always been around, says Dr. Zeitels, but singers used to keep them secret. Nowadays, “the minute somebody is not going to go on, it’s all over the internet. Fifteen years ago, that didn’t happen. People would cancel the show in Kansas, but you didn’t know about it in New York." As a result, singers today are more willing to acknowledge when vocal injuries have occurred, and feel less shame about admitting it.

"Performers are essentially athletes," says Zeitels. "They’re asked to perform at a high level even when they have a common cold. If you or I get sick and we’re a little hoarse, we don’t necessarily do anything other than slow down a bit and go to work. A singer's job is to go out and perform in front of tens of thousands of people, and the tissues in their vocal cords need to rest. They’re not the type to sit out unless they really have to. In the past, people didn't acknowledge what was going on, and they didn’t get checked. Now you have the ability to get checked more easily."

But there are more surgeries happening, and with better results.
In 1997, Julie Andrews checked into Mt. Sinai Hospital to have noncancerous nodules removed from her vocal cords. The surgery left her once-effervescent voice scratchy and irreparable, ultimately leading to her filing a medical-malpractice lawsuit in 1999. Stories like that predictably made performers reluctant to go under the knife. “There were more risks with procedures in the past because the equipment wasn’t as good, so fewer singers had surgery,” acknowledges Zeitels, who has since worked with Andrews to try to rehabilitate her voice. “It was difficult to deal with bleeding. I would have to peel each vessel out with a needle. Now I can do this with a laser so much more precisely and faster." That assurance makes it easier to safely care for singers, and for singers to care for themselves.

And yet, surgery isn’t always the answer.
Seeing irregularities on the vocal cords is not uncommon, but that doesn't always mean surgery is necessary. “We don’t operate just because something’s there,” Zeitels says. “You operate because of a person's assessment of how their voice is failing, whether it’s stamina, projection, frequency, or range. People who have things on their vocal cords and don’t touch them, it’s usually because they’re doing what they need to do. It’s not a mandate to operate just because the vocal cords don’t look normal. We only mandate doing something when we see something that looks like a tumor." Keith Urban and Lionel Richie are two examples of singers whom Zeitels says sound great and are able to perform with or without surgery. “These are people who are incredibly skilled," he says. Once they have surgery, singing "is just easier for them, but they were still able to perform despite anything that was going on.”

Everyone has a different threshold before surgery is required.
For a variety of reasons, the point at which vocal-cord damage becomes unbearable varies from performer to performer. "A majority of what I operate on, whether it’s a cancer or a polyp, it’s been there for years," says Zeitels. "Vocal nodules are just scars that develop from a lot of voice use, and eventually there is a tipping point whereby singers can’t effectively use their voices. This could be because they've suddenly become much more successful and are expected to do more, or it could be because they've lost too much range to adequately perform their signature songs.”

An example he uses is singer Christina Perri: "Her career was accelerating, and she was having trouble keeping up,” he says. “She had a cyst in her vocal cord that she was probably born with. It wasn't until she had success that it caused enough of an impediment to restrict her ability to sing. Then, once that cyst is removed, she’s never had a problem again, and her voice is stronger than ever.” The three signs that tell singers they're having problems, he explained, are stamina, recovery time, and the actual acoustic quality of their voices.

Downtime is essential.
Zeitels says vocal-cord surgery is minor, but the recovery time can be brutal. “I’m very conservative: absolute voice rest for two to three weeks, and then I’ll let them start talking, and then start singing roughly at four weeks,” he says. “I don’t want someone to be expected to be onstage in front of folks for at least six weeks. Think of it as if you were a runner and you hadn’t done it in a while; you wouldn’t want to jump right back into a competitive race. My ideal is a minimum of six weeks following surgery before they’re back on tour, and more comfortably, eight weeks. Artists are a lot more vigilant about getting checked because it’s so complicated rescheduling these tours and returning to cities.”

Zeitels wants to help create the world's first "supersingers."
At some point in a veteran singer's career, his or her voice can simply start to lose strength. Zeitels wants to make sure those entertainers can keep on going when that happens. “A lot of what’s considered aging isn’t really aging when it comes to voices,” Zeitels explains. “It’s long-term trauma. If someone has used their voice a lot, their vocal cords stiffen. We are working on materials — we just received our second patent — for synthetic materials we can put in the vocal cords to make them soft. It will be just as important what you put into a vocal cord as what you remove, and that’s the future within the next three to five years.”

With this material, Zeitels says, “technically, it’s possible that this would create ‘supersingers.’ Meaning, all of a sudden, at the age of 40 or 50, your vocal cords were as supple as they were at the age of 15. Since you had already built up the skill sets to manage them without that suppleness, you would be able to do tasks that took decades of training. The skills to keep on performing over decades [are] very much neurological brain control. When we have these materials, not only are careers going to be lasting much longer, singers are going to be capable of things that just weren’t possible before.” So there's no need to worry when artists have to take some time off and rest their voices. We should have plenty of chances to enjoy them in the years to come.