'21,' By The Numbers: Billboard Breaks Down Adele's Breakout Sophomore Release
'21,' By The Numbers: Billboard Breaks Down Adele's Breakout Sophomore Release

It seems every week brings word of another music star going in for throat surgery. In early October, Adele said she was canceling all appearances through 2011 to undergo laser microsurgery to repair a hemorrhaged vocal cord. Two weeks later, John Mayer revealed he had gone under the knife and was confined to vocal rest for a month or more. Then Keith Urban said he was postponing all but "one-song performance commitments" leading up to surgery in November to remove a polyp on his vocal cords.

Many in the music industry are wondering whether the rash of surgeries is a coincidence or a sign that singers are being overworked. After all, touring, an artist's best chance to pocket revenue in an age of anemic record sales, is more demanding than ever.

"Ten years ago, I used to see hemorrhages twice a year; now I see them once a month," says Dr. Shawn Nasseri, a Beverly Hills otolaryngologist who has treated dozens of singers from Justin Bieber to Kelly Rowland (she bowed out of the U.K. "X Factor" in October due to a throat infection) and serves as the on-call vocals doc for Fox's "American Idol" and U.S. "X Factor." "When they're successful, there's a lot more of everything -- press, promo, they have to tweet, Facebook and chat, they tour and record simultaneously, often late at night … People don't slow down because you've got to strike when the iron is hot. Before, the market would forgive a one- or two-month hiatus; now it's very different."

Indeed, many singers go decades without properly maintaining their instrument (primarily, rest, proper diet and vocal warmups), which Nasseri likens to "to "tuning up a Lamborghini." Paul Stanley of Kiss, who had surgery Oct. 26 to "tweak" blood vessels in his vocal cords, says he powered through four decades of concerts "through sheer willpower" so the band could "cram in as many shows as possible to maximize profit." But, he cautions, "the nature of rock singing is a strain on the voice and when you compound that with that amount of shows, you're not giving yourself time to recuperate and the problem is compounded… I was finding myself working harder and harder to do what was once effortless, and having already passed through puberty, I was surprised to hear my voice cracking."

Throw in cigarettes and alcohol (two of Adele's well-documented vices), late-night meals, heavy travel and a five-nights-on, one-night-off itinerary -- up from the more sane two-on, one-off, says Nasseri -- and you have a recipe for damage that could cancel the rest of a tour. "If you're going to mix alcohol, cigarettes and drugs with singing, you've got a combustible combination that can only get you in trouble," says Stanley of his experience. "When I was starring in 'Phantom of the Opera,' I found I couldn't drink a glass of wine the night before because it affected my vocal cords the next night, so people who are staying up till all hours, snorting this, smoking that and drinking the other, turn over the sand timer and when the sand runs out, your number comes up."

In Adele's case, 17 shows were scrapped at a potential loss of up to $10 million. In such instances, cancellation insurance may be the only remedy and it's a costly one. "Non-appearance coverage is subject to extensive underwriting," explains Adam Siegel who oversees event coverage for New York-based GFI Insurance Services. "The policy is typically paid for by whoever stands to lose revenue, it could be the venue in expenses that have already been paid out to put on the concert, or revenues in the form of income or profit."

And there's a ripple effect, too. Music executive Ken Komisar, a 16-year Sony Music veteran who's worked with Justin Timberlake and Natasha Beddingfield, says it's not unlike the current NBA lockout. "[The Lakers] aren't playing in Staples Center, so everyone in the surrounding area is directly affected, never mind the people who bought in on merchandise or services and can't get it for sale." As for ticket buyers, Adele acknowledged the impact her cancelations would have when she blogged about the news. "I know it's not only disappointing because of the show, but it's plane tickets, hotel bookings, birthdays, anniversaries and time wasted," she wrote.

Adele underwent surgery on Monday at Massachusetts General's renowned Center for Laryngeal Surgery and Voice Rehabilitation, whose patients and supporters include Julie Andrews, who famously -- and tragically -- lost her voice to a botched surgery in 1997, Aerosmith's Steven Tyler and The Who's Roger Daltry. Adele is expected to make a full recovery, according to her doctor, Steven Zeitels. But now comes the tricky responsibility of staying quiet. Says Nasseri: "Typically, a singer will be on vocal rest between one and three weeks, but on that third week, it can't go from 0 to 60. I tell them to cut down [using their voice] to at least less than 50% so they're not saying as many words in the day. It gives the voice a chance to catch up."

Without insurance, unforeseen medical hiatuses can impact a performer's bottom line, but not resting can lead to potentially career-derailing damage (think Whitney Houston). To that end, Komisar says the age-old "exhaustion" mantra holds true. "It's a 24/7 business, and the expectations are more," he says. "So much overuse of a singer's vocal cords can be extremely detrimental to their ability to perform. We should all be advocates of taking better care of ourselves and our artists."