It should have been the pinnacle of a glittering year. Since wowing fans with a mesmerizing  performance at the Brit awards in February, singer Adele has achieved global fame and critical reward aplenty. But her failure to perform at the Q awards in London Monday, combined with the cancellation of American tour dates, suggests that there is no clear end to the throat problems that are plaguing the songbird.

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A hemorrhaged vocal chord has forced the singer to completely rest her voice and there is as yet no indication when she will be able to return. So far her label has said only that she will need "an extended rest period" before being able to perform.

Fans have reacted with sadness to the singer's continued absence, as well as to fears that the British artist could have long-term problems with her voice.

Following the Q Awards no-show, What-duh_Hal tweeted: "Adele, if your throat doesn't heal and prevents you making beautiful music I don't know what I'll do with myself."

Adele's complete absence at the Q awards was in contrast to her appearance at the Mercury Music Awards - also in London - in early September.

Then, the singer appeared in person to receive her awards, but a clearly throaty and congested voice meant that she was unable to sing. She told the audience that she was under doctors' orders to rest her voice and was "terribly sad" not to be able to perform.

Earlier this month she cancelled a 10-city sold-out tour of the U.S. after the vocal chord issues that had forced her to cancel earlier British tour dates seem to have put her future performing in jeopardy.

The singer, who won Best Female and Best Track at the Q Awards is also nominated for three MTV Europe Music Awards - to be handed out in Belfast next month on Nov. 6 - but there is no indication that the singer will be well enough to perform.

After announcing that she was canceling her U.S. tour dates three weeks ago, the singer blogged: "Guys, I'm heartbroken and worried to tell you that I am yet again experiencing problems with my voice… I follow all the advice I am given and stick to regimes, rules and practices to the best of my ability, but it seems to simply not be enough."