- Alice Vincent
In 2015, rising US opera star Stephen Costello was minutes away from making his Metropolitan Opera debut when he lost his voice.
"All of a sudden I did something and my neck got really tight. I remember thinking 'oh my god' - it felt almost like something in my throat had popped", he told The Daily Beast.
"Then I couldn't sing. Nothing would come out. Then, as they were calling me to the stage to get ready and walk on...my neck went into spasm, my throat and all the muscles around it just got so tight... I could barely talk."
It transpired that Costello's voice has disappeared due to stress induced by the divorce from his soprano wife. Acid reflex had irritated his vocal cords, making it impossible to sing. Those who had paid $300 for a ticket were left waiting while fellow singer Francesco Demuro stepped into the limelight in the last minute.
On Saturday morning, Adele had her own Costello moment. Mere hours before the penultimate and final shows of an 18-month-long tour, she was forced cancel both.
In the posting of a Twitter update, nearly 200,000 fans, who had clamoured for tickets for her sold-out final gigs, were let down. The Grammy Award-winning, record-breaking singer had damaged her vocal cords; she was unable to perform on medical advice.
Many fans lent their support, singing outside Wembley as signs flashed, "Sorry, Adele show cancelled" as part of a #SingForAdele social media campaign. But others struggled to find sympathy for the singer, especially after paying hundreds of pounds on flights, transport and accommodation to make what were being tipped as Adele's last ever shows.
This was familiar territory for Adele fans.
In 2011, the singer cancelled her entire US tour and six UK dates after suffering a vocal cord haemorrhage as a result of talking too much off-stage and smoking, she told The Sun at the time. Adele underwent vocal surgery at the hands of celebrity laryngologist Dr Steven Zeitels shortly afterwards, and enjoyed such a miraculous recovery that he was the first person she thanked during one of her six Grammy Award acceptance speeches the next year.
Zeitels' later described the procedure - and Adele's subsequent rendition of Rolling in the Deep in the clinic - as "one of the most memorable [moments] in my career". Both surgeon and patient attested that Adele's voice was better than before, clearer and higher, she had lost her husk.
So how have her cords become damaged again, and, having undergone surgery once, can Adele's voice be fixed?
'It felt like something ripping in my throat'
In January 2011, two significant things happened in Adele's career. She released 21, her scorched second album that catapulted her to international super-stardom, and she first started having trouble with her voice.
Weakened by a bout of 'flu the previous December, Adele's voice never regained its full strength by the time of her promotional tour and, as she explained at length on her now-defunct blog, "it just got weaker and weaker until it eventually 'broke'".
Adele wasn't aware of the storm brewing in her throat. She was still smoking, and this was the first instance of her having problems with her voice. She was diagnosed with laryngitis and ordered to rest for 10 days, only to return immediately to an international touring schedule.
In May, still touring, she was diagnosed with her first vocal hemorrhage. "It's like a black eye on the vocal cord," she wrote, "it was incredibly tender and dangerous if I was to sing through it." When she did, it felt like "something ripping in my throat".
By October, after being laid down with a respiratory and chest infection, Adele decided to have surgery. "If I continue to pick up everything before I have properly conquered these problems and nipped them in the bud, I will be totally and utterly f-----", she wrote.
' 'The injuries occur because of their unbelievable work ethic'
Adele is not alone in suffering vocal hemorrhages. During the summer of 2015 the music industry press sought answers after Sam Smith became the latest British Grammy winner to cancel tour dates due to bleeding vocal cords.
All About That Bass singer Megan Trainorfollowed suit weeks later. They were the latest in a string of stars who had pulled out of international tours due to vocal cord trouble: Ariana Grande, John Mayer and R Kelly were forced to let down fans, as Adele had before them.
Rather than an epidemic of vocal cord illnesses sweeping showbusiness, there are more banal factors at play behind this plethora of cancellations. The internet has made all aspects of touring more visible to the public, from opening of a hot ticket sale - and its inevitable selling-out - to what goes on backstage. It is common practice for artists to share their experience of touring through Instagram, lifting the veil on what would previously only have been captured by trusted photographers with a AAA pass.
In the same way, when a star cancels, it becomes major entertainment news online.
Disappointed ticket-holders share their anguish on social media and the artist may excuse themselves through their website or Twitter feed. Blanket coverage means that everybody hears about cancellations that previously would have only affected those going. As Zeitels told Vulture: "Fifteen years ago, [it] didn't happen. People would cancel the show in Kansas, but you didn't know about it in New York".
But touring intensity has ramped up, too. The decline in record sales has pushed artists to make money from touring for the last decade, if not longer. In the decade since her first concert tour, in 1983, Celine Dion performed 306 shows. Rihanna, 13 years later, clocked up 437 between 2006 and 2016. Adele was scheduled to play 174 across just two concert tours since 2011.
"We advise not to do more than a couple shows in a row and a day off in between," Evita vocal coach Joan Lader told Entertainment Weekly in 2015. Zeitels agreed: "More often than not, the injuries occur because of their unbelievable work ethic."
' 'Total silence, no whispering, no humming; you have to write everything down'
Adele is yet to specify what is happening with her voice beyond telling fans, "I have damaged my vocal cords". Declan Costello, a consultant ear nose and throat surgeon specialising in voice disorders, told The Telegraph that Adele's cancellation suggests that "something more acute or immediate [must be] going on which needs more urgent attention, rather than more long term care."
"There are very few situations where I would say to a singer, 'You must not use your voice', but a vocal cord hemorrhage is one of them. It's a distinct possibility," Costello said.
"Most laryngologists would say that a singer in that situation needs to completely rest their voice for couple of weeks. Total silence, no whispering, no humming; you have to write everything down. Because when you've got a hemorrhage, you want it to heal without any scarring, and if you immediately start to use your voice it might scar, and then the cord will never vibrate again properly if it's not treated adequately."
Bouts of silence is the standard treatment for others in Adele's situation. Sam Smith was subject to silence for three weeks after Zeitels operated on his vocal cords, while Celine Dion eschewed surgery in exchange for two mute weeks to combat extreme swelling.
John Mayer found success once his vocal cords were paralysed with Botox, allowing them to rest after three years of recurring tissue inflammation.
' 'No singer wants to have an operation on her larynx, let alone two or three'
Adele's emotional statement suggested that the singer intends to complete the mammoth tour that started in February 2016. "I have changed my life drastically in every way to make sure I got through this tour that started at the beginning of last year," she wrote.
"To not be able to finish it, is something I'm really struggling to come to terms with."
More information, fans were told, would be coming over the next few days, with the promise that there would be refunds if the shows couldn't be rescheduled.
But what of her voice? Surgery is often a last resort for laryngologists: Dion's doctor, Gwen Korovin, who has also worked with Ariana Grande and Hugh Jackman, is known for trying every option before opting for the knife.
"Clearly no singer wants to have another operation on her larynx, let alone two or three," Costello says. "As a surgeon, it's a constant balancing act between wanting to remove the damaged areas, and at the same time not overdo it or remove too much so as to cause scarring through surgery."
But Adele's surgeon, Zeitels, is "world-renowned", Costello says, and "a safe pair of hands" should she need to go under the knife to have other broken blood vessels removed by laser treatment.
And, while Adele does appear to suffer more than other stars, there is "every reason to be optimistic" that she will return in good voice. "There are very few pathologies of the vocal cords that mean you'll never sing again," says Costello. Here's hoping that Adele will return for one last goodbye.