British singer-songwriter Adele has canceled a 10-city U.S. tour because of a hemorrhage she likened to a "black eye" on her vocal cord.
"i have a hemorrhage again and it is paramount that i rest and therefore wont be able to come and do these already rescheduled U.S shows which are due to start this friday in atlantic city," the 23-year-old wrote in a blog posted Tuesday. "i apologise from the bottom of my heart, sincerely i do."
The "Rolling in the Deep" and "Someone Like You" singer canceled U.S. shows in April because of laryngitis and U.K. shows in September because of a chest infection. But Adele said she's never had the opportunity to fully rest and recover because of her touring commitments.
"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. "singing is literally my life, its my hobbie, my love, my freedom and now my job. I have absolutely no choice but to recuperate properly and fully, or i risk damaging my voice forever."
The vocal cords are small folds in the windpipe that vibrate to create sound. They get nutrients from tiny blood vessels, which can rupture and leak when strained.
"When they become damaged, they typically leak and have spread under the surface -- literally like a bruise," said Dr. Gaelyn Garrett, medical director of the Vanderbilt Voice Center in Nashville. "The typical scenario is, a singer will say, 'I was doing fine and then all of a sudden, in the middle of a show or a rehearsal, I had a break in my voice and couldn't sing well anymore.'"
Garrett said the blood accumulating under the surface makes it harder for the vocal cords to vibrate, causing a sudden change in the voice. Like a black eye, the bruise will heal. But recurrent damage can cause scar tissue to build up and cause a permanent change in a person's voice.
"I'll put someone on complete voice rest for a week," said Garrett, adding that "complete" means no singing and no talking. "Then I'll check them again in a week to make sure there's no recurrent bleed."
Using a tiny scope slipped down through the mouth or the nose, Garret can see the bruise changing color and eventually disappearing.
"I'll follow it closely until it looks fairly healed – usually a couple, maybe three weeks," she said.
What causes the blood vessels feeding the vocal cords to suddenly rupture is unclear.
"I wish we knew," said Garrett. "But generally speaking, it's a fragile blood vessel."
People with recurrent hemorrhages can have the offending blood vessel surgically sealed. The remaining blood vessels will take over its job, Garrett said, and the voice can return to normal.
Although Adele's April cancellation was blamed on laryngitis, the singer wrote in her blog that she was diagnosed with a hemorrhage then, too, and ordered to rest for a month.
Garrett said anyone can suffer a vocal cord hemorrhage, but singers are more likely to notice minor voice changes.
"It can even occur after coughing, or anything that generates a lot of pressure," she said. "There are some patients that just come in with evidence of a bleed from several days ago."
Whether a person needs rest or surgery depends on whether the injury recurs and on their voice demands, Garrett said.
In her blog post Adele said she plans to start vocal rehab soon, and assured fans she will "smash the ball out the park" when she resumes touring.
"… please have faith in me that this is the only thing i can do to make sure i can always sing and always make music for you to the best of my ability."