(The Guardian) - Adele cancelled the remaining two shows of a sold-out, four-night residency at Wembley Stadium in June, after her doctor told her she had damaged her vocal cords.

Though only 29, the most powerful young voice in the music business had been here before. In 2011, she had suffered a haemorrhage to her vocal cords after singing live on a French radio programme. In order to repair the injury, she underwent an incredibly delicate, high-risk medical intervention: vocal cord microsurgery.

Meghan Trainor and Sam Smith also underwent career-saving surgery in their 20s. Vocal burnout is afflicting amateurs, too. One veteran teacher in Italy said that female students in their early 20s who want to sing like Adele or a young Whitney Houston are the ones who damage their vocal cords. Another music teacher said she recently had to instruct one of her 10-year-old students to stop singing and get his damaged cords checked by a specialist.

The rise in vocal injuries is linked to a change in what we consider good singing. Across all genres, it has become normal to believe that louder is better. (One reason that Adele is such a big star is that her voice is so big.)

As a result, singers are pushing their cords like never before, which leads to vocal breakdown. Voice coach Marianna Brilla said: "It's a motor problem. The singer has to understand it's the way you're running your engine" - the singing techniques. "If you don't fix the engine, it's going to happen again."

On 12 February 2012, three months after her surgery, Adele swept up six Grammys and thanked her surgeon, Dr Steven Zeitels, for restoring her voice.

For years, vocal cord microsurgery had been considered risky. (In 1997, an unsuccessful surgical procedure left Julie Andrews' already damaged voice beyond repair.)

More than the physical risk, though, singers feared the damage to their careers that could follow if word got out. In the world of showbusiness, it was safer to be seen as a singer with a healthy young voice than as a one-time great with surgically repaired cords.

Now, Adele had suddenly swept away the stigma. In the years since, his business has boomed, along with those of many of his peers. They have no shortage of patients: there is an epidemic of serious vocal cord injuries in the performing arts. In addition to his work on Adele, Dr Zeitels, who directs the Massachusetts General Hospital Centre for Laryngeal Surgery and Voice Rehabilitation, has repaired the cords of more than 700 performing artists, including Smith, Lionel Richie, Bono and Cher.

Michael Bublé, Keith Urban, Celine Dion and Trainor have also had to quit touring to get their cords surgically repaired. In a mark of how attitudes to surgery have changed, both Smith and Bublé broke the news of their surgeries to their fans via Instagram.

While the media was celebrating Adele's 2011 surgery, one woman in the music industry raised a dissenting voice. According to Lisa Paglin, a former opera singer turned voice coach, Dr Zeitels had simply found a temporary fix; in the not too distant future, Adele would once again be forced off the stage and back into the operating theatre. It was a prediction that Paglin and Brilla, her coaching partner, were willing to stake their reputations on.

When Adele cancelled the final nights of her recent tour, Brilla and Paglin felt saddened but vindicated. For more than a decade, they have been pushing for a revolution in the way that almost every modern performer has been taught to use their voice. After years of painstaking research in musical archives, early scientific journals and the classroom, Brilla and Paglin say they can deliver what medical science has failed to: a permanent fix for vocal burnout.

Their solution requires the revival of an all-but-vanished singing method that is not just beautiful to the ear, but also easy on the throat. It is based on a provocative theory that has been gaining ground among a small cadre of international talents: that we have all been singing completely wrong - even Adele.

Singing is a rough business. Every vocal performance involves hundreds of thousands of micro-collisions in the throat. The vocal cords - also known as vocal folds - are a pair of thin, reed-like, muscular strips located inside the larynx, or voice box, in the throat. They are shaped like a wishbone, and contain the densest concentration of nerve tissue in the body.

When we are silent, the cords remain apart to facilitate breathing. When we sing or speak, air is pushed up from the lungs, and the edges of the cords come together in a rapid chopping motion. The air causes the cords to vibrate, creating sound. The greater the vibration, the higher the pitch. By the time a soprano hits those lush high notes, her vocal cords are thwacking together 1,000 times per second, transforming a burst of air from her lungs into music powerful enough to shatter glass.

Beautiful singing requires lithe cords, but all that slapping together can wear down their fine, spongy surface and lead to tiny contusions. Over years of heavy use, nodules, polyps or cysts form on the vocal folds, distorting the sound they create. For a singer, the first sign of trouble is often the wobble. His pitch fluctuates on and off key because his ragged cords have lost their natural vibrato - their ability to resonate properly.

Singing through the wear and tear can cause the lesions to burst and bleed, creating voice-ruining scars, which is what happened to Adele in 2011.

Brilla met Paglin while studying voice at Indiana University's school of music. The two bonded over their love for Italian opera and their frustration with the way singing was taught, even by their legendary teacher Margaret Harshaw.

In 1977, Brilla won a prestigious Fulbright scholarship to travel to Italy to search for a way to sing beautifully without risking injury. There, she heard glimpses of perfect arias from older, mostly Italian opera singers who learned their craft in the early 20th century. These singers seemed to effortlessly produce clear, powerful musical tones, and so many of them were still performing with vigour well into their 60s, 70s and 80s.

Paglin soon joined Brilla in Rome, where they started spending hours each day at the national sound archive, La Discoteca di Stato, listening to early recordings.

Their research pointed them to a surprising conclusion: that responsibility for the modern decline of the voice lay at the feet of Verdi, Wagner and Puccini. These three composers were the pop music sensations of their day. Music scholars credit them with being the first to challenge their singers to push their voices to new limits, in order to capture the emotional ups and downs their characters were feeling.

But Brilla and Paglin heard something different - that the emotionally charged, full-throated, operatic singing style Verdi and Wagner made popular in the late 19th century and that Puccini amped up even further in the early 20th century - had subsequently infiltrated all singing genres and public performances.

In 1983, Brilla convinced Maria Carbone, a retired Italian operatic soprano, to work with them. Carbone was nearing 80, but still had a powerful voice. While she sang, Brilla would clasp her abdomen to feel what was happening inside her body.

Carbone started with an aria from Tosca. As her voice rose, hitting higher and higher notes, Brilla's eyes widened. "I could feel this tick, tick. Tick, tick," she recalled. It was the natural up-down release of her diaphragm. "Nothing else was happening."

Carbone's ribcage wasn't ballooning out as she sang, and there were no deep gulps of air, as is common with today's big-voiced singers. More amazing still, the movement of Carbone's abdomen while singing was just as quiet and rhythmic as when she spoke. "It was a discovery of what the perfect singer's posture should be," Paglin said.

Brilla and Paglin's track record with difficult cases has earned them a small international following. Veteran Italian stage actor Moni Ovadia was one of their earliest big-name success stories. Throughout his mid-40s, he performed up to 250 shows a year, in Europe and the United States, but by 48 he was ready to quit showbusiness. His voice had become flat and raspy, and he found it physically painful to perform.

He credits Paglin and Brilla with restoring his voice and his career. "They saved my life," he said. Today, at 71, he is a bull on stage, and can perform non-stop for up to three hours.

The question remains: Could Brilla and Paglin's approach permanently cure an artist like Adele by teaching her to sing in a more natural way? Dr Zeitels is dismissive of such an approach, and quick to defend Adele and his other clients against the contention that bad technique is causing their vocal problems. "People used to think if you needed an operation it meant you don't know how to sing. The people I see - they know how to sing!"

Another renowned throat surgeon, Dr Robert T Sataloff, who has performed voice-corrective surgery on several Grammy Award winners, including Patti LuPone, bristles at the notion that surgery is not a sensible way to keep singers healthy. Combined with proper education on the dangers of improper singing technique, he believes it can keep people on stage for longer. "Is it perfect? No. And it probably never will be," he said. But some of Brilla and Paglin's students are thriving without medical intervention, including Maddalena Crippa, who at 59 years old is in the midst of a remarkable second act. Her voice has been injury-free since she started working with Brilla and Paglin 15 years ago, and last May she wrapped up a critically acclaimed tour of L'Allegra Vedova, a one-woman-show based on a 1905 operetta. For 75 minutes each night, she sang and acted two roles, the husky-voiced Danilo and the high-pitched Anna, who at one point sing a virtuosic duet. Critics were impressed, with one raving that Crippa is still "a brilliant singer".

On July 1, when news broke of Adele's cancellations, Paglin was frustrated by the press coverage. Recalling that Adele's original surgery in 2011 had proved to be a huge PR victory for vocal-cord microsurgery, she worried that the message from Adele's latest setback would be that, not to worry, a second or third surgery will get the star back on stage.

"What makes matters worse is that the 'mechanics' are still convinced that all there is to it is to keep operating, while the singers themselves still talk about air travel, drafts, allergies and 'stress'. #elephantintheroom could be a good hashtag," she wrote via WhatsApp, referring to what is wrong, as she sees it, with how people are taught to sing in the first place.

"We know how to fix Adele's problems (sans surgery), and for good. If only we could talk with her."Guardian