text: Adele’s raspy and passionate voice is her signature sound. Millions of fans have responded to her rough and sweet music in overwhelming ways, with her first two albums going multi-platinum. As a fan and a physician specializing in voice issues, though not her physician, I have a concern that the sound we love from Adele may change. Reading an interview with her last week, I came across words that scared me: a description of Adele with “a cigarette dangling from one hand.” I tore into writing about the dangers of cigarette smoke on the singing voice and a prayer that Adele would not fall victim to them.
  Two days later came news that she had cancelled her next performance due to laryngitis; the day after that, her whole tour was cancelled. While I am not claiming to know what has happened to her voice, we know that smoking causes laryngitis, it increases the likelihood of vocal injury, and it often results in permanent damage. I can’t deny that I adore Adele’s voice and it’s very possible that the cigarettes cause the raspy quality that contributes to her voice’s uniqueness. However, in the long run, most singers who smoke will find their voices suffering. Smoking and singing make you more prone to injury and, over time, there is no question it causes irrevocable deterioration. These effects are aside from the obvious association between smoking and throat cancer.
  The vocal cords are complicated structures, so much so that they are now termed “vocal folds” to emphasize that they are multi-layered and complex, not simply cords of tissue. I often stress how important each portion of the vocal folds is by giving an analogy. Imagine all the notes a singer’s voice can hit (a singer may boast of a four octave range but even 2-3 octaves is a large range). Now imagine a piano and how much real estate is required to duplicate those same 2-4 octaves. Add in the keys, the hammers, and the full length of the strings. And now imagine that same spectrum of notes being produced by a vocal fold that is little more than the width of a key on your keyboard. It emphasizes how finely controlled each component must be to produce such a variety of sound in such a small space.
  When this delicate system is exposed to toxins such as cigarettes or air pollution, the tissue becomes swollen. Swollen tissue, placed under the stresses of singing, swells further. When tissue is swollen it is more prone to injury like bleeding or scarring. The chronic swelling of smoking makes the stress of singing every note a game of Russian roulette: will I or won’t I injure myself with this note? Smoking also thickens the vocal folds, lowering the pitch of the voice and potentially eliminating the top notes in a singer’s range. This change is usually irreversible.
  To go into the full gamut of voice problems that smoking can cause would take much longer. But it is worth it for singers who choose to smoke to learn about this, so they can understand the potential damage to their voice. There is nothing worse than seeing a singer who smokes and has an untreatable voice problem saying they wish they’d known the risks. I hope that Adele only suffers from a temporary laryngitis caused by the increased vocal demands of touring. Watching someone so young and gifted risk her career, regardless of how addictive cigarettes are, is difficult. I also hope that she and other singers learn about the voice, the effects of smoking and how to prevent voice problems before vocal injuries cut short their careers. After all, how Adele takes care of her voice affects everyone that longs to hear her music.
  Healthy Skin Tip: There are numerous health-related reasons to quit smoking. One of the many reasons to quit is your skin - smoking depletes your skin of vital nutrients and minerals needed to maintain a youthful, healthy glow, and can often cause pronounced facial wrinkles. So not only will you feel better if you quit smoking, but you'll look better, too!