“It was 11-part harmony for 90 minutes straight — and it tested the limits of every part of my vocal range.”

“In the moment of that show when it happened, I remember in my head going, ‘OK, this is the end of your career.’”

“You do what you have to do. You just push through. No one tells you that you should take a break.”

Many performers have experienced that harrowing moment on stage or in rehearsals where they’re singing and then, suddenly, there’s a click. Or a pop. Their voice feels strained — maybe even inaccessible.

Vocal injuries are a common occurrence, especially for actors performing eight times a week, but they’re not talked about when they happen. Whether it’s on a grand scale or more of a small, recurring issue, vocal damage carries a stigma: Actors blame themselves and fear it could hurt their future employment.

To combat the shame, some leading actors are now speaking out about their injuries in the hope that doing so may prevent a similar fate from befalling others, and to help those who have already suffered find a sense of community.

What happened

These unseen injuries often occur at the worst moments, when stress and vocal demands are at a high.

For George Salazar, it was in the middle of singing “Michael in the Bathroom” during previews of “Be More Chill” this past winter.

Salazar had been sick during tech week, leading into previews for the Broadway show. On Valentine’s Day, he woke up coughing, his speaking voice cracking, but he still went on to do the evening show. Salazar’s character, Michael, and his hit song helped propel the musical to Broadway, so Salazar felt that he had an obligation to both his company and the fans to be in the show.

As he made it to his big number, a song which Salazar notes he had sung at least 400 to 500 times by that point, he felt his voice give out, signaling that something had gone seriously wrong.

“It was painful to do the song. My voice was thin,” Salazar said. “I was actually having a panic attack on stage.”

The next day he went to an ear, nose and throat specialist and found that he had suffered a vocal cord hemorrhage, a bleed in his vocal cords. He was put on vocal rest for a week, then went back to do a few more shows, but found that the problem had worsened.

Because of the importance of his character to the success of the show (and with awards season looming), Salazar and his team of doctors developed a plan: He would go on complete vocal rest for two additional weeks — no talking, no whispering, no coughing — then jump back in during press previews and the opening of the show, appear in a few television performances and then plan a surgery to cauterize the bleeding vessel. All of this left Salazar devastated.

“I felt like I had blown my opportunity,” he said. “I’ve let millions of people down. I’ve let my producers down, my cast down, my fans.”

Yet through some combination of vocal rest and, as Salazar sees it, an outpouring of love from his friends and family, his vocal cords healed. And then he was back in the show through Tonys season and the rest of the run.

A vocal hemorrhage is the most common injury to occur to professional singers, and one that can result from overuse of the voice or even one aggressive moment of screaming, laughing or belting — particularly when combined with an illness.

For Jessica Keenan Wynn, all of those factors were at play, including a scream that was not pre-recorded and a particularly harsh winter in 2014. She ended up suffering two vocal hemorrhages — the first while she was put on complete vocal rest after a diagnosis of laryngitis — during the Off-Broadway run of “Heathers.” She used doctor-prescribed steroids and went on strict vocal rest between shows to make it through the five-month run.

About nine months into his contract as the lead in “School of Rock,” Alex Brightman was performing the particularly raucous and improvisational song “The Legend of the Rent” when he yelled out a word and then felt the next note come out an octave lower. He made it through the rest of the act and then called his ear, nose and throat doctor who told him he had suffered a vocal cord hemorrhage.

After a few days of vocal rest and steroids to help the swelling go down, Brightman returned to the show, but found that could no longer do matinees because it now took his voice several hours to warm up before he could go on stage. He performed five shows a week for the rest of the run, with the newfound perspective that the performance he had created was not sustainable across an eight-show week.

He also found that he was no longer able to access the higher end of his range.

“A lot of it was me saying yes to a lot of things that maybe I should have said no to, but a lot of it was me wanting to do something that was extraordinary,” Brightman said. “I just didn’t realize the toll it was going to take.”

The stigma

Speaking out about vocal injuries is a rare and brave step in an industry where many fear that doing so will affect their ability to get hired for the next job.

“It tends to be a bit hushed and kind of a taboo topic even when you open up the conversation to a group of Broadway performers,” said Wynn, who’s currently performing in “Beautiful.”

Performers, particularly on Broadway, want to be seen as dependable people who can not only carry an eight-show week but promote it through television and other press appearances. The fear is that a known vocal injury negates that image, labeling the actor as “damaged goods” in the eyes of producers and people in charge of hiring.

Whether that fear will morph into reality is a complicated question.

Inside the audition room, casting director Tara Rubin said stories about a performer’s vocal damage may come up, but she tries to move the conversation toward what the actor sounds like at the moment.

“I encourage the team to listen to what’s happening in the room rather than focusing on something they might have heard about a recent job that actor did or a recent injury,” Rubin said.

However, those stories do lead some producers to check with previous employers and production members to see if that singer has taken appropriate action to heal from the injury, particularly when it comes to principal roles, according to one Broadway producer. If the singer has done so and is the right person for the job, they’re likely to be hired. If not, their dependability may be called into question.

And then there’s how it’s viewed from the outside. During Salazar’s run in “Be More Chill,” while he said the producers were supportive of his recovery process, he was advised by producers, friends and publicists not to speak out about his injury lest it influence reviews or his chance at a nomination.

“There was a lot of talk of the nominators will come and it’ll be on the back of their minds throughout your performance. It’s not a good idea to come out and talk about it,” Salazar said. “So I lied and said I was sick.”

Telly Leung was one of the first to lead the charge in speaking publicly about an injury. During the 2016 run of the a capella musical “In Transit,” in which Leung sang almost continuously — ranging from falsetto to bass and baritone parts, with moments of beatboxing — he began experiencing difficulty producing sound. This led him to an ear, nose and throat expert and a diagnosis of a large pseduo-cyst, or a fluid-filled sac on his vocal folds.

Vocal rest alone could not heal his injury. He needed surgery, an idea even more feared than injury itself, to remove the cyst. He made it through previews of the show, underwent surgery and then progressed through a week-by-week recovery process to retrain his speaking and singing voice. He returned to the musical six weeks later.

In addition to fear about his future employment prospects, Leung said he felt a loss of self during the process.

“It’s frightening to have such a big part of you be in jeopardy,” Leung said. “It’s scary, it’s frustrating, and you ask yourself: ‘Why me? Why is this happening to me? Is it my fault?’”

Self-blame is the other reason singers do not speak out about their injuries, as many presume their injuries are the result of poor singing technique.

After some time, Leung wanted to share his own story in the hopes of helping others who may be feeling alone as they deal with a vocal injury. In November 2018, he launched a one-man show entitled “Sing Happy,” in which he details his injury and recovery. But, even then, he was nervous about sharing his story.

“I was still scared that the business was going to treat me differently if they knew I had been sidelined with an injury,” he said.

Recently, the conversation has been reignited. In July, Caissie Levy, currently playing Elsa in “Frozen” on Broadway, tweeted about a vocal injury she encountered a decade ago, surrounding her run as Elphaba in “Wicked” in Los Angeles.

Her follow-up tweet asking for stories of vocal injuries from Broadway actors received more than 120 responses.

Treating the injury

Medical professionals like to use sports analogies when talking about vocal injuries. A vocal hemorrhage, for example, is often compared to an ACL tear due to the suddenness with which it occurs.

These analogies come into play for a few reasons, the first being that it highlights the athletic endurance required to sing on Broadway — particularly in a lead role, and particularly on two-show days.

“If you look at force and energy that transmits through the vocal folds during the course of any given performance in a week on Broadway and multiply it by eight shows a week, it’s absolutely equivalent to what football players do on the field,” said Dr. Paul Kwak, a laryngologist (representing the “T” part of ENT) who specializes in voice at NYU Langone.

It also serves as part of a process that Dr. Lucian Sulica, a fellow laryngologist and director of the Sean Parker Institute for the Voice in New York, calls “decastrophization.” Singers tend to only visit these specialists in emergency situations, and in those situations they come into the appointment feeling scared, and often ashamed that their poor vocal technique is to blame for the injury.

But while bad technique can lead to injury, damage could also occur in a singer with impeccable technique, or as a result of sheer vocal load from singing eight shows a week in addition to regular speaking. An injury can even occur even while the individual is not singing, after an aggressive cough or a sneeze.

That’s why vocal specialists prefer to describe these injuries as more of an occupational hazard, akin to a football player getting hurt in the course of a game. Their sports analogies make the damage more understandable and visible.

Aside from vocal hemorrhages, common injuries include the presence of nodules and polyps on the vocal folds, which are lesions that appear “as essentially the body’s wound-healing reactions to chronic injuries,” as in micro-tears over time in the vocal cords, Kwak said.

Most of these injuries are repairable, with the first fix for hemorrhages being complete vocal rest for three to seven days followed by work with a vocal therapist to re-engage the voice. Sometimes patients are prescribed steroids — which the doctors note are only advisable as a short-term fix — to reduce inflammation. All told, these singers could be out for one to two weeks.

Surgery is used as a last resort and only when the hemorrhage, polyps or nodules do not improve over time and impact the voice in a meaningful way. Sulica notes that surgery has gained a particularly bad rap because of singers’ reluctance to speak about vocal injuries, even when the procedures go well.

“You really only hear about the disasters,” Sulica said.

All of these treatments ultimately depend on the individual, as does how singing a certain role affects the vocal cords. One person could sing Jean Valjean eight shows a week with no problem, as a function of their musculature, while another might struggle through two. And to that end, some performers could continue to sing perfectly well with polyps or nodules on their cords.

Members of Actors’ Equity can file injury reports about vocal strain or vocal injury with their union. Once the injury claim is processed, the actor can file for workers’ compensation so that the associated medical costs are covered by the producers’ insurance.

It’s reported in the same way a member would file a claim about a sprained ankle or a broken arm. But, just as many do not want to speak publicly about vocal injuries, many are reticent to have a vocal injury on file. As a result, the total scope of the problem is unknown.

“The prevalence of injury on Broadway is likely to be far higher than anyone estimates,” Kwak said.

Moving forward

In the past few years, there has been an incremental shift toward more performers speaking out about these injuries, particularly on social media.

But the frequency of injury itself may only be increasing, as new musicals trend toward vocally-demanding pop, rock and belt-heavy scores. (“Look at Elphaba’s keys, and then look at the keys for Nellie Forbush!” Leung said.)

A few shows are beginning to bring voice teachers onto the production staff in order to work with cast members to prevent damage and to monitor vocal health throughout the run of the show, said Christine Estes, a vocal therapist who works with Sulica as part of the Sean Parker Institute. The constant monitoring helps catch problems early, perhaps preventing worse injuries in the future.

Estes also works with singers on training their speaking voices, since they’re participating in multiple interviews a day, on top of performing in the show, or having to speak loudly at stage doors and other loud settings that can also strain the voice.

She was one of the people Brightman worked with when approaching his next role of the title character in “Beetlejuice.”

Because of his previous vocal hemorrhage, he was hesitant about taking on a role that required speaking in the character’s trademark growl. So with his vocal team, Brightman developed a technique, called ventricular fold phonation, in which his gravely speaking voice emanates from cartilage above his throat, rather than within the vocal folds. Thus far, Brightman has been able to manage eight-show weeks, without yet missing a performance. (The technique does require maintenance: He still has to practice the voice at least once a day on his days off, so that he does not lose it, in addition to conducting specific warmups.)

The unique sound of that voice has also sparked questions from fans at the stagedoor, giving Brightman an opportunity to educate the younger generation on vocal health.

“I really try to use that as a moment of education for people that are performers to say, ‘This is a business and your career is a career and if you want it to be long, don’t make the same mistakes that I did,’” Brightman said.

In that same vein, Leung, who was able to jump into the title role of “Aladdin” following “In Transit,” continues to travel with his one-man show. That show, and his willingness to talk about it, has led to several of his castmates seeking help and to Salazar reaching out to him during his “Be More Chill” run.

While the experience was trying, many of those interviewed said the vocal injury made them better singers in the end, as it taught them to become more attuned to their bodies.

Their hope is that the industry, too, gains greater recognition of the problem.

“There are a lot of expectations put on the actors in this business, and it’s all understandable and valid,” Salazar said. “But it’s easy to forget that we’re all human beings.”