Stevie Nicks Voice Changes: Can a Perforated Septum Affect Your Voice?

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

Stevie Nicks has come back onto the stage in a big way. The current Fleetwood Mac tour has shed the spotlight on her once again, and among other topics, she is opening up about her struggles with drug addiction. Among the most prominent tales in Nicks’s lore is that of the hole in her septum. She has openly discussed that it is large and that it affects her eyes and her sinuses. But she has also mentioned it impacts her singing voice.

stevie nicks voice change

Fans have bemoaned the change in Stevie Nicks’s voice over her decades-long career. But even those unfamiliar with her music can hear a clear difference in the vocal quality between the same song, recorded in the 70s and then performed in the 2000s. Searching videos of her performances confirms how, in earlier recordings, her voice is agile, with a clear tone, easy pitch manipulation and effortless appearance. Her recent recordings are usually keyed down and sound more and effortful, with a heavier reliance on backing vocals.

So could a perforated septum have changed all that?

The latter, recorded in 2011, is rewritten to avoid higher pitches. The earlier recording (from 1977) shows the vocal agility and quality that made Nicks a star. From 2:10 to 2:49 in that video, her gift is obvious. Clear tone, easy pitch manipulation, effortless appearance while singing and lyricism all stand out.

So could a perforated septum have changed all that?

What is a septum?

The septum is the structure in your nose that divides it into two sides (right and left). It is made up of bone in the back and cartilage in the front. The septum is lined by mucosa, a moist tissue that is like the lining of the inside of your mouth. Through blood vessels in the mucosa, the septum receives nutrients and oxygen to survive.

A perforation of the septum most commonly occurs in the cartilage portion of the septum. Many things can cause a septal perforation. The most important factor is the blood supply to the cartilage must be blocked.

What can block blood supply to the septum?

Medications and drugs that cause the blood vessels to constrict (or tighten up) will result in less blood flow to the cartilage. When this occurs chronically, over time the mucosa dies as do the blood vessels within the mucosa. When the blood vessels die, the cartilage can no longer receive nutrients and oxygen and so it, too, dies.

Blood supply can be interrupted, causing perforation, by:

  • Afrin
  • Cocaine
  • Nasal trauma
  • Rhinoplasty or septum surgery
  • Chronic nose-picking

Can a perforated septum affect your voice?

A perforated septum does affect on the voice:

  • Nasal resonance: the voice sounds more nasal
  • Post nasal drip: increased nasal secretions due to a septal perforation will drip onto the vocal cords, cause mild hoarseness and throat clearing

It will not cause a loss of vocal range nor should it produce chronic raspiness.

Will correcting the septal perforation change Stevie Nicks’s voice?

Fixing her septum will not worsen Nicks’s voice, nor did the perforation cause the changes in her voice. More likely than the perforation, the probable causes of her loss of range and change in quality are:

  • Cocaine: when cocaine is sniffed, it drips on to the vocal cords, causing chronic swelling
  • Rock singing: if not done carefully and with excellent technique, this can result in vocal scarring that is irreversible.
  • Aging: younger vocal cords may be able to “get away with” some of the behaviors (i.e., smoking, drug use, not resting, singing incorrectly) that over time will become unrecoverable. Vocal cords lose their ability to heal from injury with age.

These factors likely resulted in scarring which produces a loss of vocal range and change in vocal quality.

However, repairing the septum will improve her nasal resonance, giving her sound a more rich color and making it less nasal. This is feasible, should she choose to do it, with the help of an expert surgeon.

Luckily, Stevie Nicks’ legacy and gift for songwriting and performing, as well as her passion for music, will continue to inspire fans and music-lovers alike, enabling her to defy what might be career-ending for any other performer.

To learn more about Dr. Jason Hamilton or septal perforation repair, please visit

Read patient stories about Dr. Reena Gupta from The Division of Voice at the Osborne Head and Neck Institute.

To learn more about the voice, click here.