Negotiating the passaggio is one of the singer’s great challenges. In the untrained voice, the shift from chest to head voice is naturally uncertain—a smooth transition is indeed one of the hallmarks of a well-trained singer. In most cases, difficulties in this area of the voice are technical, and need to be corrected with the assistance of the voice teacher or a voice therapist.
Passaggio problems can also signal medical problems, however. As physicians we often see well-trained singers who complain of difficulties around the passaggio, and we need to decide whether the issue is technical, medical, or both.
In anatomic terms, (may I have the first slide, please?) the passaggio represents a transition point in laryngeal muscle activity. In chest voice, the vocal folds are pulled together, tightened and firmed up by several sets of muscles which attach to the inside of the laryngeal cartilages (the lateral cricoarytenoids, the interarytenoids, and the vocalis). As the voice goes higher, these muscles contract with greater and greater force.
In head voice, by contrast, these muscles are held at a somewhat reduced level of tension, as the two muscles attached to the outside of the larynx (the cricothyroid muscles) contract. This produces a tilting forward of the thyroid cartilage on the cricoid, and produces an elongation and thinning of the vocal folds. The cricothyroid muscles have greater mass, the contraction is more gentle, and involves a degree of coordinated, simultaneous relaxation in the chest-voice muscles. The overall muscle effort is less.
Negotiating the passaggio involves mastering the gear shift, learning how to sustain the voice as it is handed over from one set of muscles to another.
Singers’ “money notes” are often on top, but for laryngologists the action is often in the passaggio, since the greatest muscle effort is in high chest voice. Symptoms in this part of the voice may be an early and sensitive sign of trouble.
What kinds of symptoms occur, and what do they mean?
The earliest symptom is often not one the listener can hear, just a subjective sensation of increased difficulty negotiating the transition. Later on, there may be a couple of threadbare notes that are difficult to “cover,” and eventually, a skip or even a small yodel. A slow piano or mezzo-piano glissando from chest into head, with no vibrato, can uncover these “speed bumps.”
Irritation of the pharynx from any of several causes may produce difficulty in high chest voice, and into the passaggio. An irritant, such as acid reflux, can tighten the muscles and prevent smooth contraction. In my experience, the commonest effect of reflux is not granulomas or “scalded vocal folds,” but elevated muscle tension, which causes dysphonia in the passaggio. Other irritants, such as a viral or bacterial infection, can have a similar effect. By causing inflammation of the mucous membranes, the underlying muscles also become impaired. Passaggio woes are often an earlier sign of trouble than difficulty on the top.
Singers, especially trained singers, often overcome minor difficulties by “muscling” the voice, but if the condition becomes chronic, the muscled voice itself can lead to problems of increased tension, discomfort, an
elevated larynx, and contracted supraglottic resonating space.
Excessive singing, from either an overbooked schedule or a long and difficult repertoire, also often manifests in this area. This problem occurs more in musical theatre, for several reasons. One is the grueling schedule: eight shows a week and an open run that continues for months, even years. Another is the way some musicals are written. To convey excitement, pain, and other emotions, the tessitura often lies in high chest and belt, which eventually strains the laryngeal muscles and leads to difficulties in “the mix.” The therapeutic implications of this are significant: such difficulties do not respond to medications as well as swelling of the folds does. Instead, voice rest or vocal exercises may be called for.
Finally, we see the older singer, older either in age or by virtue of the excess miles they’ve put on the vocal folds. Their complaint may be of chronic unsteadiness, of an unpredictability, a wobble in the passaggio. Unfortunately, this often represents muscles that can no longer function smoothly, no matter how much rest or medication is given. Reworking the voice with a good therapist may help.
Passaggio difficulties in an otherwise well-trained and experienced singer should be taken seriously for what they are: an early and sensitive sign of something wrong, either medical, technical, or both. Since there is often nothing for the doctor to see, it is especially important to work with a laryngologist who is sensitive and does not minimize your legitimate concerns.
