The Arytenoid Slip
Hypermobile Singers and the “Railroad Tracks” of the Passaggio
Disclaimer: I am a speech pathologist, but I’m not your speech pathologist. This material is for your education and information only. This content does not replace medical advice, diagnosis, or treatment. New research may negate or change this information. If you have questions about a medical condition, always talk with your health care provider.
Welcome back to The Zebra’s Voice.
This issue is for the hypermobile singer — the one with the enormous range, the effortless flexibility, and the voice that sometimes just... drops out at the worst possible moment.
Why Hypermobile Singers Sound Like That (in a Good Way — and a Frustrating Way)
Singers with hEDS or HSD are drawn to voice for a reason. Because the vocal folds are connective tissue, the natural laxity in a hypermobile body allows for extended arytenoid movement and a long, flexible vocal mechanism. That often means an impressively wide range.
The catch: the same laxity that gives you extra notes makes your voice structurally unstable. If you’ve spent years dealing with unpredictable register breaks — those abrupt cracks right at your primo passaggio — there’s likely a mechanical reason for it.
What We Found: Non-Traumatic Arytenoid Subluxation
As I mentioned in a previous newsletter, a team I work with recently published a case report examining exactly this phenomenon.
The singer we followed was a 39-year-old with hEDS who developed acute, persistent hoarseness after COVID-19. Standard voice therapy and vocal fold injections didn’t help. When we ran a dynamic CT scan to observe her larynx in real time, we found something clinically significant:
On /i/ (”meet”) and normal breathing: Her cricoarytenoid joints held perfectly symmetrical alignment.
On /u/ (”moot”): Her left arytenoid cartilage subluxed medially — it physically slid out of the joint. Her vocal fold and aryepiglottic fold prolapsed into the airway, causing acute vocal decline and significant discomfort.
The instability wasn’t random. It was vowel-specific.
Why /u/ and Not /i/?
I think it comes down to tongue position.
The vowel /i/ requires a high back-of-tongue position, which braces the hyolaryngeal complex and provides structural stability. The vowel /u/ drops the tongue base — and for a hypermobile singer, that removes the muscular scaffolding entirely. Without it, the joint instability is unmasked.
At the passaggio, your larynx is already managing complex muscular transitions. If your arytenoids are subluxing depending on the vowel, your neuromuscular system loses its anchor. The result is the jarring, uncoordinated register break that no amount of “support more” has ever fixed.
This is also why standard stroboscopy misses it. Most exams don’t test multiple vowels from varied angles — so the mechanism stays invisible, and singers are told nothing is wrong.
Managing It: Core Principles
Retraining a hypermobile voice means prioritizing efficiency over effort. A few high-level starting points:
Avoid high backpressure exercises. Techniques like the “blowfish” (cheeks puffed while singing) work well for non-hypermobile singers, but the pressure feedback can exacerbate joint instability and potentially trigger subluxation in those prone to it.
Use low-resistance SOVTEs. Straw phonation into a small amount of water, lip trills, or humming are good anchors that provide gentle airflow, efficient vocal fold vibration, and less joint compression.
If you think this is happening to you, consider keeping practice sessions short and spreading them out throughout the day. Short sessions throughout the day, with deliberate periods of complete vocal rest, are more protective of the vocal mechanism than a single long session.
A Question for You
Have you noticed your voice cracking or cutting out on specific vowels — especially /u/? Does it happen more in a particular part of your range?
I’d genuinely love to hear what you’ve experienced. Drop it in the comments.
Kind regards,
Stacey Menton, MM, MA, CCC-SLP