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hyoid bone problems
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Avatar_n_tn
Hi, Luca!

How much dollars did your surgery cost? I'm from Bulgaria and I have the same problem and no doctor in Bulgaria can help me. :( I'm afraid I'll have to travel to Los Angeles to have this fixed. Did you do CT scan before the surgery.

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TO ALL:

Thank God I found this forum. I've been suffering with this annoying condition for 6 months now. I got the clicking after a trauma to the larynx. I went to 6 ENT's and two of them are some of the best in the country. All I got was "Don't worry, boy. There's nothing wrong with you. Try not to think about it, as if you do, you'll develop a nervous breakdown" ::rolleyes::

After nobody was able to give me the answers that I needed, I decided to find them myself. I studied the human anatomy of the larynx, I read some articles, I found this forum and now I'm 100% certain that my hyoid bone is dilocated and my thyroid cartilage is hitting it during the swallowing elevation. When I press my hyoid bone inwards with fingers there's no click. There's a swallowen muscle right underneath the place of the click

The most annoying thing is that my parents think I'm crazy and are not likely to give me money for this surgery and for the whole trip. They're like "It's all in your mind. No doctor sees anything wrong, you should stop obsessing about it." I told them everything I learned on this forum, I told them about how rare this condition is and how most of you guys had been to numerous ENT's (just like me) and noone had been able to figure out what was wrong. But they still think I'm out of my mind. Really frustrating!

I understood that there was a team in the UK which reported treating similar condition. Can anyone please point me to their name/email or whatever contact info available?

Thanks

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Hi Daniel,

There is a team of surgeons at the Department of Otorhinolaryngology, Head and Neck Surgery, Singleton Hospital, Swansea, United Kingdom. ***@****

A new and clinically symptomatic variant of thyroid cartilage anatomy.Browning ST, Whittet HB.
Department of Otorhinolaryngology, Head and Neck Surgery, Singleton Hospital, Swansea, United Kingdom. ***@****

We present a previously undescribed variation in the anatomy of the superior cornu of the thyroid cartilage. In the five cases described, the tip of the cornu turned medially and caused an indentation into the pharynx. These indentations were symptomatic and caused pain and globus sensation. Resection of them led to resolution of the symptoms. A survey of the incidence of this variation of the thyroid cartilage in a clinic population is presented. Copyright 2000 Wiley-Liss, Inc.

These surgeons might be able to help you I also know this team has tried to amputate the cornu intra-orally without external excisions and has been successful, although when I spoke to the head surgeon at UCLA he said he has always done an external approach and feels it is much safer due to better field of vision and less risk of infection.
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You dont need a CT scan before the surgery but I think it is worth the money because often times they can detect abnormalities on the CT  that can explain your clicking like an elongated superior cornu, or an elongated greater cornu of the hyoid and this will obviously help give you and the surgeon a higher chance of success before going into the procedure
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Avatar_m_tn

I've responded with a private message

Bye
Luca
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Avatar_m_tn
I noticed that when swallowed part under the chin on the side where they removed part of the hyoid bone and cartilage is prominent.
I don't remember if this happened even before the surgery.
Notice something similar too?
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Yes that area is going to be very inflamed for at least 3 weeks, it took about a month for the prominence or swelling which I think is what is causing what you describe to go away.
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I had a quick question for you. I was wondering what you thought helped more the superior thyroid cartilage excision or the hyoid bone excision. After the surgery, which part did feel was causing more of the problem. Thanks
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I had a quick question for you. I was wondering what you thought helped more the superior cornu thyroid cartilage excision or the hyoid bone excision. After the surgery, which part did feel was causing more of the problem. Thanks
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I was wondering if anyone here had any advise for me. In 2 weeks I see an ENT specialist for what I was told was a broken HYOID-bone. I would like to know what I should push for and important questions I can ask to get all this figured out.

Originally I was told through an Xray that I had this very rare fracture. I was immediately seen by and ENT who wasnt convinced it was broken but after a scope she wasnt going to do more tests because the bone would heal without effecting my airflow, and voice box, the week after she gave me an apt 3 months down the road and I was told I would be fine and back to work within 10 days.

Since I have been in and out of different ERs been seen by my GP, 3 different ER doctors, 2 doctors at a well known clinic.Ive seen 2 chiropractors which only do pressure point treatment. The physiotherapist I have seen just told me she isnt qualified enough to help me and has passed me onto an private physio clinic that might be able to help.

Last week I was once again in an ER, everytime I go I get rushed in quickly, in canada normally you wait hours to be seen on a priority and first come first serve basis. I finally got a CT scan and the results came back as no fracture of the hyoid-bone and everything in the area looked fine. I havent discussed this with an ENT specialist but will when I finally see one. I also havent discussed this with the doctor and the radiologist that originally said without a doubt I had a broken HYoid bone. It will take me 3 weeks just to be seen by that doctor.

Here are my sympthoms. A few times but more the first month was an occasional choking feeling and I would have trouble swallowing, I could but it was very difficult. My jaw was completely swollen shut for a week then started to open. my breathing was very loud and often had difficulty getting air and breathing. My voice sounded irritated or coarse and when I spoke too long or did any minor amount of excersice it would get more and more coarse and my breathing would be more pronounced. For 9 and a half weeks I ve had a feeling that someone has their hands around my neck.That feeling never goes away and only get dramatically worse when I walk a city block or talk for 10 min straight. The muscles in my neck go from a strain thats bareable to a muscle pull that makes me want to take my life and get to an ER ASAP.The most pain is always in the center front of my throat.Ive had headaches in the top center of my head. I have lost strength in my right arm which is my dominant arm, its noticably weaker than my left now according to my physiotherapist. I have had the back bottom part of my tongue feel llike a muscle pull, my jaw will tighten up for days when I do any amount of activity and still wont open as much as it should.I can bring my chin down but its very restricked turning left and right.I have very limited movement left and right. I am not able to move my chin high even if I could handle the pain which I cant its to restricted to move up. Most of the severe pain is in the middle front of my neck-throat. Everytime I have been to the doctor or an ER I have been told I have high blood pressure but it due to the pain.I have never had high blood pressure before.

Im sure I have other symptoms aswell but those are the ones I havent forgotten about.Im a 32 year old male and was in great shape. Now I cant walk more than a block or 2, cant talk for more than 10 min. No healthcare ppl here have any idea whats going on or why, they all want me to see an ENT specialist to get answers. Unfortunately no one can get me in sooner because Im not in a life or death senario so I have to wait. No improvements in 9plus weeks is scary.Some ppl even say from a physical stand point I look worse.

Ow I also have lots of swelling in my neck- throat. I dont know how much but at one point you could see my adams apple and now you cant. Ive taken 4-8 tylonol 3s a day and 2 500mg of neproxen a day. It dropped the pain from a constant 7-8 out of a scale on 0 to 10, to 6-7. I stopped taking it for a number of reasons. Im now on hydromorphone which again doesnt drop the pain that much but relaxes me and makes everything feel better(like being high without the terrible high feeling you get from oxycodone)

If anyone has the time to give some of your opinions that would be greatly appreciated. Im sure everyone here has gone through a lot worse than what Im currently experiencing but not knowing and not being able to do anything is tough. thanks for all your time

scott
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Out of all the stories I have read yours sounds the most if not exactly identical to mine. I actually just got back from the UCLA Medical Center I had an appointment this afternoon for my surgery follow-up. It turns out I will need another surgery on both sides of my neck to remove both greater cornua of the hyoid bone which are displaced and hitting my cervical transverse process (I had a prior surgery to remove both superior thyroid cornu), I feel pretty confident you have a similar injury. I have been living with these symptoms for almost two years now. I used to be in extremely good shape also I was a top college athlete, and now I cannot walk more than 1 or 2 blocks without feeling like I am going to pass out and die, I cannot speak for more than 5 min without feeling like my throat is going to explode, and I get headaches so bad I feel like I am going to pass out. By researching a lot and staring at countless diagrams, combing medical journals, health sites, and head and neck anatomy books for further detail I have come up with a pretty strong hypothesis for what causes these terrible chain of hyoid bone related symptoms. The hyoid bone is a very delicate structure and when that structure gets warped or displaced from an injury it is going to start rubbing on other nearby structures, namely thyroid cartilage and your cervical transverse process, and if your lucky like me both! And the added bonus is that the hyoid bone is located near the carotid artery so when it starts grinding against other structures it creates inflammation this inflammation presses on nearby nerves and the carotid artery and will create horrible migraine like headache sensations you may even feel like you are growing a brain tumor but trust me you are probably not. In addition to this the inflammation and displacement of the hyoid will put pressure on the hypopharnx because it is out of position and give you that feeling like someone is jamming a metal cue tip down your throat 24 hours a day (foreign body sensation, understandably this makes it painful and difficult to talk. In addition to this slight variations in the position of the hyoid bone have been documented to affect your breathing patterns so you will become short of breath and feel like your breathing mechanics are faulty, dsypnea or wheezing may occur and make you feel like you are oxygen starved sending you into a panic frenzy to get to the ER. Trust me, you don’t want to become like me or experience the 24/7 pain that I live in every second of the day. After a while this injury will change you into a person you do not even know, wreck relationships with those you love and your ability to function normally in everyday life. Your perception of the universe will most likely become altered, and if you had any faith to begin with, it will be strictly questioned. Once damaged and displaced the hyoid bone has no way to correct itself so you can be left with a devastating injury your entire life if you chose to live without surgery. I have researched a lot and I am fairly confident you have the same thing as me I think your hyoid bone is posteriorly displaced or has become bent, elongated,  or damaged from the injury. Since you basically speak verbatim my symptoms I would assume it would be logical to say you could also benefit from such a procedure in which they remove the injured portion of the hyoid bone. UCLA is the best place to get this procedure I have researched it a lot, after all I don’t want to spend the rest of my life in pain, staring at the white wall in my room like some vegetable. Sorry this letter isn’t more encouraging but I believe at this point an honest response will help you the most in your journey towards recovery. My advice to you is to get to UCLA and talk to the head surgeon there they have seen this injury countless times and can most likely fix or significantly improve this condition.
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I also forget to mention dont listen to physiotherapists or chiropractors they are honestly a waste of your time and will do more harm then good.

We share all symptoms in common down to the most minute detail AND I mean every tiny symptom you listed exactly the same.  I am glad you wrote on this board so you can get help early on. Many people have lived years or over a decade with this without knowing who to go to or what it is. At least you are informed and know where to go I would focus your prioroties on seeking treatment at UCLA, the sooner the better prolonged suffering is no fun.
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thanks...I cant even imagine dealing with this for 2 years like you have. In 9 weeks Ive had moments of becoming a different person, twice now Ive thought of suiside from the helpless painfilled moments. Im not depressed and know I would never do anything like that. For it to get to a point that a person thinks about suiside is very troubling and somewhat scary. I dont know if the trouble Im dealing with is the unknown and having all medical ppl tell me they have no clue, the ridiculous pain, not being able to do anything or from the trauma of getting stomped on 6 plus times. Does the constant feeling of someone choking you and your neck muscles feeling strained if not pulled never go away? Im thankful Im not in a wheel chair but this lifestyle is as close as I ever want to get to a life llike that. I was told hydromorphone is a crazy pain killer. It still doesnt take the pain away just makes it more bareable.I do apreciate your input and hope everything gets back to normal ASAP for you. At this point I have no choice but to go through the medical channels here and hope someone figures this out. Im far away from a lawsuit from the guy that did this to me and even then who knows if he has money to pay me. Im not going to sell me house to be able to afford to go to UCLA. In the future I may have no choice. My next apt with an ENT specialist is sept 30 they cancelled my sept 29 apt and wanted me to wait til nov4 I had to complain to get one on the 30th. They seem to think this is a joke yet all the non specialists I see are soo blown away with my case, its just they have no idea and according to them no way of helping. Do you mind if I tell you how that goes, what was said and what their guesses are etc etc. Your information and experience could really help me with all thats going on. Please dont take any disrespect from this but part of me hopes you are some bored teen just playing a mean joke, I cant imagine dealing with this as long as you have. Did it take a long time to get answers, best of luck with your recovery and hopefully getting your life back.
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I dont take any disrespect but I am definitely not a mean teen playing jokes far from if you checked I have almost 150 posts on this subject definitely not a joke here I am sorry that you thought it was a joke this injury is very real and very debilitating.  Be sure to keep me updated on what they find I am very interested because your symptoms relate very closely to mine. It is unfortunate that  few doctors have experience with fixing this type of injury. People directly and indirectly mentioned on this forum have flown from Italy, the East Coast, New York, Texas, and China to receive treatment for this condition at UCLA. If you have to use your resources there which I do not recommend because of  the location of the injury I would find the best ENT surgeon you can find show him the Clicking Throat article and talk to him about options to correct the hyoid bone injury.

Does the constant feeling of someone choking you and your neck muscles feeling strained if not pulled never go away?

No, this hasnt gone away for me yet but after 2 years I have become really good at disconnecting myself from my body and tolerating the pain. Here are some suggestions since I have lots of experience over the years: Strong anti-inflammatories (Naproxen) (High doses of Ibuprofen) will help you the most symptoms if your stomach can tolerate it, avoid any form of high impact exercise, a rolled up towel will help you sleep better thick pillows will strain and stiffen your neck.  

What is your pain distribution is one side 80 and the other 20, or is the pain all centered on one side 100 percent.

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I said the teen thing to take away the seriousness with all this and was hoping what I read wasnt real, I still have to read all the posts here and I know you are too well informed to ever be a punk kid. Its just easier to hope thats the case than realise this could continue for a very long time.Im still in the hope phase, I cant imagine this lasting 2 years or going through what you have. 9 and a half weeks seems like forever, its scary not improving and not knowing.

As of right now most of the pain in central front part of my throat. Thats the most severe pain. the muscles in the front left and right part of my neck have felt strained since it happened. It almost feels like my 2 large glands are extrely swollen and my body is trying to fight of some infection.I can also feel little muscles around my left anf right side. Lately Its felt like I pulled something on my right side that goes from just above the collar bone area to just under my right jaw. Right now the pain is definetely more on my right from that.I also walk around with either my head and shoulders slouched forward, or more recently with my haed angled to my left shoulder, probably only slightly but enough for my friends and family to make fun it.Been nicknamed Frank(frankenstein) for awhile now

When my tongue went in was just at the back botton, not really on a side. I tell everyone the pain is in the middle of my neck throat, if that extreme pain wasnt there i would say I have extreme pain on the left 40% and my right 60%. that pain is bareable only because the pain in the middle can be soo bad.feels like for lack of a better description a karate chop hard right in the middle of your throat-neck.

Ive never had migrains or headaches before this and I have to say the ones I get arent that bad. From not being able to lift my chin high if I dont slouch on a chair and Im looking up at someone I will get a very swollen pounding feeling right around my eyebrows. Im sure thats just from my eyes and not being use to looking continuosly at such a high angle. The pain that I have gotten in my head is at the top back area.A few times its felt like someone stabed me with little pins. not a great feeling and doesnt last long but conpared to the pain in my neck its almost not worth mentioning.

My chiropractor who wont adjust me just does pressure point treatments thinks I may have a slight brain stem injury aswell. I told a doctor that and he laughed, not sure why but probably from the old fued some doctors have with chiroprators.

Do you have good days and bad days ? I dont really know how far I can walk before I lose all my energy and feel like someone is strangling myself as hard as they can. If I had never felt that feeling before I would call 911 everytime but Im use to it and almost expect it if I chose to go anywhere. some days this happens after walking a very short distance.

Any other questions? I have tons but I dont think it right to ask them until I take the time to read every single post in this section. i dont want to ask you something youve already wrote to someone else. At some point I would love to know how a doctor finally came to the conclusion they did with you. To everyone here ppl are so confused with me, but im hoping my ENT will take this more seriously than she originally did.
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Just thought I would add, I dont have any clicking feeling or noise, I cant and wont let anyone touch the front part of my neck, its soo sore and swollen, last time someone just touched my front left side I almost instantly became more swollen and spend that day in an ER, then again the next day in a different ER that had an ENT department. when I was taking 2 -500 mg pills on neproxen I never got any noticable releif. I just agreed to take them with a lot of tylonol3s to get my blood pressure down. Everytime Ive had that checked since the incident its been high. I hope that wont cause any more troubles with my organs and body. I thought Id mention probably not important but possibly that My teeth are now slanted to one side and i have a much bigger overbite. Once I think I can handle going to a dentist I will need to get that looked at. I found my old file from my old dentist and my teeth were perfectly inline, I saw an oral surgoen through the hospital and he told me my bite was fine, I had no broken jaw and my teeth were brobably always angled like that i just never noticed it before.....how stupid of a comment is that. In first world countries every human being brushes their teeth, most of the time in front of a mirror in the washroom.I coudnt believe I got that answer, but the government doesnt have to pay for it now so maybe they say that to keep costs under control, who knows. I dont know if it was like this for you but I can do more talking and walking if I either have alcohol, or drink a slurpee. its not a noticable improvement to others but I can tell is for me. If you want I can add pictures to my profile of the cleat marks all over my lower face,neck and jaw that caused me to be in this state. they arent that bad but they will be used in court in Oct.
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Dont listen to chiropractors unless someone kicked you in the head you do not have a brain steam injury, what is probably happening is like what I have and several others on this site who get the referred pain from the hyoid up the back of the head into the occipital region. I know for a fact that inflammation of the hyoid bone causes this, several people on this site have gotten mris for this weird headache symptom thinking they had tumors.

Also the whole one arm thing less strong than the other, got that one also, thats probably just a ploy to get you back in the door for more treatment. Kind of how they like saying one leg is shorter than the other, or that your cervical veterbate has "subluxations" which they claim they can feel and magically and perfectly manipulate back into the right position. Any real injury is going to take more than pressure and gentle massage to fix itself.

"From not being able to lift my chin high if I dont slouch on a chair and Im looking up at someone I will get a very swollen pounding feeling right around my eyebrows. Im sure thats just from my eyes and not being use to looking continuosly at such a high angle. The pain that I have gotten in my head is at the top back area.A few times its felt like someone stabed me with little pins. not a great feeling and doesnt last long but conpared to the pain in my neck its almost not worth mentioning."

Wow you describe that symptom well I get the same thing it is like my eyeballs are swollen, that is definitely the inflammation I took 2 advils last night and it helped that symptom a lot because it was keeping me from sleeping.

You definitely have the right attitude about approaching this issue you have to research a lot and become your own doctor thats the only way I ever got the point where I could find a doctor who could help me. I cannot stress that enough dont expect the doctors to fix you, you gotta become your own expert so you can work togethor with them. I would be glad to email and provide you with the necessary diagrams and articles to show your doctors that will help you figure out what is going on in there.

From reading over your symptoms I find it very interesting that you have no clicking in greater cornua regions or anywhere. Do you ever get clicking when you swallow or turn your head that is very important. If you do not than the most likely situation I can think of is that you have a small fracture of the hyoid bone that they overlooked in your CT scan at the ER. This often times happens in ER settings because they are evaluating you on a life and death basis and will overlook small fractures, displacements, dislocations, elongations, and other non-fatal abnormalities. Your first doctor may have been right and the ER people were just rushed and missed something I would definitely check back with him, usually doctors dont make up the fact that something is broken, but they may miss it in an ER type setting. The faster your figure out what is structurally damaged in there the sooner you can seek treatment to get fixed, trust me there is hope out there if  it is the hyoid bone they can remove it.
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And ask as many questions on this board as you want you can just list them in a row. Dont worry I dont care if its already been asked, and I have time on my hands because I am by my computer a lot, I want to learn more about problems in the hyoid bone region just as much as you, hearing your story has helped a lot in understanding some of my weirdest symptoms
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The original doctor consulted with a radiologist and they felt strongly that it was broken even after the ENT specialist wasnt so sure. No one has seen the CT scan other than the ER doctor and the radiologist at that hospital. Im hoping I will know more once I FINALLY see a specialist.

In the condition Im in right now I cant turn left or right more than a very minor amount so I dont think I could feel the clicking poping sensation because my neck really isnt moving. I also dont dare feel around in the center of my neck-throat area. Its too swollen and way to painful. Maybe at some point I will be able to and will be able to look to my left and to my right without using my shoulders to turn each way.

The financial impact of all this could be too much for me. I may be forced to hope the canadian health care system can look after me and figure this out. Your information certainly helps. Its hard to find anything on the internet about this injury. You know its bad when you have doctor after doctor stumped.

I know a few nurses and they cant believe I could be walking after an injury like this. Its tought as you  Im sure know to be in a state where you almost cant function, with the pain and the total restrictions it puts on your life. Im half feeling completly helpless and half feeling thankful I can walk and arent in a worse state. Its also pretty sad when crazy pain killers barely help reduse the pain. Ive heard some ppl get total releif from hydromorphone and lesser medications but not me and Im sure you know what I mean and what Im experiencing.

I forgot to ask you if stress can make everything tighten up that much more and do the same damage so to speak as walking, lifting and talking can. My stress level is high with this and all the other things its effecting in my life but the other day something happened that took my stress level to an extremely high point. Pills didnt help and I wasnt in an anxiety state(which has only happened once) but the pain and tightness everywhere lasted for 36 to 48 hours.

Just curious if you can relate to that. Seems you can relate to way too many of my symptoms. I cant tell you how sorry I am you or anyone else has to deal with this. I wouldnt wish this on the guy that did this to me or anyone else.
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Stress is medically documented to heighten ones awareness of their senses and tighten the body up, my symptoms are definitely worse during stressful times as is true with all chronic pain conditions. I am thankful also my injuries were not worse, luckily hyoid bone injuries dont paralyze people and it should not effect your motor skills or hand and leg coordination. I felt clicking and popping within 2 weeks of the injury but its possible your muscles are so tight and in spasm that you may not notice this. My family also teased me at first because they did not understand the injury and how serious it was which was extremely frustrating. I would definitely consult with that specialist about breaks/fractures and I am interested to hear what they say.
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Hi I just started reading all the posts and have made it to jan 2 09. I will continue reading them as soon as I can. I cant remember if Ive thanked you for all your information and getting back to me with all this. Its a great feeling knowing someone can relate to you.Thank you. I did have a few questions from all that I have read up to this point. Alot of ppl talk about this clicking poping sensation that happens a few times here and there for some ppl to 1000times a day for you or GGsomething. I cant feel my hyoid and dont get any feeling like that but my neck is soo swollen and sore I can barely handle even lightly touching the area myself. My neck also doesnt really move to my left or right so I cant check to see if I would get that clicking feeling. You said while driving you lost mobilty to shoulder check while changing lanes, I have to fully rotate my shoulders to shoulder check.I use my mirrors and have to be very aware of all the vehicles around me. definately no weaving in and out of traffic,lol. I also cant really back up safely. I have to go slow and hope to hell no one is coming. It takes so long to look left while reversing then look right and back and forth. I would fail a driving test right now. Infact I doubt a driving instructor would even get in a car with me the way I look( my appearance from my neck) Sorry useless information. Another point someone brought up was lifting small weights and trying to strengthen certain neck muscles. I cant even imagine lifting the lightest weight right now. Im sure when I was 4 I could lift more than I can right now. If I lock my elbows so my arms are straight I can lift or carry a minor amount but not for a long time, Im sure I physically can lift and carry more but even the smallest amount of weight will bring the pain right to my neck. I lose almost all my energy and feel like someone is chocking me to death. Im not exaggerating either. this feeling I can get from talking and walking too. Im sure you know the pain/feeling. If I hadnt had this feeling before I would call 911. That feeling of being choked 24 hrs a day, minus when you are finally asleep is aweful.Anytime I get more infortmation from my ENT or most likely the next time I go to an ER I will let you know.Still waiting for sept30th. If money wasnt an issue I would get all your info at UCLA and speak to the ppl that have been treating you. Right now that just isnt possible.
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I know the feeling of being choked 24 hours a day for two years now is so awful. It feels like someone literally has two hands around your neck and any walking on cement transfers all the pressure into the throat region. In my case this is because the hyoid bone is posteriorly displaced so it is not in its correct position its putting an incredible amount of pressure on my throat. If you do not have a break, then it could be a dislocation or displacement I would mention these terms to your ENT. The fact they you are having wheezing and trouble breathing really sounds to me like it is a fracture or dislocation. Here is something from an article I have in one of my medical folders that really ties in closely with your symptoms. The following information is taken directly from a 2008 case report "Hyoid bone dislocation: A new clinical condition"

DISCUSSION
Hyoid bone injury is generally asymptomatic but can result
in throat pain, which is typically exacerbated by swallowing,
nose blowing, or coughing.4 Dysphagia and odynophagia
can be a feature of a hyoid bone fracture and, with a
displaced fracture or dislocation, the bone may even cause
pharyngeal obstruction by compressing the pharyngeal lumen.
Dysphonia or stridor may occur due to either fragment
encroachment on the larynx or associated crush injury of the
recurrent laryngeal nerve in trauma. Patients with dyspnea
may compensate by elevating their chin, pushing the hyoid
bone anteriorly.
Physical exam findings may be remarkable for swelling
in the neck, tenderness to palpation, crepitus, and pain with
neck movement. Alternatively, the physical examination
may be normal. CT scans are superior to plain films because
subtle findings on plain radiographs may be obscured by the
patient’s mandible. Although the diagnosis of hyoid bone
dislocation may be confirmed radiographically, the finding
can be inconspicuous or it can be overlooked if there is a
low clinical suspicion. This is particularly true in the setting
of a rapid trauma evaluation, and it may lead to significant
cardiorespiratory consequences.5 In the end, flexible fiberoptic
laryngoscopic findings of an anterior bulge in the
hypopharynx might be the only visible indicator of the
dislocation.
The management of hyoid bone dislocations should follow
similarly to fracture management. A brief period of a
soft diet may be helpful in patients with dysphagia who are
being observed for mild discomfort. If aerodigestive symptoms
are severe or persistent, as in this case, wire reduction
and internal fixation or partial excision of the bone should
be performed.6
CONCLUSION
This is the first case report of a hyoid bone dislocation. This
patient was diagnosed with laryngoscopy and was treated
successfully with excision of the offending portion of bone.
Further clinical experience is needed to make more specific
recommendations regarding this clinical situation; however,
the current case suggests that surgical excision of the dislocated
portion of the hyoid bone can be accomplished
safely and resolve the patient’s symptoms.
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One other thing, is your neck extremely swollen to the touch in the front anterior region of the neck?
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Also if you are reading over my old posts here are the symptoms that I am still left with after the first surgery that are coming from the displaced hyoid bone. I dont get clicks 1000 times a day anymore since that was the thyroid cartilage but I do still get clicks when I push in on the hyoid or rotate my head in the right position.

Intense Pressure in hyoid region
Severe Headaches (occipital and temple)
Inability to speak without pain and pressure
Shortness of Breath
Constant Foreign Body Sensation
Neck pain and blockage upon head rotation
All symptoms emanate from clicking hyoid regions
Left > Right  Pain Distribution 80% Left, 20% Right
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I would say it is swollen to the touch, I can touch my skin all over in the area and eventhough I am doing it lightly myself it still irritates my throat. It just slightly stiffens up the area. I can shave, its not more painful, just doesnt feel good to do. If I press or feel around in the area from the outside left lymph node to my outside right lymph node and as high as just under my jaw both sides and under my chin to my collar bone area I will get a lot of pain and what feels like more swelling and more pressure. I dont try to touch the area often for numerous reason. I also fear others bumping into me. Ive either been in a daze or woken up from a dream and almost been crying from the pain. Its just from the thought of someone pushing me or getting a hit to my body. Ive played almost every sport competitively at some point of my life so Im guessing I still dream of playing then realise Im still in this condition. Maybe the pain I feel is the stress from the thoughts or dreams. Honestly I have no idea. I dont know about you but being in a crowded area, mall, party, bar etc freaks me out. I still go and enjoy myself for the most part but going through a crowd and possibly getting pushed is something I worry about. I should tell you there`s a lot of medical terms I have never seen before while reading your posts and others.I havent pulled out a dictionary for years but I think I will have to. I dont know if you had that trouble when you first starting researching this problem yourself. Its almost like reading english with a bunch of a foreign language thrown in. Ill have to do something to fix this so I can be better informed when I speak to more doctors. Have you noticed that as soon as you say something about a HYOID bone problem to the medical field they instantly get curious, yet that curiousity has never seemed to be helpful with figuring this out. Before this Ive never had a doctor apologize to me and say they really have no idea. Ive now experienced that more than a few times. Ive also never heard of a physio therapist telling a patient they just arent qualified to help you and they have to pass you along to someone with alot more qualifications. This lady who told me that is late 40s and has worked at the hospitals physio department for years. You would think she would have enough experience to treat any injury. Even after doing her own research she still got frustrated and thought it would be best if I tried someone else. She knew ppl in the field so that was one good thing. In the last 2 years did you often pull your shirt up and let it sit on your chin so it doesnt press on your neck? Just curious I do that all the time. For a wedding recently I couldnt do up the collar and just tightened up the tie at the highest point I could.I find it really strange a crazy bad cough, a lifting accident/incident and a major repeated stomping on a neck could create 3 cases so similar. I have to hope that Im just finding peace with finally finding ppl that have very similar symptoms as I have and that hopefully my case ends up being different. I have to hope its not as serious as yours and hope everything heals sooner than later. I really doubt thats the case but what are the chances of having a condition so rare basically no doctors know what to do with it.The medical community around the world has done some amazing things in the last century and even before that its really strange how no one can have an answer to this. Im guessing most ppl with this condition or from trauma related injuries usually arent alive when the injury is found. So no one has really researched it. Why would you if in most cases the patients have dies from the trauma. hope that made sense. Its just a frustrating place to be right now and I know you must be far more frustrated than I am
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I also find it interesting  that three people with three completely different methods of injury now have very similar symptoms. I think once the hyoid bone becomes inflamed like a sprained ankle these are basically the default symptoms from having so much inflammation in the area. Problems of the hyoid bone have been treated and researched going into the year 2010 I can tell you though that even in the United States only the very best hospitals in major cities (population of 2 million or more)  in the US could probably treat something like this. I realize Winnipeg is not a very large city (half million population or so) and this can really add to the problem, but be reassured that at the larger hospitals injuries in these region have been seen many times. I think the biggest problem is not going to be what is finding out what is wrong with you because me and you can practically do that just be reading all the medical articles their are really only a handful of things that can happen in that area that could create the viscious cycle of chronic pain and swelling you discuss: fracture, displacement, dislocation, elongation, deflection. The hard part is going to be finding a really experienced surgeon where you live in Canada to do this operation, trust me, this is not something you want someone doing the operation for the first time on if you have an option.
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I have been reading both of your posts, but have not joined in lately as my throat has been particularly bad...I thought that almost 3 years later it had gotten as bad as it was going to get, but it is getting worse to my disbelief.  It feels like my hyoid is just loosely hanging in there getting caught on EVERYTHING.  I can hardly swallow without major clicking and popping.  I always feel like somthing is in my throat when I swallow and it seems that I am always sore on the left side with shooting pains going into my left ear the past month among many other symptoms, I felt like I don't even want to be awake anymore and I have been extremely depressed.  I am so afraid I won't get the help I need in time before permanent damage is done if it hasn't been done already.  I feel that too much readjusting of the hyoid by me has caused the problem to get worse.

Wildblue98, I hope your 2nd surgery gets rid of the rest of your symptoms.  One question, did the 1st surgery make anything worse?  Did the swallowing click/pop stop after?  Does your throat feel stranger since the surgery?
Yes, scottiek, I too cannot stand anything around my neck.  I cannot wear anything around my throat any higher than my collar bone without feeling that I am being strangled and suffocated.  I agree, even though we have an extremely rare problem it has helped me to be able to talk with you guys on this site, I don't feel so alone anymore.  I sometimes wanted to end it, but I have been able to hang on because of the people in this forum, especially because of you wildblue98.  Unfortunately, even though I live in an area with some of the world's best hospitals (Boston, MA), I have been unable to find anyone out here that can help me. There are so many hospitals here that I even sent a letter to every ENT department in each one and nobody wanted anything to do with me.  I recently sent my records to Dr. Berke, and hope to be able to see him before the end of the year.  I still don't have the insurance to cover seeing him, but I am still trying.  When I finally do make it out there, I would like to see you wildblue98.  Hey, I have not seen Adam post for a while...I do hope that he is okay..I would like to know how he is doing, so Adam if you are reading this, let us know how you are.

I agree, it is a very frustrating place to be right now, medical science and do heart transplants and double lung transplants, but not many doctors seem to know what to do about this problem.  The first 2 years I was even more scared and frustrated because I did not even know of anyone in the world who could help me, but since I found out that there is a doctor out there that may be able to, I have gotten some hope back.  I know there is a chance for all of us now.  I will do what ever it takes to take advantage of this chance, I hope that you do too.  Please hang in there and I will hang in there with you both.
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Wildblue98, I hope your 2nd surgery gets rid of the rest of your symptoms.  One question, did the 1st surgery make anything worse?  Did the swallowing click/pop stop after?  Does your throat feel stranger since the surgery?

No the first surgery definitely did not make anything worse if anything it helped the repeated snagging/clicking feeling felt on the left and right side a lot. GGCB I could have easily been fixed by now they were right over my hyoid bone during the surgery! and could have easily snipped off the greater cornua, but I had decided in the consultation room I did not want to risk doing both at once,especially since the surgeons said it was rarer for the clicking to becoming from the actual hyoid bone. After having the surgery now I do think we have the same thing and I think you are probably catching in both spots too, I would get the Left SCE and Left hyoid bone trim at the same time, especially since you dont live here in Los Angeles. If you have an email address I would be willing to email you diagrams of what was excised during my surgery and 3D reconstructions of where the remaining clicking is coming from. I feel your case is so similar to mine that when you do get to LA you should mention me and show the diagrams to Dr. Berke.
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I posted diagrams and pictures on my profile of all the problems we have been discussing, feel free to look at them.
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hi,

I just joined this forum.  After I typed and submitted a post, how long before my post shows?  thanks.
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ok, now I've joined....here is my post:
hi,
I have similar symptoms. I had facial paralysis from a shingles outbreak, which is the chicken pox virus that can reactivate and infect your cranial nerves.  This causes deinervation of facial muscles, causing paralysis.  Then, the muscles atrophy from disuse, since the muscles have lost the nerves which contract them.  As if this wasn't difficult enough, after the facial muscles recovered mostly, THEN the muscles controlling the larynx were affected also, especially the NUMEROUS muscles connected to the hyoid bone.  I also know the experience of the CONSTANT STRANGULATION FEELING.  Because some of these muscles are now paralyzed, my hyoid bone is being held too far back.
My ENT doctor is hopeful these muscles may recover their function. He said we will wait and watch, may take several more months.  If anyone knows of anything to help alleviate these symptoms, please tell me.  I also have found that laying down makes it feel much worse, some days worse than others.  I found that sleeping with a pair of socks rolled up under my neck helped to support the weight of the front part of my neck, which was pulling and feeling horrible.  Also, believe it or not, SINGING for 45 minutes will usually relieve some of my symptoms for the remainder of the day, or for hours at least.  Some days I cannot sing, something is rubbing, like you described.  But if I can sing, after about 20 minutes I improve.  Then I sing for another 20 minutes, and it seems to strengthen the muscles.  Then I need to stop, or it feels like I am doing damage to something in there.  You are right........if you had any faith to begin with, you will be significantly challenged to keep it.  I told my ENT doctor that for the first 2 weeks with this, I thought God might kill me.  Then I later apologized for not keeping a completely positive attitude.  But I told him I felt so uncomfortable, for a long time.
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here are links to 2 internet articles I found, explaining surgical procedures to pull the hyoid bone forward.  Neither looks too pleasant, but neither are my current symptoms.
This surgical procedure is called a "hyoid suspension" procedure.  These short articles show diagrams that illustrate the problem, and helped me visualize what is wrong.  These procedures are used to reposition the hyoid bone, to alleviate sleep apnea symptoms.  Don't be put off that these are ads for medical supplies for surgeons to use for these procedures.
http://www.osasurgery.com/hyoid.htm
and
http://www.xomed.com/xomed_products_repose_hyoid_suspension.html
Hope you find these informative, as I did.

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I am actually aware of the hyoid bone suspension procedure I researched it a little bit before my operation. I found it really interesting they can actually repostion the hyoid bone by detaching two tendons on the upper surface of the hyoid bone and some of the muscle on the lower surface, the hyoid can then be advanced over the thyroid cartilage and secured in position. I really wouldnt know how to give you any advice if it is a muscular problem from paralysis I guess you will just have to wait to see if your muscles recover function. Your hyoid bone is probably moving out if its normal range of position though that is probably what is causing this strangulation feeling so it makes sense that if it does not go away you could try something like a hyoid bone supension procedure to get it in a better position, or some other sort of procedure that involves removing parts of the hyoid that may be causing the hyoid bone to click. But I really have no clue I am not a doctor.
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Sorry I didnt get back to you guys sooner. GGCB Im very sorry you`ve been dealing with this for so long. I hope you have a lot of better days ahead and sooner than later can be back to normal.

I went to safeway today and avoided most of the isles. Even with just grabing a few things and walking as short of a distance as I could I still almost colapsed. The embarrassment was the only thing that kept me from hitting the floor and calling for an ambulance. I think Im getting worse rather than better and thats scary.

I dont know if you GCCB have the information and research that wildblue98 has but I was wondering if you 2 would mind taking the time to email me some of the info you have. I still dont know if our cases are the same since mine is so early on but it really seems like we have the same problem, same symptoms.I just dont have that clicking thing you both have. I see my ENT specalist sept30 and with your help Im thinking I can inform myself enough so I can point the ENT in the right direction rather than getting the "wow I have no idea what this could be, interesting" type response Im getting over and over again.

wildblue98 would you mind helping me out? I still havent read all the posts here but I noticed you cant put personnal info on here. so Ill space out my email so you can figure it out. Hope you both are doing well. or as well as we can be with this.

jsburbank Im sorry you have some of the same symptoms as we have. Ive never dreamt of singing, always been an athletic guy but with my injury I can say I wish I could sing for 5 min yet alone the 45 you can. Thinking seriously about singing that long or talking that long makes me think of the pain that would cause.terrible thought. Be thankful you can still do that.hopefully your condition improves soon.

my add is @ hotmail .com ...its s c o t t k e a s t 2 5 @ . hope that isnt blocked out.
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I sent you some studies and diagrams I thought would help the rest I posted under my photos
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I was also really really short of breath today I had to bike a couple miles to campus and then was carrying some boxes in and it did me it takes nothing to set off that inflammation and shortness of breath around the hyoid bone. I think jsburbanks are interesting I have a poseterior displacement which causes my breathing problems maybe you have a similar thing the hyoid bone is knocked bacwards and starts putting pressure on the throat.
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Thanks for all the info. For what ever reason the last thing you sent me I couldnt open. I might try to open it on someone elses computer and see if the problem was my mine. So far all the information I have has been through googling hyoid-bone. I wish I had your clicking so I could take some of that info to my ENT apointment. I was also curious you said something about biking. Before the surgery was that activity possible? or did the first surgery help so you can now bike. All I know is That Im not able to do any type of activity..Its 24hr a day pain but any small amount of activity or talking makes the symptoms and pain that much stronger. So if you can bike does this condition come and go for you? or is it more your body allows you to do a little bit of activity before it gets too painful to move or do anything? before this injury I wouldnt consider walking  or biking a few miles exercise but now I cant even imagine peedling a bike. Do you have a date for your second surgery?
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No I am always in pain but I am still able to bike even though it makes me short of breath and the symptoms worse. The surgery helped the clicking it used to be when I biked my head would be clicking whenever I turned it but the hyoid bone is still putting a lot of pressure on my throat whenever I speak, walk, or do any sort of activity. Biking is a lot easier for me than walking because it does not put pressure on my throat but it is still hard and I was in amazing shape also I could run miles and be fine and now just biking a mile leaves me winded. I think yours sounds like it may be a fracture and a displacement though because I can tell you that the front of my throat was never extremely sore to the touch to the point that I thought people were going to bump into me, also I did not have a direct blow my injury came from tensing up. It really doesnt matter though because fracture or displacement they can cut it out, it would be ideal though if your fractures were off to the side because then they may only have to remove the greater cornua and not the whole bone. I am getting surgery in December, which document did not go through email me back and I can resend it.
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That has been one of the hardest parts by far to deal with though is losing my active lifestlye at such a young age I also lost 15 lbs from stress and physically do not look nearly as healthy since the injury two years of this injury will take a lot out of a person thats why I dont recommend to wait that long, and I should never have waited that long but I couldnt financially afford to quit school to recover from surgery and repay the tuition so I had to finish.
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  It was this document. No Subjec...mht (423.8 KB) every other one came through fine. Thanks again for all of that info. I just found out a highly recommended doctor just accepted to see me. Im sure my injury isnt his specialty but he does consultant work with our pro football team. Not sure if you`ve heard of the CFL. Im of the opinion most big time american schools would beat a CFL team but rules are different and its just my opinion. Im a huge NFL fan not the biggest CFL fan so who knows. We do get talent from all the big schools in the states and have some talented players. Even some go onto the NFL. I see this doctor on OCT 7 and his secretary said he knew of me and thats why he accepted to see me. No idea if it was from the news or if in a city  of half a mill news of a hyoid-bone injury would get around in the medical community. Either way it doesnt matter, the more ppl that can see me at this point the better.


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Im like you but 32. Always been crazy athletic and heavily into sports. When this first happened I lost weight. I couldnt open my mouth to eat solid food for about a week.Then when my jaw finally started to open I was able to eat again but with NO EXERCISE Ive put on weight. about 1/2 of my pants no longer fit. Its frustrating normally I eat what ever and up to a year ago I could always run it off. now with my age, eating habits and no exercise my body is changing for the worst.Not fat compared others but Im getting there and thats stressful. I havent changed pant sizes since grade 9 or 10. sorry just frustrating to think about. Its good everything has gone fairly quickly for you, even if you had to wait. seems like GGCB has been dealing with this for far too long. I wish I could help all of us and anyone else that has this terrible rare problem.
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This explains our shortness of breath....

IFMBE Proceedings Vol. 14/4
2320 Volume 4 Track 14
3D Modelling and Evaluation of the Morphology of Hyoid Bone
Wan Abdul Rahman Wan Harun1 Zainul Ahmad Rajion2, Izhar Abdul Aziz1,
and Abdul Rani Samsudin2
1 National CAD/CAM Programme, SIRIM Berhad, Shah Alam, Malaysia
2 School of Dental Studies, Universiti Sains Malaysia, Kelantan, Malaysia
Abstract— The hyoid bone, a small U-shaped bone in the
upper neck above the thyroid cartilage is a unique structure in
humans as it has no bony articulation. The lack of data on
morphology and position of hyoid bone is due to a large extent
to difficulty in visualizing the hyoid bone using conventional
radiographic techniques. Lateral cephalometry has significant
limitations such as superimposition of structures, difficulty in
identifying landmarks and poor visualization of structures.
The aim of this study is to compare morphological and
positional variations of the hyoid bone in patients who had
undergone CT scans. CT scan images are modeled in MIMICS
and using anthropometric analysis module, several
measurements of hyoids are obtained. Hyoid bone angle was
measured from the most superior medial point on the surface
of the body to the base of the skull. 3D visualization of hyoid
bone helps to locate the most inferior point of the anterior
aspect of the foramen magnum in the mid-sagittal plane
(basion) and the most inferior point of the spheno-occipital
synchondrosis (SOS) on the sphenoid bone. Data collected
using 3D images are used to compare the position of the hyoid
bone and epiglottis in relation to the cervical vertebrae and
cranial base.
Keywords— 3D modeling, hyoid bone, morphology
I. INTRODUCTION
The hyoid bone has no bony articulation, with the floor
of the mouth and the tongue lie above it, the larynx below,
and the epiglottis and pharynx posteriorly. Important muscles
are attached to the hyoid bone with a range of functions
including maintenance of the airway, swallowing and the
prevention of regurgitation. Problems with these vital functions
may be associated with variations in position of the
hyoid bone in relation to the craniofacial structures and
head posture [1], [2]. Alteration in the morphology and
position of the hyoid bone presents significant potential
problems in terms of breathing, swallowing and head posture
due to the alterations in the attachment and pull of the
muscles responsible for these functions. These observations
motivate us to study this significant structure and the use of
3D visualization package such as MIMICS facilitates the
investigation. The objectives of this study are to quantify
anatomical variations of the hyoid bone, to compare the
anatomical length and height of the hyoid bone and the
position of the hyoid bone and epiglottis in relation to the
cervical vertebrae and to record the degree of fusion of the
greater horns to the hyoid body.
II. METHODS
Samples of CT scan data of patients undergoing examination
at Hospital University Sains Malaysia (HUSM) were
collected using a GE Lightspeed Plus scanner. 3D CT scan
images of patients in a supine position was reconstructed in
MIMICS software version 9.11 and the coordinates of osseous
landmarks were determined. MIMICS provides an
effective visualization tool as it allows the display of the CT
scan data around a 3D marker simultaneously in windows
containing axial, sagittal and coronal reformats and reconstructions
of the external craniofacial bones and the cranial
base.
The length of the hyoid bone was measured from the
greater horn’s posterior tip to the greater horn’s anterior-tip
on the right and left as shown in Fig. 1. Landmarks used to
determine the midline, left and right heights and the superior
and inferior lengths of the body of the hyoid bone are
shown in Fig. 2.
Fig. 1 Measurements of the length, breadth and angles of the hyoid body
and greater horns
E1
B2 B1
D2 E2
D1
C2
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Has any doctor ever said why this type or problem is so rare and why the medical community seems to know very little about this bone and injury?. Its blows my mind that the medical community can do so many things and have research labs everywhere all over the world and yet this injury is still so foreign to most doctors Ive seen and Im sure youve seen. Sorry just having a frustrating/extremely painful day.
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I'm completely with you! After seeing the vastness of replies on here... it can't be THAT uncommon.

I'm all freaked out, I think my condition is in its early stages. It started about a month ago, 2 or 3 separate occasions where I got this strange ache in my throat. After playing around I found that if I applied pressure to the left side of my larynx, the thing popped then the pain was gone. Obviously it was easily solvable so I thought nothing of it, but this Friday (just gone), I moved my head up quite quickly and got the most horrific pain, my larynx popped out and I couldn't get it back in, I struggled for about a minute having difficulty breathing or talking to my girlfriend who at this point was freaking out herself, before popping it back in.

This is how I came to this post, I'm glad I found it because by the sounds of it, the longer you leave it the worse it gets.

Having a failed experience with a doctor today, I am taking this with me on my memory stick to show a different doctor... hopefully this will spur him/her into doing something.

Im sorry but also thankful that other people are experiencing this, maybe the more of us there are, the more doctors will know in the future.


Take care you lot!
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USC running back Stafon Johnson injured his throat in a weight lifting accident Monday and required emergency surgery.

This is a new story on espn and all over the sporting world. The only details as of right now  is that he was bench pressing when the bar slipped ouf of his hand or hands and landed right now his throat. He had a spotter but Im assuming he didnt stop the bar from hitting him in the throat and only helped him get the bar off of him. Hopefully this kid is alright and doesnt have the throuble we all are having.

DanimalHolland sorry to hear you are dealing with your injury. Unfortunately I cant help you as off right now. Im 12 weeks into my injury and am still waiting to see an ENT and hopefully find some answers. A few of the other ppl here have been dealing with this for a lot longer than I have. They might be able to help you.We all have very similar symptoms but unlike the others I dont have a clicking in my neck/ throat area.

I would ask a few of the others about something popping out. That hasnt happened to me so I really dont know what to say to you. Hopefully you get answers soon and dont have to deal that on going pain. If its anything like we have described in earlier posts then for your sake I hope the medical community in your area can help fix this ASAP.

Everytime you go to the doctor and get new answers or none at all please write back. i really hope for your sake its nothing like what I have. What ever that may be.
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My symptoms are a lot like what the original poster had when he was younger... but it seems to be progressing a lot quicker. His would happen 2 or 3 times a year, mine happened 2 or 3 in the past month... aswell as the episode on Friday night.

I notice peoples problems vary as you read through the posts, some have clicking when they swallow, some have clicking when they turn their heads, some (like me) have something dislocate or pop out of place. The fact there are so many bones in the neck its hard to distinguish which part is causing the problem. Since I apply preasure to my larynx I figure it is that or even my Hyoid bone.

Update on my condition: when i put my chin to my chest and turn my head, I get a crunching sound and feeling, I figure it is deffinatly something catching.

I am just about to go to the doctors so I will keep you posted.


Thank you for your concern.
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UPDATE

Went to the doctors, he said he wouldn't look at this forum as its not a medical journal. He has no idea what is wrong with me so has referred me to an ENT. 6 - 8 weeks, I guess time will tell.
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I just got back from my ENT apt. 2 different doctors looked at me and asked a bunch of questions. the first which would be someone working under the specialist had no idea what could be causing the pain and why I`m still injured, he thought about possibly getting an MRI done. Around my laryx it was extremely sore to the touch and very painful when you felt around. Higher up around the hyoid bone it wasnt as sore to the touch but when he felt around and put minor pressure it was a pain I had never felt before.

The specialist then came into the room with a chip on her shoulder, she seemed very upset and was very short with me. She was upset with my changing physical therapists until I explained that it was the physical therapist she recomended me too that felt she wasnt qualified enough to handle my injury after treating me unsuccessfully for 8 weeks. The specialist repeated that nothign was broken and nothing was swollen on the inside by my laryx when I was scoped twice and that my problem is all muscle related.

She blamed the way I hold myself for my neck pain and stated if any healthy person kept himself in the position I am in that they would have the same neck pain. She wants me to keep moving, keep active and get the muscles moving. Shes going to refer me to a Pain clinic so I dont have to rely on narcottics. She wont write me a perscription for them. She was upset that I was even there and thought this was a case for my GP/family doctor. But my family doctor had no idea and doesnt want me continually going to him because this is a problem for an ENT.

So now Im in the same spot, still in ridiculous amount of pain, cant walk for more than a block and the 2 doctors that should be helping me are putting blame on each other while the patient doesnt get better. Ive followed the treatments of going to a physical therapist twice a week since I was refered to one 8-10 weeks ago but no improvements what so ever. I see another doctor in a week but he isnt an ENT specialist and in this city I can only be seen by 1. Its not like in the states where you can pick and choose.

My ENT through her ranting even through out these words" what are you 40 do you really want to be in this state all your life". Im 32 my chart would say that and everyone I have ever met thinks Im in my mid twenties or much younger than I am....Im still trrying to figure out if that was her way of giving me a shot or if she just didnt care to read the file. Ive never met a doctor so upset and so short with someone.I had 2 family members with me and they even noticed the way she acted.

Im at a lose with no answers and no idea what to do other than to continue to go to physio, and hope the next doctor can figure something out and in the very least can treat me with some respect. GGCB and wildblue98 does any of this sound familiar to you guys? Im more upset with the ENT specialist than I am with the guy that jumped on my head/neck etc etc over and over again.
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Drs like to be short and terse when they dont have any clue what is going on in there it is their defensive mechanism for hiding the fact they dont know **** trust me sounds very familiar. So they did not find anything broken?
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Around my larynx it was extremely sore to the touch and very painful when you felt around. Higher up around the hyoid bone it wasnt as sore to the touch but when he felt around and put minor pressure it was a pain I had never felt before. This is important I dont have any pain to the touch in any areas and you describe this pain you "have never felt before" when they touched you around the hyoid can you tell me more about this is it excrucaiting pain. 3d axial ct scans are the best imaging you can get for that area. At this point you just really need to figure out if anything is fractured in there did they give you an answer on this.
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They didnt do any tests and it felt like she was trying to put the responsibility on me for not getting better. She told me all along this wasnt broken and I should have been getting physical therapy done. My original doctor and his very experienced radiologist disputed that with her and told me he felt she was wrong in her assesment and that it was indeed broken. So with that info being passed to my physical therapist and the ENT only speculating it wasnt broken and not doing any more tests. The physical therapist wouldnt touch the front part of my neck, she attemted to once early on and I was in the hospitals ER that day and another ones the next.

This ENT was one of the rudest most short ppl I have ever met. I still cant figure out why she was so upset with me. I do have my opinions as to why but it would be all speculation.She didnt offer to do any more test and I cant see her for another 3-4 months. A CT scan, the one where they put a die substance in your IV was givin to me a few weeks ago at an ER. the doctor there said he wasnt a specialist but after talking to the radiologist they both felt the hyoid was intact not broken and all the muscles in the area looked normal. Im sure this scan was given to the ENT.

When the first doctor felt around my laryx is was extremely sore, ppl have even told me my adams apple is no longer visible from all the swelling in the area. When he felt what i think is around the hyoid bone it wasnt as sore but the more slight force he used to feel around the more I could feel pain. Once he got to that area I jumped from the pain and even this morning Im in a lot of discomfort and pain. Im more tightened up all over including my shoulders and my chest.Normally Im at my best in the morning and minor daily activity cause me to have more and more pain and issues throughout the day.

Im going to go back to the doctor that originally saw me and get his opinion on all this. If a doctor is as upset as this lady(ENT) was they no longer have your best interest at hand.Im a very polite guy that rarely uses profanity and would never in a proessionnal place such as this. There was no reason for that type of attitude.when someone is crying from the pain and absolutely desperate for answers why treat them like a sack of sh*t.
I know you said you were a college athlete, Ive always been an athlete just never at that level.Iplayed through a broken knee cap, broke fingers and toes and kept playing soccer. burst my bursasac in my elbow in a provincial game. We were down and I kept playing eventually it looked like a bone was coming out of my forarm. 6 weeks later I still had a bruise from just below my shoulder to just above my wrist. I have many many other injuries  and stories Im just telling you this so you know I can handle pain. when the pain is so bad Im crying in front of others you know the Pain is extreme.

A teamate once made a statement that someone can shoot scott and he would still find a way to play. I would sooner get hit by a bat then deal with the pain I am in all the time.Im sure you know the pain Im talking about.I wish doctors could understand that pain and just figure this out. I still dont know when it will get better if it is only muscles or when I can get back to work etc etc
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My original doctor and his very experienced radiologist disputed that with her and told me he felt she was wrong in her assesment and that it was indeed broken. I would definitely check back with your original doctor. It is very important for you to know if it is broken or not when do you plan on meeting with him again.
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I see him this monday. I havent seen him in 2 months. The apt Im more excited about is wed with a highly recommended doctor. Not sure what his specialty is but any doctor that does consultation work with a pro sports team must be very well respected.
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Hope your doctor appointment went well. I had another question for you since the injury do you ever get tightness/pain in the chest, shoulders, and lower back. I think the hyoid bone can throw off these areas because I have more stifness pain in these areas than I am used to just curious if you have that also.
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Hi sorry I didnt get to you sooner. I have a lot of stiftness and really sore muscles in my upper chest. No problems with my lower back but 2 plus months ago when I first saw the chiropractor he did computer sensor test on my back. I also had one of these done last summer so I had something to go by when looking at it. The exam/test showed my neck area had extreme muscle trauma and had a higher temp than other areas, this was also the case on my loser back on the left side where I also got stomped on. Ive never notice any lower back pain but the pain Im in could easily mask slight discomfort.

As for my shoulders I havent had any real issue but one day last week it felt like my right shoulder was completely out of its joint/socket. my shoulder didnt hurt but my right arm and the muscle above the collar bone going from my shoulder to my neck just killed for over a few mins.Not sure why it did that or why it suddenly settled down but it was very odd. I also have soreness in my right foot. Not like a foot cramp but just something ive never felt before and has slightly annoyed me for the last 6-8 weeks. I cant do any physical activity so I have no idea why this is going on. hope that info helps a bit.

I saw the original doctor monday and I informed him what the ENT said and that I was seeing someone highly recommended on wed. He thought the muscle problem diagnosis made sense but he really wasnt sure. Its such a foreign injury for him. I left his business card with the doctor I saw today and Im guessing they will be in contact.

Not sure if you did a lot of physio or not but since the ENT said it had to be just a muscle injury now. My physical therapist has been really working on moving my neck and working on the front part of my neck. Shes also working with needles around my neck,face and head.On monday the pain from simple neck stretches was soo severe I could barely speak or move. Even she refused to do anymore treatment. Since She got the okay to work on my throat/neck Ive had trouble getting to sleep and I can feel something(probably my hyoid bone) pushing in my throat with a lot more force. For the past week Ive tried to vomit numerous times because it feels like something is stuck but nothing happens. its just another odd odd feeling.

I use to have slight trouble falling asleep but be good once I fell asleep. Now because of that extra pressure in my throat its taking me an hour or 2 to fall asleep. last night it felt like I never slept, I just couldnt get comfortable with that feeling in my throat. I also lost my medication so I couldnt use that to try and relax everything. Waking up in the middle of the night that feeling in the throat wouldnt be as severe and falling back asleep is much simple, minus last night.

The new doctor I saw this morning was the first doctor since my original one to actually take time and go through everything with me. He acutally did a full exam. He didnt just scope me and say nothing is wrong, or look at me in awe and have no idea what was wrong. I was very impressed eventhough it hurt like hell. He couldnt believe after 13 plus weeks I still hadnt had an MRI or at least one requested. He started that process and said they would be intouch with me when I have a date scheduled.On the way out I the office staff informed me they were booking for january but didnt know how urgent my MRI would be.

In theexam the doctor wasnt sure what was going on or why I had so much pain in my throat/neck. He told me that the easy way out was to say it was a muscle injury(which it could be) and it will heal in time. He told me no one could give me a guess on how much time that would be. And since muscles typically heal sooner than the 13 weeks Ive been dealing with this there most likely is another cause and its in both our best interest to try and figure it out.

He also asked if I would be willing to switch ENTs and the answer was an obvious yes. No guarantees but he seems to be willing to dive into this and try and help me. Thats all I can ask at this point. Another doctor I spoke to for 30 min today said in 30 plus years he has never seen anything like my injury and wish I was in the states or had insurance to go there. Hes asian and said he loves canada but in the states they deal with things right away. He thought a nerologist might be reallly helpful and I could have major nerve damage in the area. He couldnt figure out why there would be soo much pain after this long.




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Thats interesting I disagree about it being a muscle injury there is just no way a muscle injury is going to cause that kind of pain for so long, it might have something with the actual bone like me. Also if you dont exercise for a long time you may start to experience new aches and pains, I know I was used to moving and being active like you now that I dont exercise its like all my old injuries are stiffening up and revisiting me your body starts to feel pretty old fast without a real exercise regimen that might explain some of your pains. Your case is a harder one to figure out because it doesnt make an actual noise or they cant feel it by pressing in. Where did your neck show extreme muscle trauma which exact muscles, be careful chiropractors love to run those type of ******** tests on you a lot of times there is no science behind them. I was hoping you would have answers by now but it took me almost two years here in the United States at major research hospitals to get an exact diagnosis "posteriorly displaced hyoid bone" and I can imagine it being that much harder in Canada, what did your original doctor say about it being broken did he confirm or takeback this diagnosis?
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The orginal doctor showed me the report of from theradiologist that stated a fracture in the hyoid bone. didnt say which area of it. He agreed a ct and Mri would be the best ways to see everything in the area. He said its possible that it wasnt but with the information he had and going with an experienced radiologist he trusts they thought it was. He ordered a copy of the ct scan after I left and as of right now I dont have another apt with him. No real answers but it looks like this new doctor doesnt agree with it being a simple muscle injury. He also called the front part of my neck hyper sensitive so he felt around and made me do movements in all directions but since he could tell the pain I was in when he felt around the front part of my neck he didnt use a lot of force and recommended that until we can figure this out that its best not to have ppl(physical therapists) working on my throat(from part of my neck)At this point I wish I had that clicking. I never thought a soccer game could turn so ugly and now I have to pay for playing a sport i love.BRUTAL.
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Just wanted to let you know that I too get the tightness and sore feeling sometime in my upper chest, shoulders, and upper back.  It seems to come in spurts.  I will have it happen for a couple of weeks or so, then it will go away for a little while and then come back again.  I think it may be because I hold my head differently (posture) and I sleep in a different (less comfortable) position than I used to before this problem.  I believe that is putting more stress on the muscles in that area.

I have a question for you guys...for the past several days my hyoid has been especially bad, then last night I was shifting it around to try to get it into a more comfortable position and all of a sudden it did shift and then immediately afterwards the right side of my head filled with extreme pressure and I could very loudy hear and feel my heart beating in my right ear.  Then when I tried to lay down, it got worse and felt like the hyoid was pressing on something to cause this pressure.  I feel a bit better today, but it really freaked me out last night...I could hardly sleep...I was afraid I was going to have a stroke or die (still am afraid)...I know it sounds crazy, but I was wondering if either of you have had this happen because of the hyoid bone shifting?  The strange thing though is that today my hyoid feels a lot more comfortable than it has in months, but I find the pain is easier for me to deal with than this pressure and I wish it would go back the way it was.
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Thats terrible, sorry to hear that. Unlike the 2 of you I dont have any clicking and I dont feel around that area just due to the pain. Since my physical therapist got the okay to move my neck( and the movements are very basic and minor but still difficult for me to do) I have felt more pressure in my throat. Not more pain or pressure like you described though.Its more of a gaging reflex and I almost always feel like something is stuck and pushing in my throat. After I saw an oral surgeon I had added pressure in my ears and one side would click or make a weird sound everytime I touched the back bottom part of my ear.It lasted for a few weeks but was never painful. Through all this Ive been told alot about the muscle running around your hyoid. The jaw, tongue,below your ears to your chest, shoulders and I know so many others, so it effects everything. Add all the major nerves too and I can see why we are all having so many problems. Unfortunately I dont have any answers for any of us. I wonder if the hyoid or something in the area got pinched and caused that reaction for you. Can you sleep on your side? or on your stomach? just curious because I cant its way to painful. hope that feeling subsides soon for you.
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Hi Scottiek:

To answer your question about sleeping, I cannot sleep on either side or on my stomach, which is difficult because all of my life I have been a side sleeper.  I must sleep on my back with a special bead filled pillow around my neck and head situated so that once I am laying down in a fairly comfortable position for my throat, it keeps my head in one position so it does not move much when I sleep.  It really *****, but I have very little choice.  I hope the feeling goes away soon too...thank you for your thoughts and concerns.  Talk you you later.
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Hi GGCB its good to hear back from you, trust me you are not going crazy, I have had episodes of the heartbeating loudly in the ear also when I get the hyoid bone in a really bad position last night it was so bad I literally almost passed out when I was talking loudly with my brother and jerked my head in the wrong position, immediately I heard an intense rushing beating sensation in my ears and my heart was thumping loudly I felt very unsteady for about 30 seconds readjusted my throat and it went away. Events like this arent the norm for me but I am fairly confident  what causes this is the displaced hyoid bone putting pressure on the carotid artery in the neck so you can hear your pulse. Also hyoid bone displacement will most definitely effect your head positioning from studies I read that is why it will create tightness in your shoulders and chest because these structures than have to support an 8 pound head with bad positioning.Scottiek thats good they may have found a fracture at this point that is probably better for you than no information at all because their is something they can actually correct. I would check this fracture finding out more all you may need is a procedure to excise the horn depending on where it is. Entire hyoid bones are even removed for cancer and cysts and patients do fine, so the greater cornua being removed should not be a big deal it could also completely give back your quality of life.
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typical cost for this procedure without insurance seems to be around 5-10k with the two patients on this site I spoke with. This seems to be very reasonable I dont know how your credit is but I know their are many companies that will loan you money for procedures that you can gradually pay off. I know this isnt ideal but its just a suggestion.
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I also forget to say that I get clicking in my ears sometimes too I know this is from the hyoid displacement it is effecting the pressure in my ears and sometimes I get a mild clogged left ear.
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I was just reading over your post about the head rushing thing again and I cannot believe how crazy a coincidence that is. I had not had a serious episode of that for maybe 8 months and mine occured last night and it was intense its like all the blood immediately rushed into the left side of my head you say right side of your head that is interesting arent your symptoms way worse on the left?
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"Alteration in the morphology and
position of the hyoid bone presents significant potential
problems in terms of breathing, swallowing and head posture
due to the alterations in the attachment and pull of the
muscles responsible for these functions"

This article definitely explains the ear click and the reason why we cant sleep with a normal pillow because an alteration in hyoid bone positioning will effect head positioning, and a displaced hyoid will start effecting the pull of muscles I bet our ear clicking is a muscle behind the ear being pulled from the displaced hyoid.Maybe a clue to you whats going on in there?
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WOW!  That is a coincidence.  When you wrote "immediately I heard an intense rushing beating sensation in my ears and my heart was thumping loudly"...you described it perfectly...that was me!!!  Yes, my hyoid is way worse on the left, but what happened is that it hurt so much on the left that I was playing with the hyoid (you know, it is hard to keep your hands off of it when it is bothering you) and I may have accidentally pushed it too far over to the right...and BAM!...that is when the head pressure and ear pounding thing happened.  I totally agree with you regarding the hyoid pushing against the carotid artery.  I am going to TRY not to adjust my hyoid too much again, as I did some research yesterday and found a medical paper on an 85 year old woman where her hyoid cut off too much bloodflow to her brain and she got stroke-like symptoms.  When I read that, it scared me because I guess you can actually have a stroke.  Thankfully, I am starting to feel better regarding the head pressure, and only had one episode of my heart beating in my right ear yesterday (when I exerted myself walking up the stairs)...I hope for none today.  This was the first time that had ever happened (and I hope it was the last time) in the almost 3 years I have had this...new symptoms always unnerve me.  Thanks for your reply.
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Hi thanks for looking into that for me. I have a feeling there isnt a fracture or evendence of one but the orginal doctor who I saw said he and the radiologist believed there was. After this long a bone would heal and the ER doc said there was no evedence of a hyoid fracture in the CT results 9-10 weeks after the incident. The original doctor hadnt seen the CT scan but will be looking at it. I just wonder if he was right and it was broken and now is intact or if it was never broken to begin with. I know with normal bones you would have calcium build up where the fracture was to know there was one there. I would assume its the same for the HYoid but with how small it is maybe its hard to see. know idea.
The ENT just kept saying it was never broken but didnt say how she knew that.she was so short and angry/upset it was hard to ask questions.She also refused do any tests other than a scope which wouldn`t help look at the Hyoid bone. Hope I never have to see that lady again. Im sure the MRI when ever I get it will help show more in the area.
The ENT has been so aweful to deal with that she still hasnt sent anything to a group/program that is covering my wage loss. ( compensation of victoms of crime) without doctors info directly to them my case worker wont be able to continue to cover some expenses and 55% of my wage. I cant work and dont have any disability insurance or any of that on my morgage either so that form being filled out is important. I know you have said some ENTs havent been helpful but have you ever had one this upset and this mean?
The new doctor I just saw that requested the MRI even thought it was laughable that the ENT wouldnt see me again until Jan when I am in the condition Im in.Its hard to not be upset when you need help and ppl treat you like ****.Hope GGCB hasnt had any similar situations over the last 3 years with ENTs.When we have this much pain and need help the last thing we need is a bunch of attitude and someone unwilling to help.
Any word on that RB and how he is doing or what procedure he had done?I missed the USC game on TV last weekend so I didnt get to hear the announcers talk about the accident.
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I have actually read a lot of scary literature too on the hyoid bone and how it can interact with the carotid artery sometimes even being fatal in some cases it increases my anxiety a lot to know this is possible. I was wondering if you could forward me that article or show me where to find it, there is no doubt that a badly positioned hyoid can put pressure on the carotid artery. The fact that we have both been fine for so long makes me think nothing really bad will happen but it is not comforting to read what can happen in the area I agree. I constantly have a feeling of lowgrade pressure in my head that emanates up the left side where I hear the hyoid click.I know its the carotid artery and (surgeons agree this is possible) because when ever I try do something that gets my pulse up I have an intense urge to faint, or if someone comes up and scares me from behind like last night I almost passed out from my heart rate shooting up. I know this happens because when you get your pulse up the carotid artery becomes more engorged with blood and it squeezes against the displaced hyoid making you feel like you want to faint because it is restricting blood flow. In addition to this the added inflammation from exercise inflames the area which can also prompt fainting. Adam told me also he would pass out when he tried to exercise and doctor Berke corrected this symptom for him.   I know a lot of people have bad headaches on the site, so I think it just really uncomfortable inflammation pressing on the carotid artery which mimicks a migraine stroke like headache, we will all probably be fine but yes I know another crazy thing to stress about.
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From listening to all your posts I know this is speculation, but I think the most likely scenario is the original doctor was right, ER doctors are notorious for overlooking fractures like this they are always in a rush and if you are breathing, talking, and walking they will just shove you out the door. Who can blame them when they have a car accident victim bleeding to death in the next room. I have had similar experiences ER doctors missed everything on my mri. I also think yours is fractured because of the way you were injured and the fact you have intense soreness to the touch two important things that set you apart from GGCB and I. You had a traumatic and sudden force exerted on your neck, this is much more likely to result in a fracture than coughing or lifting. Also GGCB and I are very disabled but your symptoms do sound a little more debilitating than ours do you work a desk job? Because of the way you were injured and the original finding and the extreme soreness to the touch and the fact that muscle injuries usually dont leave you in utter debilitation for months without improvement it really sounds like a break or fracture. It would be great news for you if that old doctor could pinpoint that fracture because then you could move ahead and seek surgical intervention, their definitely are options out their that can fix fractures and breaks in all areas of the hyoid bone. I am interested what your old doctor and radiologist has to say let me know. I may be wrong I am just trying to give you my honest advice from what I know.
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Yes, my hyoid is way worse on the left, but what happened is that it hurt so much on the left that I was playing with the hyoid (you know, it is hard to keep your hands off of it when it is bothering you) and I may have accidentally pushed it too far over to the right...and BAM!...that is when the head pressure and ear pounding thing happened,

I have the same thing happen! When I am playing with it on the left and push to hard sometimes it will pop out the other end on the right side. I really feel strongly that you have the same thing as me your symptoms are so exact in every department. I would definitely metion "posterior displacement of the hyoid bone" clicking on the tranverse process when you see Dr. Berke and print up my images from this site. Have you taken a look at the pictures I posted, I am interested if yours is coming from where I drew the arrow.
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I am not sure how to access the pictures you posted.  Can you tell me how to do this?  I would be interested in see this.  Thanks!
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If you click on the picture to the right of my profile name wildblue98, double click on the small icon of the larnyx it will open up my profile and pictures. I am interested if your clicking is coming from that exact spot also.
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Have you thought of finding a surgeon at Johns Hopkins Ent Department in Baltimore, Maryland. I was curious because I know they were the best ranked hospital this year maybe someone there would know about hyoid bone problems.
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I know many people on this site and others have discussed hyoid bone clicking come on from relatively minor incidents or for no apparent reason at all. This article shows why this may happen in people with age the joint space of the hyoid bone begins to narrow this may cause a click to occur because when the space narrows the greater cornu of the hyoid bone can start catching on other structures like the nearby tranverse process.  

Object: Age-related morphological changes in the human hyoid bone were investigated radiographically and histologically. Materials and Methods: Thirty-two measurements were performed on radiographs of 238 hyoid bones from autopsy cases of known age and sex. Thirty-one hyoid bones that were studied by radiography were also examined histologically in horizontal sections. Results: Analysis of the length and width of the hyoid bone revealed significant increases in the body and the anterior part of the greater cornu and a significant decrease in the posterior part of the greater cornu with aging. Most measurements of the body and the greater cornu revealed differences between male and female hyoid bones. The outer margins of the body and the greater cornu were situated further outside in older males compared with females. The breadth of the joint space showed a significant age-related decrease, and the degree of fusion showed a significant age-related increase. Histological findings showed ossified or calcified fusion, with osteoclasts in the marginal area of the joint space. Conclusions: Increasing age induces fusion of the body and the greater cornu. The morphometric changes in the shape of the hyoid bone may represent functional adaptation to articulation fixation.

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No...I have not thought about going there, I really do not even want to try to go there since they would also be out of network and would also not be covered.  I may as well wait until I can see Dr. Berke in California.  He already has my records and I am just waiting until my new insurance kicks in and then I can arrange to rent a mobile home and drive out there.  I want to see someone with "experience"  no more "experiments".
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I thought this article related a lot to what we are going through in case you havent seen it hear it is
Question:
I am a 35 year old male. I smoked for approximately 15 years prior to quitting. The issue I am having is about 2 years I woke up with a very small, but noticeable, click in my throat. There was some trauma to the chin which occurred a week or two before the issue was noticed (I fell and hit the underside of my chin on a table). When it first appeared it was sporadic and, while noticeable, not painful. Since then it has become an extreme discomfort. Now when I swallow there is a palpable double click on the right side of my neck. It is uncomfortable, and is worse when I am lying down. Lately it has gotten so bad that it is interrupting my sleep. I also have difficulty swallowing.
I saw several doctors before I found one that realized it was causing me discomfort and did not dismiss the issue as being unimportant. Tests I have had (all normal) include a swallow study, CT (Hyoid looks ok) with and without contrast, a neurological exam, upper endoscopy, direct laryngoscopy, and a chest x-ray. I was also treated with a high dose of nsaids, but was quickly taken off of those when my creatinine started to rise (and they are now reluctant to try that again). Because of the issue with NSAIDS I was instead put on a regiment of steroids. Neither approach had an affect on the intensity of the click or the discomfort it causes. I have also gone through a regiment of PT to strengthen the neck - but it did not make a difference.

At the recommendation of my doctor I then saw the head of surgery for one of the universities in our area. He suggested the removal of the center portion of the hyoid (can`t remember what the procedure is called). I was reluctant to do a procedure that was based off of a guess (which the doctor admitted).

Since then I did discover and share with my doctor an article Throat Click: Fact or Fiction. My doctor had communications with the individual that did the study and found that an option might be surgery in which I was awake and he could observe the issue. While reluctant, I was getting desperate because this issue is only progressing and not getting better. I decided to look into this as an option and my insurance said they would not cover the procedure without a clear diagnosis and evidence of the issue (like a palpable double thump - which has gotten quit violent - is not evidence enough).

I apologize for the length of the message, and know that the content was similar to http://www.netwellness.org/question.cfm/30911.htm. However, I am really desperate to figure out where to go next. Are there different imaging techniques that can be done (I had seen one article about a 3d image reconstruction of the throat to find this issue. Was done somewhere in Germany and haven`t been able to find the article since)? Is there a specialist somewhere in the US that is recognized for this type of work? I am even considering paying for the surgery myself.

Any thoughts are greatly appreciated.


Answer:
There are some abnormalities that can cause "clicking" in the neck and face. One of the most common is temporo-mandibular joint dysfunction. This is a problem of the jaw joint that can cause jaw, ear, and neck pain. From the history given, this is not likely here. The hyoid can also cause a neck click. This was evaluated with a CT that showed normal hyoid anatomy by report. One more cause is the thyroid cartilage (the main cartilage of the larynx) rubbing against the cervical vertebrae. Usually, it is the superior cornu (horn) that rubs against the transverse process of the cervical vertebra. During normal swallow, the larynx is lifted towards the back of the tongue. This is when the "click" happens. It can be hard to detect, especially if not suspected first. The cartilage is hard to see on x-rays (and in swallow studies with fluoroscopy), because it is not usually calcified at it's superior end. It could have been caused by trauma to the larynx. A CT can sometimes show a posteriorly displaced superior cornu. It can be treated by surgically removing the displaced piece of cartilage. An otolaryngologist with interest in swallow dysfunction (sometimes with specific training in laryngology--voice problems) may be able to help. Again, it can be hard to prove that this is what is causing the click. Any surgeon should be cautious about going to surgery without a definitive diagnosis, and the patient must be prepared to have a procedure that may not help the problem.


Michael J Wolfe, MD
Assistant Professor
Department of Otolaryngology
College of Medicine
University of Cincinnati
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Guys, what kind of CT scan do I need to do?

As much as I don't want to expose myself to radiation, obvisouly I can't have a surgery without first doing a CT. Is there a specific name/brand that I need to be looking for. Since the click happens when I swallow doesn't the CT scan have to be more like a video image rather than a picture? Are there such kinds of CT scans at all?
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you need a 3d axial ct scan of the larnyx and hyoid bone since your clicking happens when you swallow the best thing to do would be to do whatever recreates these symptoms (head rotation, swallowing) while they are taking the ct images.
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^ Thanks, wildblue!
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i, too, get the "popping out of place" episodes.  Started when i was 13, i'm 44 now, and have seen many drs. for this, none of which had any idea, most of them acted like i was making it up.  Luckily, my breathing has never been affected during the episodes, but i sure feel like i'm gonna die when it happens, just because of the severity of the pain when i swallow, i'm sure something in there is going to break.  Oddly, last night it happened when i stretched in bed.  Odd neck contortions seem to bring it on, so normally i'm very careful .  last night was the first time in about three years.  After an hour and a half of trying to relax and rest and limit my swallowing, frustration brought me to tears.  I cried so hard my nose got stuffy, and strangely enough, when i blew my nose, it popped back into place.  I'm hoping i'm on to a way to deal with it the next time it happens.  I'm sore this morning, but ok.  I've given up on trying to find a dr. that can help me, however, i have had good luck with taking diazepam tablets during episodes, it seems to relax the muscles enough to assist it popping back into place, and i'm less sore the next day. My episode last night was the shortest ever, i've had them last as long as 38 hours.
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After two years of experiencing with various prescription drugs I have found two that are very helpful in dealing with this clicking hyoid condition and that improve ones ability to function on a higher level.

Diclofenac (marketed as Voltaren and under a number of other trade names, see below) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation and as an analgesic reducing pain in conditions such as arthritis. It is the most potent anti-inlfammatory on the market and can be taken in a convenient 24 hour form once a day that provides relief of symptoms throughtout the day

Klonopin- is an amazing drug that helps reduce the feelings of pressure and strangulation on the throat, makes sleeping much easier, and helps keep the hyoid headaches under control.

Taking 1 klonopin at night for sleep and 1 Diclofenac for breakfeast in the morning can make all the difference in getting through the day. If you had not tried these drugs I would give them a shot they could help a lot.
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thanks for the info. No new news on my front still waiting on the MRI request and still have no idea when that will take place or when I will see my new doctor again. I do have a question for you though. Ive been getting more and more headaches all over the place they dont last long but are annoying. and over the past few weeks Ive notice this sound coming from my throat. You and GGCB have a clicking around your hyoid. I noticed this before but I`m noticing this a lot more often now. Its a very slight squeaking noice and my best guess is its coming from my throat well above my laryx. Not sure if you ever had a little circular candy call fizz. Originaly made in argentina and its still givin out a lot on halloween. Anyway that fizzy sound in your mouth without the snaping cracking part is what i feel/hear in my throat. very very odd. Maybe thats a bad description but its the best Ive got. Its such and odd foreign sound. Have you experienced anything like this before? I think it happens more when Im tired/stressed etc.
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a few hours ago I was still waiting to hear about when my MRI would be. I finally got an MRI. I was givin 45min notice to be there.Now that its done I have to wait 2 weeks for the results. I see the doctor nov6 to see what the results were and what the game plan is now. I still havent improved in 15plus weeks.
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"Anyway that fizzy sound in your mouth without the snaping cracking part is what i feel/hear in my throat. very very odd."

Ive never had that but the noise is important, not suprisingly noise usually comes from the exact region of the injury because structural muskoskeletal problems/injuries create weird noises, understanding the anatomical mechanics of this noise can make all the difference in diagnosis because if you cant find an injury radiographically your only other real tangible clue is to go from noise. where exactly is it coming from, does it happenen when you swallow? Sounds like saliva might be getting trapped in the area of you throat injury creating that fizzy sensation noise. My throat sounds more like a clunking grating sound of bone hitting bone (hyoid bone slipping across the tranverse process). Hopefully that mri gets you some answers, but ct scan is actually better for hyoid bone injuries, and if there is a clicking hyoid syndrome computer 3d reconstruction of the hyoid using computer software is the best way to diagnosis the anatomical abnormality causing the clicking.
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is the fizzy sound coming directly from the center of the hyoid bone or off to the sides, how often do you hear this, and what brings on the noise?
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So I was just reading a long paper to my brother and low and behold my hyoid starts popping like crazy just from talking. Its like there are pop rocks in my throat. Maybe this is what you meant by that fizz candy are they like pop rocks ever had those.
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I have had pop rocks but not in a long long time. Im not sure Im doing a good job describing this sound/ feeling. Pop rocks is more of a loud poping cracking sound. what I heal/feel is much lighter. I might not have noticed it early on with dealing with so much. I noticed it forsure a month ago and it barely happened. Now I get it a few times a day lasting between 2 to 20 seconds. The best I can figure is it happens when Im tired or my neck is tired. The sound feeling doesnt hurt and comes from the upper center part of my throat. It doesnt come from anything I do.( that Im aware of)

I just got informed that my MRI was scheduled for mid JAN. they didnt know I already had it.3months in Canada is still pretty good for an MRI wait list. Isnt that sad some wait a lot longer.
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Ive had similar noises mine isnt nearly as loud as a pop rock either and it is a little fizzy sounding one could describe it that way. Mine is coming from the sides of the hyoid though and I particularly notice it if I am trying to lift my head up from a pillow and turn my head or put strain on my neck the noise in my case is the greater cornua of the hyoid bone jamming against the tranverse process as it slips across the lateral process it makes this very distinct grating noise. If yours is coming from the direct center I really dont know what this could be. Maybe its where the fracture is? I know the hyoid bone can catch on the thyroid lamina cartilage in the center and make weird noises, maybe if your hyoid bone is damaged in the center the fracture or injury has a thyroid lamina component also. These are just ideas throwing out there. The things in the middle region you describe that are most commonly injured are the central portion of the hyoid bone and the thyroid lamina of the thyroid cartilage. I would have your doctor look extra carefully at these regions on the mri.
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heres the results from my MRI. FINDINGS:
AT C3 4 there is a very shallow left uncinate process osteophyte with very minimal left foraminal narrowing
AT C4 5 there are uncinate process osteophytes larger on the left side and this results in mild left foraminal narrowing and minima flattening of the left side of the cord
AT C5 6 there is a moderate difuse disc and ostephyte complex. A moderate left uncinate process osteophyte is present and this results in moderate left foraminal norrowing
AT C6 7 there are shallow uncinate process osteophytes with only mild narrowing bilaterally of the foramina
The remaining cervical and visulized upper thoracic levels are unremarkable. There is no abnormal signal present within the cord
(  )this study is a saturation band anteriorly and the hyoid can not be reliably seen. The visculized (  )vertebral soft tissues are unremarkable.

The (  ) in 2 or 3 unknown letters that didnt come through in the copy I recieved
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for the first time surgery was brought up. Its not in the near future he just brought it up as possible option but one that we should try to avoid. He said hes seen many neck injuries but they arent normally this restrictive 16 weeks later and they dont effect the vocal cords. its normally one or the other not both like my case. I will be refered to a neurologist but he wasnt sure that would be helpful. but at this point anything is worth a look. No idea when I will see the doctor again but he said they would be in contact with me......this is the best  doctor I have dealt with so far, everyone else has seemed to pass the buck or give up he hasnt which is good. Thats all the info I have at this point hope you are doing better than me. cheers bud
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hey that’s good you finally got your ct results back they found quite a few things there, I know that some wear and tear (osteophytes) can be normal for people in their early thirties but what did the doctor think of these results in explaining your symptoms. Did he think they were incidental or that they actually explained something. Be careful I went through a similar process in which a doctor told me I had a C2-C3 mild right disc osteophyte on my first mri, and it ended up having nothing to do with it, these osteophytes and narrowing could be totally normal and have nothing to do with your pain. I had another appointment at UCLA today and talked with three of the surgeons again about the greater cornua excision procedure. After talking for 30 minutes with one of the other head and neck surgeons who was very helpful in answering all my concerns about the hyoid procedure and reading more medical articles I learned the following new things:

1. The greatest risks of the procedure are bleeding and infection, there is no real risk to the spinal cord, and the mortality rate is extremely low if not non-existence and is basically the mortality rate of dying from anesthesia (which is comparable to driving in a car for some length of time)

2. According to one surgeon the clicking hyoid syndrome had been seen hundreds of times at UCLA the most common abnormality that creates this distinct hyoid click is the tip of the end of the greater cornua coming into contact hitting the transverse process.

3. Excising the greater cornua is effective in eliminating clicking entirely and reducing pressure, patients note immediate improvement recovery time is approximately 1-2 weeks similar to the bilateral superior cornua excision procedure.

4. Alteration in hyoid morphology could cause the sensation of being out of breathe even though the actual respiratory system is not directly being effected (i.e. lung function).

5. The best way to diagnosis a hyoid click is through a contrast or normal ct with spiral computed tomography with the patient's neck in the position of greatest discomfort and with 3-dimensional reconstruction of the hyoid bone using computer software.

6. Certain types of anatomy/genetic predisposition may be more prone to a hyoid click (i.e. people with narrower space between the hyoid bone and transverse process)

7. Risk to surrounding arteries is unlikely with an experienced surgeon; internal scarring is minimal and should not lead to future problems.

8. The greater cornua is usually transected up to the region approximately perpendicular to the inferior cornu.

9. Patients who have one side of the hyoid excised often note problems with clicking on the other side (this could possibly be due to uneven weights which alter the normal elevation of the hyoid bone. This is why a bilateral greater cornua resection may be the best approach.

10. 2 lateral skin incisions of about 3 cm are made on each side to remove the cornua majus of the hyoid bone.

11. Patients may note improvement in head rotation, discomfort, clunking, and blocking starting the day after the surgery.

12. Sometimes the surgeons can actually push the tips of the greater cornua with their fingers and manipulate it in a manner such that it clicks during the procedure.

13. Discomfort in the region of the hyoid bone at rest or when turning the head is considered a relatively common condition.

14. Pain may be due to tenosynovitis of the attached digastric muscle, other authors blame anatomical malformations of the hyoid bone as the most important factor. If there is a distinct click coming from the tip of the greater cornua this suggests an actual underlying structural problem of the hyoid bone (most commonly an elongated greater cornua of the hyoid bone hitting the transverse process).

15. If the hyoid click is coming from the center it is usually the center part of the hyoid bone clicking against the thyroid lamina.
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The best way to diagnosis a hyoid click is through a contrast or normal ct with spiral computed tomography with the patient's neck in the position of greatest discomfort and with 3-dimensional reconstruction of the hyoid bone using computer software. I think you should do a 3-dimensional reconstruction of the hyoid bone since you did not get a look at it with the CT (have any of your images really visualized the bony architecture in this area well?).

This is how one study recommends it be done:
“A spiral CT scan with fast acquisition time of the hyoid region was performed. On acquisition the patient was asked to turn her head to the right to provoke the blockage. The continuous scanning time was 28 seconds. The table speed was 3mm per rotation and collimation was 2mm. Axial slices were reconstructed with an increment of 2mm; subsequently, 3 dimensional reconstructions from various angles were produced with standard software"

Source: ARCH OTOLARYNGOL HEAD NECK SURG/VOL 124, July 1998
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That is some great information about the problem and the procedure!

Thanks!
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I came across this great article in the archives of an American Head and Neck Surgery Journal published out of Japan it is titled " Reconsideration of the Hyoid syndrome" anyways the detailed cases in this study of a series of 4 patients undergoing very similar problems with the area at the tip of there greater cornua ( I can email you this if you want). I do think we both share a greater cornua hyoid syndrome in common in which the tips of our greater cornua of the hyoid bone have somehow been malformed altered shape in such a manner that they click on the nearby tranverse process. I encourage you to check out all the pictures and diagrams I have posted by double-clicking on the icon to the left of my name wildblue98, I am interested in your opinion of how you feel the theories and diagrams relate to your condition.
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I was interested to see that this greater cornua excision procedure has been being done since before 1975 with very good results. Ernest Kopstein describes the procedure back in 1975 in one of his publications "Hyoid Syndrome"  Arch Otolaryngol-Vol 101, Aug 1975, "The actual procedure is simple and rapid. Both sides of the neck are prepared for operation so that the hyoid can be pushed on the side opposite the resection. A tranverse incision of about 5 cm is made over the palpable greater cornua (today it is 3 cm). This is carried down to the deep fascia. Further dissection is done with repeated palpation of the greater cornua as a landmark. Over it the platysma muscle is incised parallel to its fibers, remaining anterior to the sternocleidomastoid muscle and well anterior to the palpable external carotid artery. At this point the greater horn can be pushed into the field from the opposite side and grasped with Allis forceps. Further dissection is done simply by cleaning off the lateral tip, staying close to the bone to avoid entering the hypopharynx or injuring the hypoglossal nerve. About 1 or 1.5 cm of the tip of the greater cornua is then smoothly excised, after which the Allis forceps is removed and the hyoid bone is allowed to drop back in place. The wound is closed in layers, and the patiend is discharged on the first or second postoperative day."
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The article goes onto explain that "a greater index of suspicion" for the hyoid syndrome is urged. I really think there are a lot more sufferers out there who suffer from similar hyoid syndromes but cannot figure it out because in a sense it has been lost in the mainstream medical literature probably because its symptoms are vague and obscure and doctor's pass out off as something else. It is one of those diagnosis that doctors must make based on exclusion which makes it even harder.. "Before the diagnosis of hyoid syndrome can be made, other disorders that may cause similar symptoms must be ruled out. This includes TMJ-joint disease; dental abnormalities, especially unerupted molars; cervical arthritis;esophageal diverticula; tumor; foriegn body; chronic tonsillitis; and nueralgias." Not to mention Eagles syndrome with which a hyoid syndrome could easily be confused with based on the symptoms. Luckily in our cases, we have that loud distinct recreatable click with inward palpation and if 3d reconstruction cannot identify an abnormality of the greater cornua of the hyoid than that itself might be the best clue for people and ourselves to know what is going on in there.
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Scott, I also had a question for you. I was wondering based on that mri you got back if those regions are areas that you are directly feeling pain. I find it hard to believe that someone stomping on your neck would affect all those regions of the neck mentioned on the mri, I could see those all being your normal anatomy at the given time for a thirty-two year old male, and the hyoid bone still causing the majority if not all your symptoms. Do you have previous MRI's to compare to as a control?
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The info I wrote out was my MRI and I dont have a copy of my CT scan. The doctor wasnt worried about most of the info and really only wanted the last info on the Hyoid bone. All the pain I have right now is in the front center part of my neck going from the Hyoid area to the laryx. Ive had 2 scopes done on the laryx and both time they said it wasnt damaged. I have other pain and stiffness from the injury like we both have described having but most of mine is in the middle front part of my neck. I resently called the MAYO clinic to see what a rough cost would be to go down there. Ofcourse without knowing they could only give me rough figures. In the last 2 years without having surgery the ave patient there has spent between 13-15,000$. From what I have read from these post most ppl here have gone from doctor to doctor and from ENT to ENT before finally getting lucky and getting some answers.Even though the system here is slow and I am effected so badly I still cant walk more than 2 blocks work etc etc. I dont think its worth the risk to spend 15,000 and probably a lot more than that to come back with we dont know whats causing this.2 years ago and Im sure in the future Id be willing to take that risk but right now I cant afford that risk.
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Yes I would agree with the doctor that the mri findings are unrelated I would focus on that area of the hyoid bone that is causing you agonizing pain. You describe it as though it is the area where the greater cornua of the hyoid bone joins with the body of the hyoid bone. This is actually the most common place for the hyoid bone to fracture according to the medical literature. I know you discussed one doctor saying it was broken I forgot but did you ever follow up with him, because of the middle location of the injury and severity of the symptoms it sounds like a fracture from everything I have read but I am no doctor.
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The original doctor that treated me told me he thought it was broken but needed his radiologist to review it. In that report is said it was broken. The ENT I saw didnt think you could tell in the xrays but wouldnt do more tests to determin if it indeed was broken. She said it wasnt effecting my airflow or my laryx so even if it was it would heal naturally. I told the original doctor that and he said it was broken and didnt agree with her assesment but she was the specialist and he didnt think he knew enough of that area to be much of help with the injury.Roughly 8 weeks later after fighting to see the specialist who didnt think it was serious and didnt want to see me for 3 months I finally saw her. She lost it on everyone in front of my 2 witnesses and said it was not broken. Shes also failed to do a few things she said she would do for me. I then went to the original doctor and told him of the insults she had for him and asked if it was broken or not. He showed me the report and said they both thought it was indeed broken and couldnt believe the way the specialist conducted herself.( the clinic I went to is one of the biggest if not the biggest clinic in winnpeg, even has its own MRI which is the only one not in a hospital in winnipeg.not 100%sure about that but just giving you detail to show you that the radiologist at the clinic is trusted and very experienced) The original doctor was informed of me switching doctors and knew the doctor I was going to see and am now seeing by his first name. He requested the CT scan that was done 9-10 weeks after the injury but hadnt seen it when I saw him. He also gave me his business card to give to my new doctor and was going to talk to him. Thats where I left it. The new doctor didnt have the CT scan when I saw him on my 2 visits and I didnt ask him about the disputed hyoid bone fracture. I just wanted help.

Sorry that doesnt really answer your question and gives you way too much detail.Thats all I know as of right now. I know the CT scan said the hyoid bone was intact but I dont know what was written. I was just told by the ER doctor that it was intact and the area looked fine but did say he was only an ER doctor and needed to go over it with the radiologist on hand to give me answers.He said it was such a specialised area that really an ENT needed to look at it and he was passing it on to the department. Unfortunately my very nice and extremly pleasant and helpful ENT specialist didnt even bring it up or talk about what was on it. I know when a broken bone heals it ends up having calcium build up. I wonder if the CT scan showed that and if such a fine little bone would still have calcium built up on it. Would it be easy to see/notice? I have no idea but If I remember I will aske my new doctor when ever I see him next.

Next step for me is seeing a Neurologist but I dont know when thatll take place. The one good thing I have going for me is the new doctor I have isnt givin up and is trying to figure this out. Even a civilsuit lawyer I sat down with today knew him and told me I was in really good hands.

I just noticed this yesterday I can now turn my head to my right better than I can turning it to my left. I havent spoken to the doctor  about it or my physical therapist yet.. do you find that odd? everything about this injury is odd and frustrating.
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Keep me posted on what the new doctor thinks about the hyoid bone fracture. If I were you I would print up a diagram of the hyoid bone (or one of my diagrams) circle the exact area it is hurting badly and then have your new doctor take a really detailed look at that area. I know this sounds obvious but it will help a lot trust me. Remember 3d ct reconstruction and contrast can be even more helpful tools in visualizing this area. I would also be curious as to where your old doctors felt the fracture was. Was it at a region where the hyoid bone joined with the greater cornua or did they not tell you this. I am going to email you this detailed article on hyoid bone fracture which I found in an old surgery journal. It dates back to 1909 but is extremely helpful in understanding the condition of a hyoid bone fracture. Take a good look at this, it could help you a lot.
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Thanks again for all your info and insight. Unfortunately the doctor didnt tell me where it was broken and I didnt ask which area of the bone was broken. Its to bad shows like HOUSE couldnt do an episode on an injury like we have....it seems rare enough and right up their ally.
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All of the information you found is fantastic...I will definitely check out the stuff you have posted...I have been a bit slow lately as I injured my back pretty badly 2 weeks ago and have not gotten online very often due to the pain.  My doctor thinks I may have a herniated disc pinching a nerve in my lower back (lots of back, hip and leg pain, and leg and foot gets vibrating sensations 24/7 with some leg weakness).  I will be getting an MRI next Tuesday..like I need something else to be wrong with me...guess the hyoid is not enough...lol.  Anyway, I am hoping that this will go away soon...just like I thought the hyoid pain would go away....right???  No, really, I need to think positively right now about this back issue and hope for the best.  I will get back to you soon.
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Didnt tell you where it was broken? thats probably the single most important thing that could get you fixed. I have been reading a lot of literature lately and the actual procedure to remove the greater cornua of the hyoid bone is considered relatively simple its been being done back before 1975. I also know their is a procedure which name I cant remember that is geared around removing the center portion. Eitherway if there is a break I dont see any way to really fix this problem without removing the bone. I have heard of certain drugs they can inject into fractures to rebuild the bone like they just did here in Los Angeles for a famous tennis player who fractured his back. Maybe someday this will be used for hyoid bone fractures, but from what I read it seems like the most likely scenario is you find the fracture and then come up with a treatment plan to cut out the damaged area. You gotta be your own house and make sure you find that break or your going to be in bed a long time.
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sorry by "drugs" I meant chemical compounds in that last post
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Im not in bed all day and still move around, go out etc etc I just cant walk far or get my heart rate up. Even the excitement of watching football on sundays is dramatically more painful than the normal pain. But I know what you mean about needing to take action for myself rather than living a life thats so restricted.

A friend of mine who happens to be a chiropractor has been telling me for awhile that he thinks I have a soft tissue injury and I need a qualifies message therapist to work on the area. he thinks with the lack of movement the scare tissue has built up so much and it needs to be broken up for me to be able to get movement back. Today I ran into a message therapist and she said roughly the same thing.

I havent spoken to my doctor or my physical therapist about this but Im wondering if you have any thoughts on it. If their argument has any merit and if it could help. Right now I dont think I could handle the added pain or someone poking and messaging hard in that area. I already feel like Im being strangled to death and the rough moments. I dont know if I can handle more pain. I put myself through more pain for Physio but the idea of a message therapist scares the hell out of me. If youve tried that approach or have any thoughts on it please get back to me.
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I wish I could tell you that massage therapy was the answer and a cure all and I remember the days when I wished such a thing, but unfortunately massage is a very conservative treatment. It may help some minor cases but for a real injury which is more than certainly your case from everything we discussed I think it is wishful thinking to assume massage is going to cure you and that its just scar tissue. Of course you should try conservative treatments before you risk a surgery but I can tell you like myself are not of the sensitive type personality and are most likely dealing with a serious undiagnosed, now arguably "semi-diagnosed"  injury. I have read some techniques of massage that can help hyoid bone problems but in your condition I would not let any of those professionals near that area the chances they fix anything far outweighs the damage they could do by trying some "new or unusual manipulation". I remember I was so desperate not to admit to myself that I needed surgery and in the process of waiting to find answers I did some really stupid things by letting professionals work on me who were not qualified. Pain and desperation will certainly cloud your objectivity I advise you to always error on the side of caution with this injury. I almost ended up letting one chiropractor do a neck crack adjustment on me after my own dad (who’s the smartest person I ever met) suggested it as a last resort to my agonizing pain, well given my injury a bad neck adjustment could have been the end of me. I also let some doctors near my spinal cord several times with long needles in a new age therapy of sorts called "prolotherapy" which claims to heal its patients with sugar water by thickening ligaments and falls under the same class off psuedo-science and mindless antics as chiropractics. I tell you this to spare you further pain and agony and so you don’t waist thousands of dollars on mindless ****. There are some massage techniques out there that could help a hyoid bone a little bit, but honestly at this point without even a definitive diagnosis I would not let anyone near your neck.

If you are interested in some conservative pain management techniques of the hyoid check out this link: http://books.google.com/books?id=E77N-9iIaMAC&pg=PA358&lpg=PA358&dq=hyoid+bone+headache&source=bl&ots=SZB5D7MNJz&sig=IT-ggBwEPXvQ3uRL5hOx1eFdC6g&hl=en&ei=B3XySsu_K6b4tgOf6pwI&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAsQ6AEwAA#v=onepage&q=hyoid%20bone%20headache&f=false but I really doubt its worth your time or money. At least in my case I am far better off taking Klonopin and Diclofenac than any sort of conservative myofacial release or new age **** that mostly operates on the placebo effect of having another person acknowledge, touch the area that is hurting, and talk to you about your pain.  
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The hyoid been has been identified with a specific, although not well recognized, pain syndrome for over 30 years. The painful symptoms are generally caused by trauma at the greater cornua of the hyoid bone, and the pain radiates to other sites. Treatments for the condition ranges from injections of local anesthetic or cortisone to resection of the greater cornu. The pain usually radiates from the greater cornu of the hyoid bone to the throat, mandible, mandibular molar teeth, zygomatic arch, condyle, face, ear, and temple, superiorly; anteriorly to the neck, clavicle, upper half of the breast, shoulder, arm, and over the shoulder to the scapula of the back inferiorly to the same side. The condition is not well known in medicine and dentistry for at least two reasons: (1) the diffuse and seemingly unrelated radiation of symptoms and (2) the absence of histopathologic evidence of injury. Hyoid bone syndrome was first described by Brown in 1954, and later by Steinmann, Kopstein, Lim, and Ernest. The syndrome represents a group of confusing head and neck symptoms that may suggest carotodynia to the unsuspecting clinician. The primary site of pain is associated with the region of the greater cornua tip of the hyoid bone. Steinmann, Kopstein, Lim, and Ernest have reported surgical removal of the greater cornu with remarkable resolution of pain for the affected patient. However, some clinicians deny the existence or validity of hyoid bone syndrome because reports offer no evidence other than the signs, symptoms, and results of surgery. This article presents photomicroscopic evidence to validate the hyoid bone syndrome, and reports a focal, degenerative injury of the middle pharyngeal constrictor muscle (MPCM) as the site of a painful injury associated with the hyoid bone syndrome. The site of injury involving the MPCM is consistent on a clinical, anatomic, and histophathologic basis with a description of the somatic tissue responsible for the painful constellation of symptoms of hyoid bone syndrome.
The hyoid bone is the only bone that has no direct contact with any other bone in the human body. It is a U- Shaped structure lying between the root of the tongue and mandible and the thyroid cartilage. The hyoid bone forms a movable base for the tongue and it varied movement and is held in position by a large number of muscles. The hyoid bone has connections with the muscles to the mandible (mylohyoid), tongue (hyoglossues), skull (stylohoid), thyroid cartilage (thyrohoid), sternum (sternohyoid) to the medial border of the scapular notch (omohyoid) and to the pharyngeal median raphe (MPCM).
Most patients with symptoms of the hyoid bone syndrome report pain radiating to the ear, throat, temple, zygomatic arch, tempormandibular joint (TMJ), mandibular molar teeth on the same side, and a vertical axis of pain that runs from the temple superiorly down through the TMJ, continuing inferiorly to the clavicle, and terminating in the middle of the breast without extending below the nipple. The connections to the hyoid explain the radiating symptoms experience by the patients suffering from hyoid bone syndrome.
I thought the information in this article was very informative it reminded me that we must not forget all the muscles that attach into the hyoid bone as a possible source of pain. Of course there is the fact we feel clicking and we know there is most likely a structural abnormality at the tip of the greater cornua causing it to click but what this article shows is there is actual evidence that this area at the tip where the muscles insert can form a sort of tendinitis which can also become very painful. Fortunately when they excise the greater cornua they also take out the muscles that attach to the tip, so like the lady outlined in this study who had pain for 13 years from insertion tendinitis she was completely cured when she had the left side of her greater cornua removed. The following refers to this lady: “A patient with signs and symptoms of hyoid bone syndrome was evaluated and subsequently underwent surgical operation. The hyoid greater cornu was identified as the site of injury and was excised. The tissue was identified as origin fibers of the MPCM at the greater cornu. Pathologic microscopic findings of focal, degenerative changes with foci of necrosis, hyaline, chaining of centrally placed multiple nuclei and elongation of muscle fibers consistent with myopathy were confirmed. The patient’s postoperative course included initial difficult in swallowing and eating, followed by progressive improvement and elimination of the painful symptoms. The patient also noted immediate cessation of temple headache and ear pain the same day in the afternoon after the morning surgical procedure. “

Source: Hyoid bone Syndrome: A degenerative injury of the middle pharyngeal constrictor muscle with photomicroscopic evidence of insertion tendinosis.

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RE: HYOID BONE
My Hyoid Bone problem was finally diagnosed w/a Barium "Cookie" Test by a Radiologist.
Summer 2009, it was believed my symptoms (horse voice, sore throat, difficulty swallowing & cough) were caused by allergies. Then it was thought to be the lymph nodes found on my Thyroid. My Endocrinologist believed it was pressure from the nodes on my thyroid. He promised to later give me a barium test.
But over the next seven months, I developed a bad case of Dysphonia, which strained my voice easily and I sounded like Minnie Mouse. I was than referred to a Speech Pathologist for PT for my vocal cords. It helped somewhat, but I had a sore throat, ear aches, problems swallowing and coughing. This is where I put pressure on my Endocrinologist to give me a barium test he promised months before, but kept putting me off. So, I politely went over his head to the head of “Head and Neck". It didn't hurt to have my husband present when I met with him, so always bring a caring individual with you to be a witness and to ask questions.  And always document, document, document!  I made sure I was friendly but remained firm when requesting further tests.
It was the "Cookie" barium test that revealed my symptoms were not caused by lymph nodes on my thyroid, but a Hyoid Bone not closing fully shut when I swallowed, thus emitting food into my wind pipe, forcing me to cough-up food or drink. My Radiologist remarked she was surprised that I hadn't developed a severe case of Pneumonia from food going down the wrong pipe.
A DVD was made of the test and shown to me after-wards.  It was neat to watch my skeletal image swallow different thicknesses of substances, similar to baby pabulum, and my Hyoid Bone not closing completely. I was fascinated to watch food go down the wrong pipe and when I coughed the food go back up. The Radiologist advised me to take itsy bitsy bites of food and chew my food completely before swallowing, and also, not to drink from a straw, and keep my chin to my chest each time I swallow.  
After the test, I was referred to a Neurologist. She gave me a physical and blood tests. These were to check if I had a muscle disease. The physical went well, but the blood tests will take two weeks. I continue to work with a Speech Pathologist to strengthen my tongue and throat muscles. I keep asking if there were an operation to fix the Hyoid Bone, but I’m not getting any answers. Guess it’s back to the medical books again.  
I hope sharing my experience helped.  
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I also had the barium swallow test to see if they could detect any hyoid abnormalities in swallowing but it came through normal. I find your case interesting that your hyoid does not shut fully when you swallow. I do know their is a procedure for sleep apnea where they reposition the hyoid bone, I have no clue if this would help your situation just a thought to consider.
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hi, i just recently felt this clicking in my throat today....i have been coughing alot. is my coughing the cause of this? is surgery the only option to treat this? will it go away? please help. im worried!
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sorry to hear about your troubles. I havent had the barium test and honestly have no idea what it is. I dont know if you have severe pain from your hyoid the area around it. Im in winnipeg canada and out of the 8-10 doctors Ive seen in 4 months more than half hear hyoid bone and they either get a confused buzzled stare or are intrigued but admit they have no idea how to help you. Most likely your doctor wouldnt know of a procedure and I cant help you out with that either. From what Ive found on the net there isnt a lot out there on the hyoid bone and injuried to it....unless they are documenting a autopsy. Its very rare to have problems with the hyoid. So far wildblue has helped me with information hes found. sorry I cant help, I just hope you dont have the symptoms we have.
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If you are getting the severe symptoms some of us are having then it just might be. I dont have a clicking in my throat so I have no idea what thats like. From reading all the posts here the ppl that have had it deal with the same severe symptoms as i have and its a life changing horrible problem.Hopefully for you its nothing to worry about but I wouldnt have a clue. other than your cough and that clicking what are your symptoms?
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How has your blood pressure been since the injury? I have read several medical articles showing that hyoid bone problems can cause high blood pressure. I was interested if you have this symptom.
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thats wierd you brought that up. Everytime Ive had my blood pressure checked its been high. Not once to my recollection has my blood pressure ever been high. Maybe as a child who knows. Ive also had a ton of minor injuries through sports and had never heard someone say my blood pressure is high. When I first went to the doctor for my injury they said it was high. The 3 times I went to an ER after that it was also high and I think I had it tested again at the clinic that originally treating me and it was high. My family doctor and the new doctor didnt check it neither did the ENT. But Ive asked if having high blood pressure for so long could have negative health effect. My family doctor showed me results from a physical a year earlier and said it was really good and not to worry. he thought it was just due to the pain of the injury. And as you know the pain is bad to really bad. I dont say that litely. I was told of someone that was in a very minor car accident basically no damage and they whine and whine about a sore neck....that frustrates me but its hard for ppl to know this pain until they experience it. Thankfully most ppl wont ever have to experience it.
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Dude you are awesome. Love all the info you have researched and the help through all this.
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I have the high blood pressure thing too, never had it before in my life started after my injury. I know intense chronic pain can cause this, and also the actual hyoid bone injury itself has been documented to cause this as the inflammation in the area can directly affect blood pressure and the internal carotid artery. Since my injury I am like you and cannot exert myself or get excited about anything because this sends blood rushing to the region of the carotid artery making me feel like I want to faint and seizure I have at times also noted chest palpations from my increased blood pressure (you experience this?). I know this occurs because the influx of blood to the area causes the tip of the greater cornua to squeeze tighter against the internal carotid artery because when blood rushes to an area it creates a narrower space (this may also explain why you have trouble watching football). Not suprisingly anything that causes a stronger and rapid pulse brings on the urge to faint because of the increased blood flow which is being pinched by the hyoid bone because of the narrowed space.  I have collected quite a bit of articles in the past year I would be glad to forward you some of the more notable ones. After all my research, I honestly feel the case I came across that resembled you the most was a hyoid bone fracture displacement injury. This is total speculation but if I had to guess you do have a fracture somewhere around where the greater cornua of the hyoid bone joins with the body of the hyoid bone (try to confirm this radiographically) in addition to this I think you also have a posteriorly displaced hyoid bone which is causing your other strong symptoms associated with inflammation of the nearby and surrounding structures most likely the: internal carotid artery, carotid sinus, and the glossopharyngeal nerve. Current research shows there are actually two current methods these fractures are dealt with, one is to excise it and the other involves wire and reinforcement. I think GGCB and I have a hyoid bone syndrome of sorts in which the hyoid bone has become chronically inflamed at the end of the greater cornua of the hyoid bone and that the structural integrity of this region has been compromised in such a manner posteriorly that it creates our distinct clicks against the cervical transverse process. In your case however in total absence of a click and more severe respiratory symptoms as well as severe and palpable localized pain in the central body region of the hyoid you do sound more like a fracture case. Your hyoid bone may also be displaced or inflamed in such a manner that it is interfering with the internal carotid artery and nearby structures which are known for their debilitating and complex pain referral systems. This would explain the overlap between the three of us and the slight variation (your fracture) in the increased severity of your symptoms which logically correspond to your more traumatic onset.
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After looking through almost all the medical articles written on the hyoid bone I came across one that directly explains the exact biology behind our symptoms. It explains that disease or inflammation in the greater cornu of the hyoid bone and its attached muscles can "irritate the sympathetic complexus around the carotid artery or the sinus branch of the glossopharyngeal nerve, which lie close to it, and cause the referred pain reported." It is obvious to me that this is something many of us hyoid bone sufferers with complex and diffuse pain referral symptoms share in common is irritation of this sympathetic complexus around the carotid artery or the sinus branch of the glossopharyngeal nerve. When the tip of the hyoid bone alters normal position and moves closer to the carotid artery or its attached muscles are damaged in such a manner there is a chronic and localized inflammation of the region this can put vascular pressure on nearby structures. The carotid artery and the sinus branch of the glossopharyngeal nerve are the two structures of which I have encountered the most medical literature validating the complex and diffuse pain referral patterns mentioned on this site by those with hyoid bone clicks and hyoid bone inflammation. Excision of the greater cornua of the hyoid bone is very effective in relieving even the most chronic and longstanding hyoid bone syndromes.
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thanks for responding! I sent a message to you! Hope to hear from you. Thanks!
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I was just reading the most recent posts and I realized that the past few years (since I have had this hyoid problem) my blood pressure is slightly elevated.  I used to have blood pressures before this of 117 - 120 over 70...now my blood pressure runs around 130 - 140 over 80...I know that is probably not considered a huge increase to a doctor, but to me it is.  Also, when I walk, I get to a point where pressure builds up in my head and does not release...I think that is related too now, since I read the above posts.  Just after 10 minutes I feel the pressure building to the point I need to stop and then I get this dizzy, woozy, unreal feeling and feel like my head is going to pop.  I ended up having an MRA to see if I had a stroke or an aneurism (aneurysm) issue but I did not...it must have been this hyoid problem.  This stupid problem is causing me and the doctors to think I have other problems and I end up going in for tests that I don't need...it all makes sense now, but how can we tell what is hyoid related and what is a real medical issue/emergency?  If I went to an emergency room with some of the symptoms I have had in the past, they probably would have pumped me up with "life saving" drugs for something that was not happening because they do not know about or understand this hyoid thing.  They would probably do me more harm...Anyway, I don't want to think about that...
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Just after 10 minutes I feel the pressure building to the point I need to stop and then I get this dizzy, woozy, unreal feeling and feel like my head is going to pop.  I ended up having an MRA to see if I had a stroke or an aneurism (aneurysm) issue but I did not...it must have been this hyoid problem.

I have had the exact same problem and similar concerns for the past two years since my injury it is very likely that feeling we get like our head is going to explode is just vascular pressure on the carotid artery or carotid sinus even a little bit of pressure or inflammation in that area can cause nueralgias and really uncomfortable symptoms it is an unreal feeling I agree literally does feel like the head is going to explode. Since I have the exact same symptoms you describe and am young and they occurred right at the onset of my hyoid click I would not worry too much, I think it is pretty obvious that the hyoid click can cause this sensation from several other sufferers I have talked with. In one study I read over 25 percent of the hyoid syndrome sufferers had excruciating temporal headaches that were all cured by removing the greater cornua of the hyoid bone. I really think once we correct the structural problem in the area like other patients we will get rid of these horrible symptoms.
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good morning I finally got a call from the doctor that originally treated me. He said I have muscle and soft tissue injury but not fratures. he did say that there are so many bones muscles and structure in that area that all could be effected  but nothing was broken. He finally say the results of the CT scan and it stated there was no effidence of a fracture and the bone was normal and surounding area was normal. The CT scan he saw was only the report but he thought it was the best way to see that area and way better than a tradidtional xray. The call was meant to give me and you information on which part of the hyoid was broken. But this new information he felt it was never broken and didnt give me the area he originially thought was broken. This doesnt help me I just thought youd want to know.Still no word when I see a neurologist. Hopefully sooner than later. We are just trying to rule things out here before they take the surgery option more seriously.
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I find that interesting did he say what kind of soft tissue injury he found in the muscle and ligaments or he is just guessing on this. Now that he is sure there is no fracture, after contradicting himself (I would want this contradiction explained, because broken or not broken seems pretty black and white to me), It could be a similar muscle injury and bone elongation/displacement to what ggcb and I have. I mean if there really is no fracture and they are absolutely sure of this, and you feel you arent going to get any better, than you might discuss options to remove portions of the bone that are bothering you the most. As of now, where do you feel the majority of pain to the touch and the foriegn body sensation is it from the direct center of the hyoid, or off to the sides of the greater cornua?
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to me its in the center part. Eventhough I dont get a click I do get a odd foreign sound that seems to be coming from my throats area. I wouldnt say its in the sides and I dont feel worse from it the very lite  sound or feeling just comes and goes but I notice it daily. Right now Im dealing with a left calf strain but I dont do any activity so there is no way I could have strained it. Its almost like the bottom half of the calf is asleep and has been for hours now. Still compared to our neck problem its almost not worth mentioning. The doctor that told me the no break info was just reading the report of the CT and doesnt really know what it could be. He asked me how I was and seemed genuinely concerned about my situation. I really dont have any answers though and so far its a guessing game with me. My physical therapist has read some of these posts and I believe is talking my new doctor about some of your suggestions but I have no idea how thats going. I still dont know when I will be seeing a neurologist. im assuming I wont see my doctor til after that apt or unless I run out of meds in a month.
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to me its in the center part. Eventhough I dont get a click I do get a odd foreign sound that seems to be coming from my throats area.

My problem at the tip of the greater cornua can feel like cramping in the center of the throat hyoid area. When you are talking about localized pain are you actually pressing in on the body of the hyoid bone the center of this bone should rest directly below the center of your chin like you were imagining to disect yourself in half following  the direct center of your chin down to the center of the hyoid bone, is it here you have localized pain to the touch? Where do you hear that noise coming from in relation to this center of the hyoid bone. Also very carefully if you are up to it,  I would do a self examination like the picture of the lady posted in the photograph under my photos (use this for reference). Use the thumb on your right hand to press in on the right side and the index finger on the left to press in on the contralateral left side, as you put pressure in medially from the right push in from the left if there are any really noticeable clicks at the end of the greater cornua you should be able to feel something from doing this. Also if you have a hyoid bone syndrome this can recreate or exacberbate existing symptoms.
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I just went to the doctor who said I have a strained Hyoid and sent me to therapy for it.  The doctors are at UCSF and seem to know what they are talking about.  I sure hope it helps.  I agree this condition is super annoying.  I am hoping that my ear pain and swollen glands are not related.  On the bright side, at least it isn't cancer and there is something that can be done about it.  I refuse to let my bodily aches and pains rule my life.  Get to the best doctors you can find get help in any way you can.  If you are depressed about your condition get psychological help asap.  Depression can hinder your path to healing and recovery.  Good luck.  
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P.S. You rock wildblue98, thanks for the info.  It really helps to know what is potentially going on.  I will see whether the voice/swallowing therapy helps and go from there.  I don't have any clicking and didn't have any trauma, it just started out of the blue.  Then I got sick and vomited a bunch of times and it got way worse and then subsided to where the symptoms are now.  I felt like I had been strangled and a bone was sticking into my throat after the vomiting incident, but not so anymore, just feels like a lump is in my throat on the right side and right sided ear pain, headaches and swollen glands.  Lump when swallowing, sore throat when I talk.  Not sure whether the sore throat, ear ache and swollen glands are related or I got the a cold or flu or something.  Anyways, thanks again for all the research.  I will keep you posted as I am supposed to get a call re starting therapy in 1-2 weeks.  The doc said they will put a camera down my throat and I will be able to see it on a screen.  I wonder if this is something you can see.  Anyway it sounds cool.  The sooner the better.  
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Yes be sure to keep me posted UCSF is a great medical center I would be interested to hear their input on "Hyoid Strain" I have never heard it referred to as this but I am guessing it falls under the same category as "Hyoid Syndrome". I think your headaches, ear pain, and swollen glands may all be related these are the same symptoms I had after I strained my hyoid. That poking feeling in the throat usually occurs from inflammation or structural alteration of the tip of the greater cornua of the hyoid bone. There are nine muscles attached to each side of the hyoid that attach into this back part of the greater cornua, when one of them becomes strained it can lead to "Hyoid bone Syndrome" which is basically tendinitis of the muscles inserting into the Hyoid Bone.
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Just posting because I found this thread. I've had irritation around the left side of my hyoid since February 2008. Some days it really drives me mad and I can't swallow without pain; other days it's just a dull sensation of pressure, which is still maddening if I get caught up in it, but easier to ignore.

After going through a bunch of pointless stomach exams, XRays, CT, etc, and seeing a good half-dozen ENTs, I saw one who is familiar with the syndrome and has performed a greater cornu excision about a dozen times in her career. However she has cautioned me strongly to explore all non-surgical options first, so that's what I'm trying to do now.
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Hey, what hospital is this surgeon at and what is her position, It may benefit other people on this site to hear more. How have her results with the surgery been? Thanks for the post.
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The local ENT who has treated this "about a dozen" times with the cornu excision is Dr. Catharine Picken in Washington, DC. I'm not sure which hospital she does her surgeries out of, as I have been seen by her in her private office, but the webpage of her practice is http://www.washingtonent.com.

She reported a fairly high success rate; of the 12 people she's seen she said after excision of the greater cornu on the affected side, there was partial to complete improvement in 11 patients, and no improvement in 1. So, that's more or less in line with the "90% success rate" that a couple papers have mentioned. She has discouraged me from surgery because I'm not in much pain most of the time (just discomfort), and she feels that it's an invasive surgery that comes with a scar and potential complications, as well as a pretty much guaranteed painful 3-to-4-week recovery.

Does anyone know how much this procedure would cost "out of pocket" at UCLA? The idea of being seen by someone who's performed the surgery dozens or hundreds of times, is a lot more appealing than being seen by someone who has done it 12 times in 20 years, but at present my insurance would only cover (at most) 50% of UCLA expenses, and I think that would probably end up in the 10,000's of dollars, right?
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I am not sure what the exact amount is but other people on the site have ranged 8,000 to 12,000 per surgery. So, my best guess is if 50 percent is covered it would be somewhere around 5,000 for this procedure. I would email the department of head and neck surgery at UCLA and try to get an exact quote.
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typical cost for this procedure without insurance seems to be around 5-10k with the two patients on this site I spoke with.
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I looked back in a past post on this board where we had discussed it was about 5k-10k per procedure without insurance.
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"Just after 10 minutes I feel the pressure building to the point I need to stop and then I get this dizzy, woozy, unreal feeling and feel like my head is going to pop.  I ended up having an MRA to see if I had a stroke or an aneurism (aneurysm) issue but I did not...it must have been this hyoid problem."

The symptom that you describe here has been so bothersome and constant for me recently that I have decided to get an MRA I will be the third hyoid sufferer mentioned here I think to get this test and simulteanously have hyoid pain. After reading through the literature I realized that relatively minor neck injuries in the area of the hyoid bone can actually damage the Internal Carotid Artery (ICA) and this can be visualized as ICA Dissection on an MRI/MRA I think it is worth the test going into surgery to rule out the possibility of any ICA dissection seeing how close the hyoid bone is to this artery and the constant headaches I have. I cannot believe another test and another thing to worry about.
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Also Diclofenac is way better than Ibuprofen (Advil) you should try it, it will help with the headaches a lot because it is more potent, longer lasting, and directly cited in studies as a leading medication of choice for the hyoid bone syndrome,and you only have to take 1 pill a day, I bet you are like me and probably are used to popping Advil all the time during the day so you can function. This medicine is definitely worth a try to anyone seeking more conservative options.
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I was wondering if you this is how your head pressure symptoms feel: Whenever I walk for more than a couple minutes outside the pressure in my head begins to gradually build, the region I feel the foreign body sensation and cramping ache in my left greater cornua of the hyoid feels as though it begins to squeeze and inflame the nearby internal carotid artery in my neck, pressure in my head begins to build to the point that constantly I feel like I am standing on my head, my head feels like a helium balloon that is going to pop and explode, the pressure builds if I keep walking more my brain becomes incredibly fogged the pressure emanates from the greater cornua of the hyoid up the back of my head and behind my left eye and feels like I have been doing handstands for several minutes, I also have a constant low-medium feeling of pressure in my head from the area of clicking all the time, but when I try to walk anywhere the pressure builds to a point that I feel like I am going to collapse and die of a stroke, if I subside and lay down it returns to a milder state.

I researched more the exact cause of this:

I am certain that the greater cornua of the hyoid bone is having a very negative interaction with the internal carotid artery, specifically it is inflaming the sympathetic complexus that is near this artery, leading to the classic symptoms of carotydnia or pain along the distribution of the carotid artery. Not surprising when I have experimented with medicines like Klonopin which reduce vascular activity the squeezing pressure in the head has subsided. Any exercise in activity that increases vascular activity (i.e. walking, reading/ intense concentration, watching a football game) causes the same intense pressure to build from the region of the hyoid click and create that unreal, woozy, helium balloon head sensation that feels like I have done a 3 minute handstand. Upon doing more research I realize that there is no way to tell from this injury if these intense symptoms are something more life threatening like an ICA Dissection that could actually be interfering with the proper functioning of arteries that supply blood flow to the brain. Yes, a hyoid bone syndrome can mimic the exact symptoms of ICA Dissection because they are both known to inflame and possibly damage the sympathetic complexus around the carotid artery. The only way to know for sure would be to get an MRA, and really get a good look at the arteries next to the greater cornua. I personally feel that most likely there is no real damage to the sympathetic complexus of the carotid artery of people mentioned on this site, but rather the artery is in a state of chronic irritation and inflammation from the "hyoid bone syndrome" which is notorious for irritating this sympathetic complexus. That is why I would suggest any person with a hyoid bone injury and cerebrovascular symptoms such as the intense head pressure sensation from minimal activity to get a really good look at the surrounding arteries through an MRA.
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Do either of you every get dull aches and pressure behind your eyeball sockets. This symptom has been annoying me a lot lately and feels like eye strain with pressure, it is like the pressure is building up behind my left eye ball and makes it feel like it wants to pop. it emanates up from the hyoid click and follows the exact distribution of the internal carotid artery that branches into the ophthalmic artery right behind the eyeball socket. I think this is another symptoms of the inflammation of the sympathetic complexus of the carotid artery as it inflames and puts vascular pressure on the internal artery it can send this pressure aching feeling along the branches of the carotid artey up behind the eye. I know it is inflammation of this sympathetic complexus because strong anti-inflammatories along with medicines that reduce vascular activity in the area reduce the pressure and aching, where as recreating the hyoid click by inward palpation increasing symptoms by increasing inflammation and pressure.
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The hyoid bone syndrome, first described in 1954, is manifested by tenderness near the greater horn of the hyoid bone. In 1968, the syndrome was reported to be a form of insertion tendinosis, and injections of procaine HCL with corticosteroid at the tip of the greater horn was found to provide temporary relief o f pain. I report 50 patients with the hyoid bone syndrome who had excision of the involved greater horn after one month of conservative medical treatment failed to relieve the pain. Operation promptly relieved pain in 45 (90%) of the patients. An understanding of the close relationship between the greater horn of the hyoid and the posterior pharynx and the carotid sinus is important in detecting the hyoid bone syndrome.
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The abstract was from an article "Carotodynia Exposed: Hyoid Bone Syndrome"
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well, after a week of really bad symptoms, some of which was my own fault from poking and prodding at the hyoid, things have calmed down and mostly what I have is a dull swollen sensation, intermittent itching in my ear, and occasional left-side pain upon swallowing.

I saw a physiotherapist today; she said that it's not just my hyoid, but that my whole musculature on the left side of my neck/head is tighter and weaker than the right side. So, I'm going to start working on that, to see if it might provide enough relief that I don't think about this so chronically. Unfortunately, she also said that they just stopped accepting my insurance, so I'll have to find another PT! We have some of the best medical technology in the world in the US; if only we had the best medical insurance program to go along with it, instead of coming in a distant 45th or whatever.
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hmm, what is the preferred surgery for this, anyway -- the thyroid cartilage removal, or the removal of the greater cornu of the hyoid? The cartilage removal sounds like it involves less muscle damage.
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Hi, I am so happy to find this forum because I have also been suffered from the hyoid bone problem. My hyoid bone on the right side is displaced from the above muscle while the left side is attached to the normal position.
My symptoms are as follows; First, It is very hard for me to make a voice and it feels like my voice is coming from just "left side of my neck". Second, my face is severely unbalanced. According to a dental journal, hyoid bone syndrome has much to do with a facial unbalance. So, I have a very ugly-looking. Third, my face easily becomes reddish. I am sure that this symptom is caused by hyoid bone problem because it feels like only the left side of my hyoid bone is getting choked. Fourth, I have gotten a stage phobia since I recognized my speech problem. These days, I usually shiver when I speak in front of many people. I assure that this is because my hyoid bone can not support larynx proportionally.
I went to an ENT to check my neck status five years ago; the doctor told me that there is no abnormalties in larynx, but my hyoid bone on the right side is displaced from the above muscle. I asked if this right side could be repositioned properly. But he said that it is impossible to restore the damaged part. I was so abject to hear that, but I did not want to give up. I studied and searched the hyoid bone. However, I could not find any information that I want. Other doctors whom I sent many e-mails answered that they had never heard of that kind of symptoms.
Now, I spotted this forum coincidently, so I am so thrilled  and expect to hear what I want. Even though you already mentioned in the above posts, I would liketo ask again. Do you think that UCLA ENT is going to be able to help me? Do you think that my problems can be solved? And is there not any way to restore the right side of my hyoid bone, not excising the abnormal part?          
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I am sure that this symptom is caused by hyoid bone problem because it feels like only the left side of my hyoid bone is getting choked. (You said your problem was on the right side)

If your hyoid bone is displaced from the muscle on the right side I do not understand why it feels like only the left side of the hyoid bone is getting choked, you should get the choked feeling were the hyoid bone is displaced I think you may have mixed the sides up here.

Also, how did they confirm this diagnosis of a displaced hyoid bone from the muscle who and what medical center, and through what diagnositc visual imaging techniques? What caused your hyoid bone to be displaced from the muscles?

I think the problem can be greatly improved or even completely resolved according to all the medical literature written on the excision of the greater cornua of the hyoid bone I would not be getting this surgery if the medical literature did not document such a high (90 percent) success rate of success in eliminating "hyoid syndrome". Many doctors have not seen this, but it certainly exists, has been succesfully operated on, and is extensively documented in the medical journals as a leading cause of referred pain in that region of the neck.
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If you have "hyoid syndrome" the surgery would be to remove the greater cornua of the hyoid bone on the affected side, I think it would be nice if you could write a post on this board talking about the cost and insurance information you figured out about the procedure. I know other people would appreciate it.
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yes, certainly! I contacted Dr. Berke's listed number on the UCLA head&neck surgery page, and this is what they told me:
Dr. Berke has used insurance billing code 21495 for these procedures. They quoted me the costs associated with a recent self-pay patient:
$3500 - dr's fee for surgery
$5810 - facility fee for surgery
$1250 - anesthesia fee for surgery

Additionally, prior to surgery is a consult visit. If you're totally self pay, they told me that they had recently dropped this fee from $1200 to $800.

I found out, also, that Dr. Berke is in-network for me, so if I decided that surgery was my best option it sounds like my out of pocket costs would be fairly minimal. Since I'm still exploring physiotherapy and posture-based solutions, I have not decided to venture down that road yet.
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I think this is very interesting, too -- this is the abstract from a 2005 paper called "Age-Related Morphological Changes in the Human Hyoid Bone"

Object: Age-related morphological changes in the human hyoid bone were investigated radiographically and histologically. Materials and Methods: Thirty-two measurements were performed on radiographs of 238 hyoid bones from autopsy cases of known age and sex. Thirty-one hyoid bones that were studied by radiography were also examined histologically in horizontal sections. Results: Analysis of the length and width of the hyoid bone revealed significant increases in the body and the anterior part of the greater cornu and a significant decrease in the posterior part of the greater cornu with aging. Most measurements of the body and the greater cornu revealed differences between male and female hyoid bones. The outer margins of the body and the greater cornu were situated further outside in older males compared with females. The breadth of the joint space showed a significant age-related decrease, and the degree of fusion showed a significant age-related increase. Histological findings showed ossified or calcified fusion, with osteoclasts in the marginal area of the joint space. Conclusions: Increasing age induces fusion of the body and the greater cornu. The morphometric changes in the shape of the hyoid bone may represent functional adaptation to articulation fixation.
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Hey thanks for the medical quotes, I found that article interesting too I had actually posted it on that board a few months back when I was searching for possible causes of people who develop this syndrome with no apparent reason or very minimal trauma.

I also found a more detailed chart on results for surgery of the Hyoid Syndrome it shows incredibly promising results which fall in accordance with the 90 percent success rate cited by other authors. The previous author I cited Romeo Y Lim reported 50 patients with the hyoid bone syndrome who had excision of the involved greater horn after one month of conservative medical treatment failed to relieve the pain. Operation promptly relieved pain in 45 (90%) of the patients. In another source the Indian Journal of Otolaryngology,Volume 37,No. 4, December, 1985 author Avinash Bhide concluded "excision of the greater cornu of the hyoid is an extremely useful and rational procedure in cases of the hyoid syndrome, whose symptoms are produced by impingement on the cervical sympathetic plexus or the sinus branch of glossopharyngeal nerve and by a clasp-like action of the pharyngeal musculature.

Here are the exact stats in a group of patients who underwent excision of the greater cornua:

1. Dysphagia (Pricking sensation in throat) 30/36 had complete relief
4/36 had partial relief, 2/36 had no relief

2. Cervical and facial pains 20/24 complete relief, 3/24 partial relief, 1/24 no relief

3. earache All 37/37 of the patients had complete relief

Other symptoms 8/9 complete relief, 1/9 partial relief

The  thing I found most interesting where the exact criteria by which they diagnosed patients with "The Hyoid syndrome" when the following manifestations were present. These criteria match many of the patient complaints that have been mentioned on this board.

1. Dull or pricking pains in the lateral part of the neck radiating to the ears, shoulders, temples and retrobular region (retrobular means behind the eyeball socket). The distribution of pain follows the branches of the internal and external carotid arteries.

2.Chronic unilateral sorethroat, dysphagia, tightness and a feeling of "foreign body" in the neck

3. Temporo-mandibular joint pains and facial pains

4. Pain more during swallowing of liquids and saliva

The following additional manifestations were obsereved to go with the syndrome:

(i) Weakness and dull cahes in the ipsilateral upper and lower limbs

(ii) Narrowing of palppebral fissure as reported by Bhide and Debhadray (1980)

Physical examination showed

(a) Marked tenderness at the tip of the greater cornu of the hyoid bone

(b) That protrusion of the tongue and flexion of the neck aggravated the pain

(c) Relief of symptoms on local infiltration of local anaesthetic agent like Lignocaine around the greater cornu of the hyoid.

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Interesting! Here's something else I wanted to ask you. My symptoms have been worse over the past few weeks, and I've really been in a panic about it. This came to a head yesterday, I had three panic attacks in a ~2 hour span, and just decided that I can't _do it_ anymore. So, out of desperation, I took a moderate dose of Phenazepam (a benzo drug, like valium).

Needless to say, this made my anxiety reduce greatly. However, it also made the actual symtoms (symptoms) themselves a LOT better. Before I took it, everything felt so swollen that it was as though there was a golf ball caught by my hyoid. Within 20 minutes of taking ~4mg of phenazepam, the overall discomfort I was feeling reduced by something like 70-80%. I was able to watch TV with my fiancee and not even think about my throat very much for the rest of the night.

A benzo could not magically fix a physiological/mechanical issue, whether it's with my hyoid, my cartilage, etc. All the benzo does is quell anxiety and produce muscle relaxation. Since I know that I have a ton of muscle tension problems in my neck and cervical spine, it seems to me, that might really be seriously aggravating my problem? Frankly I feel so much better now that if this was how I felt normally (without a muscle relaxant drug), I don't know if it would bother me much on a daily basis.

Just curious if you've heard of anyone else getting relief from the actual _symptoms_ from a benzo drug, and curious what insight this might give you into my situation.
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Yes benzos give relief of that pressure and chocking sensation, it is not actually fixing the problem or inflammation so do not be fooled. It also helps me with the hyoid headaches because it reduces vascular activity in the inflamed external and internal carotids arteries whos sympathetic complexus are known to be irritated by the hyoid syndrome.
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well - it seems like if benzos provide relief, some other therapy which can provide the same degree of muscle relaxation could also provide relief. I don't want to be on benzos forever, but if I can find the same degree of relief through some other means, I might stop thinking about surgery. certainly, when i feel anxious about this, the muscles all constrict and get tight and that makes it all much much worse.
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Just some more info I've come across. I note that I am different from a lot of people in this thread, in that I do not have a significant amount of actual "clicking", and when I do hear a click it is usually unrelated to swallowing. Given how much muscle tension seems to have to do with my problems (not saying this is the cause, but it's clearly a factor), I've started to research muscle tension disorders and trigger points. I found this literature:
http://www.round-earth.com/HeadPainIntro.html

"Trigger points in the posterior belly [of the Digastric muscle] refer pain to the upper sternocleidomastoid muscle, pain to the throat possibly as far back as the occiput. There may also be difficulty swallowing and a bothersome feeling of a persistant "lump" in the throat. That "lump" may be the hyoid bone which, again, is not moving properly."

So, it sounds like, there is precedent for hyoid-syndrome type symptoms to emerge as a result of pure muscle tension. Whether I have an underlaying mechanical problem or not, that seems to clearly indicate that muscle tension may indeed aggravate my problems. As to "if this is a muscle tension problem, why has it gone on for almost two years?"  -- Well, I have the same bad habits now (excessive talking, poor posture, lack of exercise, frequent use of marijuana (known to promote muscle tension, I guess) as I did when my problem started. If anything, I would have expected an actual physiological problem to get worse by now, instread of more or less staying the same.  As for the inflammation, well, if the inflammation is being caused by the hyoid rubbing up on things it's not supposed to, it seems like that would happen whether the cause was a physiological defect or a result of chronic muscle overuse.

I note that my voice gets very bad when I overuse it since all this started, which is a clear symptom of "muscle tension dysphonia".

So, for the moment, I am going to attack this as a muscle tension problem which has my hyoid in the wrong place, and see if 6 months of combined PT, alexander technique, and treatment to stay off drugs, is at all successful in alleviating my discomfort. I will certainly  keep everyone posted with my progress.
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I have done a lot of research, and not once did I come accross an article citing pure muscle tension as a result for hyoid syndrome to emerge. What causes the "hyoid syndrome" is clearly identified and pathologically verified as a chronic inflammation in the region where the muscles attach into the back of the greater cornua, it is basically insertion tendinitis like any other part of the body but its in the hyoid region. Sure posture can play a role but the fact you have had it two years and its a pretty bothersome noticeable feeling makes it unlikely that any muscle tension exercise will provide much more than temporary relief, I have tried many techniques and none have  cured the problem because it is coming from inflammation on a microscopic level or a hyoid that has been structurally altered. Trigger points can refer pain but when you feel a very distinct click from the area of your pain it would be foolish to pass this off as a trigger point of the Digastric muscle, especially when you have a foriegn body sensation at that exact level of the click. The click is the tangible clue that something is mechanically off with the structure of the greater cornua of the hyoid bone I rarely have clicking either unless I manipulate the hyoid in the right manner using the Brown method by pushing in on one side with my thumb and equalizing the pressure with my index finger on the opposite side it is then I can recreate and feel the structural and mechanical deficiency occuring at the area, no matter how many stretches or techniques I do this click has not gone away for me and it has been with me for two years. Improving posture will help, techniques may temporarily improve pain like a massage on an aching back, but I would not expect complete relief of the "hyoid syndrome" through your documented measures when it has never been reported. Of course every person is different but I am just telling you up front I tried my trial run of conservative techniques for a year and nothing worked but benzos and anti-inflammatories. After 2 months of having a hyoid syndrome very few patients will respond fully to conservative treatment, unfortunately I read this in a reputable study with a respectably sized sample population and it was dissapointing news to me at the time. Hopefully, these techniques provide you better relief than they did for me, but I am just trying to be upfront and lay out my experience with this disorder because I remember I really got my hopes up with all these new age techniques and they are worth a try but just realize you have had it two years and need to be realisitic also.
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PLEASE READ THIS!!!

Firstly i sympathise with all of you! I choked at a party 2 years ago and ever since then i have had pain while swallowing and talking. Ent's do the endoscope and said nothing was wrong. People think i am crazy and its all in my mind. I am 1 billion percent certain my hyoid is broken or dislodged, i am willing to bet my life on it. I have never experienced a stabbing sensation like i did after the attack, it was like someone was cutting my throat with a nife. I have had trouble speaking and have since the attack. No one understands and people think you are crazy its so frustrating that people wont listen. The ent's in my opinion arent any better unless you actually challenge them, i have become a person that is quite introverted and i never used to be.. im not sure if anyone can understand this but its like your voice isnt connected to your feelings anymore, i feel like a monotone mute.

there is my vent...

i sympathise with you all
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how do i do this "brown" technique? because when i push one greater hyoid cornu with my thumb, and then push back against the other greater cornu with my index finger -- i am able to move the hyoid freely in the next, back and forth horizontally, and I do not hear or feel any clicking or popping.

does that make me different than you?

I should also point out that i've had muscle tension problems for years, ever since I came off Klonopin.
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i should also point out -- if i ignore the hyoid and instead move down to my neck cartilage, I can of course make that click back and forth a little. But, that has nothing to do with the hyoid, and I am able to do the same thing on my fiancee's neck (and she has none of these problems).

So, it sounds to me -- that when you hold your hyoid between your thumb and forefinger, and slide it horizontally, you hear and feel a click? This simply is not true for me, unless I'm doing it wrong?
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bottom line, i don't nor have i ever felt a notable click in the area of my discomfort. my primary symptom is foreign body/sense of swelling, which turns into dysphagia and dysphonia when the symptom gets very bad or when i abuse my voice. very curious if i am trying to create the "click" in the right way?
* push on greater cornu from right, until left greater cornu is visible through skin on other sie
* using other hand, push left side back -- slide horizontally, no click
* then push inwards with both hands, pushing hyoid into neck
*this creates a choking sensation, but, no click.
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i guess i should comment that if i really push the hyoid in HARD, and then turn my head left and right, i'll get a click from the front cartilage -- but this is not at all coming from the area where i have discomfort, and i think it's a logical effect of putting a ton of pressure on the cartilage and then moving my neck. As I said, my symptom-free fiancee can do the same thing.

Very curious what you have to say; going to try to get some sleep for the moment.
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have become a person that is quite introverted and i never used to be.. im not sure if anyone can understand this but its like your voice isnt connected to your feelings anymore, i feel like a monotone mute.

Yes I totally understand I have the same thing I talk like I am an android who can not vary the pitch of my voice one of my professors even wrote this comment on an oral presentation I gave and it was so frustrating because since my injury I physically cannot vary my voice without excruciating pressure. Have you tried ct, mri, or x ray? What are your worst symptoms?
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bottom line, i don't nor have i ever felt a notable click in the area of my discomfort. my primary symptom is foreign body/sense of swelling, which turns into dysphagia and dysphonia when the symptom gets very bad or when i abuse my voice. very curious if i am trying to create the "click" in the right way?
* push on greater cornu from right, until left greater cornu is visible through skin on other sie
* using other hand, push left side back -- slide horizontally, no click
* then push inwards with both hands, pushing hyoid into neck
*this creates a choking sensation, but, no click.

My technique has to be just right to get the click it really is an art I have practiced for hours. You have to use your thumb of the right hand to press in on the right greater cornua and simultaneously use the index finger of the left hand to push in and grab the bony protrusion of the greater cornua I remember in Dr. Berkes office I could not make it click but he found some way with his magical touch using the brown method to make it click. Now that I have learned the touch I can sometimes make it click but something really interesting happened this week I started readjusting the hyoid so much using the brown method that it seems to have slightly shifted position because I cannot click it nearly as well on command the symptoms of inflammation at the end of the distal cornu persist even in the absence of a distinct click. I think the important thing though is the fact that you can use the brown method to push the left part of the hyoid bone out of the left side of your neck and the grab this bony protrusion, in me, you, and GGCB this bony protrusion at the end of the greater cornua seems to be the culprit in causing these horrible foriegn body sensations I can literally feel the assymetry between the sides the left side I can poke out of my neck and actually grab I cannot do this with the right, if you look under my photos it shows a patient using the brown method from one side to poke the hyoid bone out the other this is where all my and GGCB discomfort is your fiance could have a really minor version of this to the point she does not notice it, but there is definitely something structurally wrong with the greater cornua of my hyoid bone and I can feel it, just how you can feel it in your pharynx when you use intraoral palpation these are both signs of hyoid syndrome. We can talk about this on aim, if you technique is not right you could be missing the click entirely.
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yah, drop me a line on aim.i gave you myaim name in a private message.

i feel no asymmetry at all. i can feel the same little bony nub on either side of my hyoid and it feels exactly the same. dr's have also told me it's not suprising i can feel it because i am very tall and skinny, 6'1" 140 lbs. it's pretty easy to feel most of my bones.

my voice is also unchanged, though i do get hoarse a bit more easily than i used to.
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i should also mention -- I think anyone in the world is going to be able to produce _some_ kind of click if they push hard enough, because even if your cartilage and bone is in a completely normal state, they are located closely enough together that if you apply a significant amount of pressure in the right direction, it's going to create some contact.

i  should be on AIM all day, i'm also going to give you my home #.
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That is interesting I can only feel the bony protrusion stick out noticeably on the left side, is this what you feel GGCB?, thanks for the contact I will try to get in touch some time.
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Hi seems like Ive missed a lot of action on this site. In the last few weeks Ive felt more pain than at any other time in my life. I think its from doing very minor new exercises with my PT. With all that pain I have had a tough time reading for any length of time. It could also be from the hydromorphone anyway sorry I never got back to you. I tried playing around in my neck and I cant  seem to do that hyoid thumb self test thing you wanted me to try. I have alot of sensitivity in the area and a lot of inflammation. Since we last spoke I saw a neurologist and was told everything seemed fine from a neurological poinit of view. I havent seen my doctor yet but the neurologist was going to recommend a I-something test. Its an inflammation test but Ive never heard of it and I have no idea how this will help me. Do you have any idea what test I mean? or if it will help?
How have your symptoms been the last 2 weeks?
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Do either of you every get dull aches and pressure behind your eyeball sockets. This symptom has been annoying me a lot lately and feels like eye strain with pressure


I forgot to answer that, sorry.

I do have pressure all over in my neck and head but even the headache are generally brief and in odd spot in my head. Ive felt strong pressure behind my eyebrows but not really behind my eye. Its too the point right now my eyes could pop out and I might not notice because of all this pain in my neck....im exaggerating but the pain has been more than i ever thought I could deal with.
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hi sorry to hear that you are dealing with some of the same issues we are. I also dont have any click like GGCB and wildblue98. But my symptoms match theirs. If you have found an ENT that thinks surgery is an option count yourself lucky. My ENT still doesnt think anything is wrong with me. Also be thankful that you have insurance and are in the states. Im in Canada so I have no insurance. I would much rather pay less taxes, pay for your own heathcare insurance and still end up with more money then have a free system where you get taxed to death for it, unless ofcourse you are poor, unable to work or in a lot of cases here unwilling to work. Both countries have great doctors but we lose ours to the US and Ive never heard the US complaining about losing doctors to Canada. Anyway you have choices and get dealth with quickly.Here you wait for everythign its free but Ive been off work and in incredible pain for 4 months now and Im more or less stuck in the system. My doctor now is outstanding but my ENT was terrible and the department wouldnt let me see other ENTs in the city....where you are you could see who ever you want. Sorry Im just frustrated but please dont complain about the american system it has its benefits just like we have ours here.  Hope you figure your situation out.
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I have never heard of an inflammation test what part of the body is this focussed on, my symptoms have been the same, do your headaches follow the distribution of the internal and external carotid arteries?  (look at my posted diagrams for reference)

I tried playing around in my neck and I cant  seem to do that hyoid thumb self test thing you wanted me to try. I have alot of sensitivity in the area and a lot of inflammation.
While if it exacberbates your symptoms it could be a hyoid syndrome GGCB can actually grab the end of the greater cornua it is sticking out of the side of our neck on the left side this may or may not be a difference between us. I dont know how to better explain the brown method you have to rock the hyoid back and forth one hand on each side.
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Im just going to pass on playing around with my hyoid, Ill let my doctor or physical therapist play around but for me there is way to much pain in the area and Im already in a great deal of pain.

When I see my doctor I will ask him about it, what he knows about it and if their are any benefits in doing it. I havent spoken to my doctor to go over what the neurologist thought and recommends. I might get to a point sooner than later where contacting Dr Burke at UCLA become an option. Right now Im just seeing what we can figure out here. I know my physical therapist and my doctor have skimmed through some of these posts. When is your second surgery schedules for?
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one thing i've just noticed -- as i said, i can feel a little nub on either side which seems to be the base of the greater cornu. I used a sharpie marker to place a  dot on my neck on the outside directly over this nub. On the left, my dot is a good 1 centimeter higher. This sort of implies to me that the lump i feel in my throat literally is the top of the greater cornu on that side, and i feel it unilaterally because it's only mis-elevated on that side.

not sure what affect if any this has on my prognosis -- clearly, chopping out the entire cornu is going to relieve the pressure, since there would no longer be anything pushing -- but if I have really done this to myself through crazy screwed up muscle use and muscle tension, seems like it might just cause more problems down the line.  I'm going to mention all this to my PT and see if there are any manual exercises which could be done to stretch the hyoid ligature on that side,  to get it to rest at a more normal angle.


My heart goes out to all of you in serious pain :( My biggest problem all along has been foreign body sensation and intermittent swallowing pain (which, for sure, is anxiety producing and screwing up my life), but it sounds like I've gotten off very easy compared to some of you. You will be in my heart and prayers.
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On the left, my dot is a good 1 centimeter higher. This sort of implies to me that the lump i feel in my throat literally is the top of the greater cornu on that side, and i feel it unilaterally because it's only mis-elevated on that side.

I totally agree with this I think the lump feeling is from the top of the greater cornu I can feel the mis-elevation with my fingers and my hyoid feels totally abnormaly curved like the lady in the pictures I posted who also marked dots with a sharpie on her neck. Did you see that photo, reminded me of you. poke poke poke 24/7
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if the hyoid being _higher_ is the real problem though, it seems like there may be some (as yet undiscovered) way of lowering it short of just excising the whole darn thing? after all, it's held in place by muscle and tendon, both of which are fairly elastic and subject to change over time. I can see that in the case of a real trauamatic injury, it might just never heal properly, but failing a traumatic injury or a morphological difference on one side vs the other, it seems like there might be another possibility of some kind.

sure sick of thinking of this. poke poke poke poke.
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OMG.. i know exactly how u feel.. 5months ago while yawning i felt tht stabbing sensation.. Like i tore something in my throat.. Ever since then ive had the clicking sensation.. Now when i feel strong feelings i cnt yell.. it all seems mechanical.. like its not me tlking.. icnt sing like iused to.. i cnt yell .. i have also become an introvert... i skipped this semester of college tryna solve this.. please respond.. im lost with this mess

the other day while whike getting my haircut my barber askedme a question.. i jus ignored it..i knoe it was directed towards me.. but my voice jus doesnt come out sometimes

- also sometimes i speak out of the right side of my mouth
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I can see that in the case of a real trauamatic injury, it might just never heal properly, but failing a traumatic injury or a morphological difference on one side vs the other, it seems like there might be another possibility of some kind.

Most people in this site have not had really traumatic injuries I can tell you somebody who coughed hard or vomited could be more disabled than someone in a terrible car wreck you cant really stereotype injuries like this into one category. Many cases have no apparent cause and can be extremely bothersome. It looks like this problem can be caused by opening your mouth too wide and suddenly, batlife and miskatonic you both share this in common as the onset of your injury. This I highly doubt is a coincidence as opening the mouth too suddenly or widely can strain that area of the hyoid. Short of hoping for it to heal and go away through physio and conservative treatments the only thing I found that exists is excision of that tip of the cornu, its unfortunate, but sometimes removing something is the best option especially if it has been plagueing for years.
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Thanks for your response.. I think this trauma was the reason why i became hypothyroid.. i read somewhere that trauma can cause hashimoto's.. Im having trouble socially because of this mess.. I cant seem to be like my old self.. im real talkative, now its hard to talk, i speak from one side of the mouth.. is it possible that i also injured my laryngeal nerve.. because i cnt sing at all .. one ENT said my throat was swollen n gave me ibiprofen.. this is gettin the best of me.. it has caused me to isolate myself, forcing my mom to put me in 2 mental hospitals.. n no1 believes me.. this *****.. no1 understands
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come to think of it, I did have a hard, hard vomit session shortly leading up to this, too.

On the other hand, I had a much harder vomit session a few years prior when I got food poisoning, and, no problems.
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Dont worry, I doubt you damaged your laryngeal nerve from yawning hyoid bone problems can definitely cause problems speaking I have pressure on the left side of my throat where the displaced hyoid is and it puts so much pressure on my throat to speak for long periods it can just be inflammation in the area or the greater cornua pushing in on the throat because it has changed position. You are not going crazy there is something structurally wrong with your hyoid it sounds like this is causing you these symptoms. Miskatonic I have read several accounts of hyoid bone fractures and problems being caused by vomiting, batlife your patient history also matches up with a hyoid bone injury. I would seek the treatment and methods that have been suggested and listed on this board. Problems in this region will drive you crazy. poke poke poke

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could everyone with this problem comment as to whether or not they were a premature baby?

For the record, I was, about 5 weeks.
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I was premature about 8 weeks
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so was my twin and he has a similar hyoid problem
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Key words  Hyoid bone - Prenatal development

I think you might be on to something maybe being premature predisposes someone to problems of the hyoid bone later on in life.

Summary  Investigations on the human hyoid bone in several developmental stages reveal that with the chondrification of the mesenchymal blastema a typical interzone between the body and the greater cornua is formed. This disc of closely packed blastemal cells, distinct and broad in the earlier stages, is reduced in thickness in the course of further development. In fetuses between 5 and 6 months old and in newborns the formation of joint cavities can be seen in some cases. In other cases, however, a small transverse line of cells persists between the two cartilaginous elements. These findings are interpreted as different developmental stages of a diarthrosis generally formed between the corpus and the cornu majus. The fact that in the adult the lesser horn is connected directly to the cornu majus and not to the body is confirmed by the embryological investigations reported in this study.

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I dont believe I was, Im sure I would have heard something about it if I was. With the articles and files on the net I have read nothing has pointed to predevelopment or being a premature baby. My case came from a 200lb soccer player stomping on my neck face and hip repeatidely. Ive read about coughing and vomitting and from severe wiplash in a car accident. thats all Ive read about but Im no expect and havent dealt with this problem as long and some of the others have here.
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Sorry I haven't posted for a while, I am just recovering from that awful H1N1 flu...yup, I got that....and the coughing has made the muscles and ligaments extremely loose and the hyoid issue even worse, if you can believe that.  Now, it is almost impossible to sleep anymore.  I used to use sleeping to get away from my problem, now whenever I lay down, the hyoid hooks onto something in my neck on the left side and makes it impossible to swallow and what ends up happening is I immediately wake up feeling like I am choking and smothering to death.  It always used to get caught when I slept (that is why I used those special bead-filled pillows to support my head and keep it in one position), but it also always used to uncatch when I swallowed...now it gets caught and stays there unless I sit up and physically manipulate it back to where it is supposed to be.  I have been able to sleep only a few hours per night for the past week.  The hyoid feels so loose now (too loose), since I got the flu.I am so afraid that things have gotten so damaged that even Dr. Berke may not be able to help me now...I truly hope that is not so, because I am making my appointment to go and see him in January and I am going to plan to have my surgery that same week...no more waiting...I can't anymore.  A person cannot live with only being able to sleep a few hours a day.  It is so strange that after 3 years of having this, that it would get worse...well, I only hope and pray that it is not too late for me, that he can still fix it.  What do you think wildblue98?  Has this ever happened to you, where it gets caught when you sleep and won't go back?  By the way, in answer to the question regarding premature babies, I was told I was an incubator baby...I believe that means I may have been born a little early.
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another incubator baby this seems too coincedental, I have had similar experiences with sleeping on the left side yours sounds a little more severe but I definitely know what you are talking about, your greater cornua of the hyoid is hooking on the thyroid cartilage or tranverse or both that is probably what you are feeling. I readjust the left side of my hyoid all the time thats the only thing that makes it temporarily better is taking that bony protrusion getting my index finger behind it and  trying to push it forward away from the tranverse process, makes sense why this would reduce pressure and the click. That is great you are going to make it out here in January I should be recovered by then and be able to give you input on the procedure. You are almost there hang in there I wouldnt worry too much about the catching being unfixable since it is a mechanical issue you should have quite a bit of relief after that portion is removed medical literature with hundreds of patients with similar hyoid bone syndromes symptoms validate this.
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man, my heart really goes out to you guys :-/ most of the time I just feel a pressure sensation over my hyoid tip, and that's the worst it gets if I don't abuse my voice or throat.

You guys are making me feel like I don't even have a real problem.

Out of curiosity, have any of you experimented with Neurontin or Lyrica for pain management? I just started a tiny dose of neurontin, but I may push my doctor to switch me over to Lyrica because it looks like a more hardcore version of the same thing, and I'd rather find out sooner than later if it's going to help.
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Ive never heard of those 2 drugs. The first month I toughed it out the best I could before I kept going to ERs. I ended up on 500mg of neproxen which is an anti inflamatory but didnt help. I was told to take tylonol3s with it which I tried. I was taking 5-8 T3s a day with 2 neproxens and it didnt help that much, gave me a bit of relieve but gave me new pain elsewhere and I became more or less an a-s-_! So Im now on 1mg of hydromorphone but need 2-3 at a time to get any relief. Sorry those are the only meds Ive really ever been on so I cant help you with the 2 you are inquiring about.
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sorry to hear that; If they're giving you dillies (hydromorphone) then you must be in a world of hurt I can't even imagine. What I found with the narcotics was that they take my mind off the condition a bit, but don't actually do anything to relieve the pressure - does that sound familiar? Benzos (klonopin, valium, xanax) can help actually relieve pressure because they are smooth muscle relaxants, but unfortunately they are probably more addictive than even opiates are, and the withdrawal can kill you.

Hang in there, we'll get to the bottom of this. All of us.
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Hey guys, I just got back from an ENT appointment with the another ENT I am working with here in Los Angeles he ordered a 3d reconstruction of the hyoid which basically takes the cat scans and runs them through a computer program that will allow us to better visualize the space between the hyoid bone and the tranverse process. I got a really good look at my ct scans with him for a good 5 min today on the computer monitor screen and both ends of the hyoid bone do appear to be close enough they could be rubbing against the tranverse process the right side is about a mm closer which another ENT surgeon from Utah had also explained as elongated. I think since there is really no control normal position for the hyoid that defines symptomatic from asymptomic (like there is in Eagle's syndrome) it is hard for them to say " it is abnormal to be off a millimeter closer to the right and that could be causing the clicking" but from looking at the scans myself with my doctor we both agree these two structures could be close enough to be clicking on one another. Also, what I got from this is that it probably does not take much maybe a couple mm for the hyoid to alter position and begin to click, that would explain why the click starts in many people with relatively uneventful episodes like a cough or yawn. Hopefully, when the ct gets digitalized and reconstructed into its 3d-dimensional format the team of surgeons at UCLA will be able to observe the exact malformation or elongation responsible for the click, I mean if one can feel and hear it, one certainly should be able to see it. I hope this 3d constructed scan and surgery provides some needed answers for all of us. Science has gotten too good to keep the hyoid syndrome in the dark for long.
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Good luck, man -- certainly keep us posted. Wishing you a click-free christmas and a pain-free new year.
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Hi, guys!

Let me remind you my case: click in the throat due to trauma. From what I can feel the hyoid bone rubs against the cartilage during swallowing. The click migrates from the left to the right side, from the back to the thryroid lamina. There's a  swollen tendon/muscle on the right side.

I did a 3d CT scan and I uploaded some of my my images in my profile. If anyone is interested, you can check them out.

Dr. Berke's team asked me to send them the CD with the images since all images are like 400 MB (around 150-200 images). So the cd is currently traveling and after they receive it they'll say what they think.


I contacted another doctor from the UK, Dr. Simon Browning. He has described a similar condition. The article is called "A new and clinically symptomatic variant of thyroid cartilage anatomy" if anyone wants to check it out, type it in google since it won't let me post links here.

He evaluted my CT scan images and said everything looks normal. He thinks I have "HYOID SYNDROME". Article on the net: "The hyoid syndrome: a pain in the neck". It basically is an inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. And the suggested treatmen is steroid injections. He said he typically has like 2 cases an year and he treats them with injections and everything goes back to normal. He said if unjections don't work, the second option is surgery in which 2/3 of the hyoid bone gets removed.

I know Adam who posted on this site had his whole bone removed without any problems, but Dr. Browning said that it's not advised because there are two important nerves right next to the hyoid bone and it's better for a certain part to be left.

What do you guys thuink about all that?

I personally don't think steroid injections would help, I think my tendons are simply streched and are not holding the hyoid bone at its right place therefore the bone needs to be excised. Of course I'm not a doctor and I could be talking out of my ***, but based on the fact that I've lived with this thing for the past 8 monts and based on all the research I've made that's what I think.

Any advise would be much apprecaited.

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Daniel those are great images which exact test did you use? (with or without contrast) that is great visualization of the area. You may very well have hyoid syndrome if this is that doctor's assessment I would not be surprised as I have similar symptoms, as I remember though your clicks are coming from the center of the hyoid region arent they? I have read for hyoid syndrome steriod injections and other conservative treatments like NSAIDS usually only work if the problem is mild and has been prevalent for a short time. Based on my experience with steriod shots in other regions of my body I can tell you they are by no means a cure all rather a temporary fix, its like a massive does of local anti-inflammatories to the area it may very well be worth a try before an invasive surgery, but in my case after having this 2 years, and based on my past injuries I can tell an injection of some steriod really isnt going to cure the problem. The normal course of action for the hyoid syndrome based on the studies I read is that if it does not respond to conservative treatment like anti-inflammatories and NSAIDS within 1 or 2 months than excision of the greater cornu of the hyoid is a very rational procedure with effective results. There are two major nerves that run near the hyoid bone these are the hypoglossal nerves and removing the whole hyoid bone at once is definitely the best approach according to the medical literature for hyoid syndrome, rather the sides of the greater cornua are transected up to the body of the bone,  but Daniel if your clicking is coming from the center region of your throat and a doctor has agreed upon this, this could be your thyroid lamina clicking against the center portion of your hyoid, then cutting out the sides would do you no good, and a cartilage excision based on the literature would be a more rational option. Depends on what is causing that click and where it anatomically is you need to find this information out to put togethor a treatment plan.
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MAJOR CORRECTION: There are two major nerves that run near the hyoid bone these are the hypoglossal nerves and removing the whole hyoid bone at once is NOT THE BEST approach according to the medical literature for hyoid syndrome (not one surgeon approached the issue this way in studies), rather the sides of the greater cornua are transected up to the body of the bone,leaving the center portion intact.
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Also Daniel I was wondering if you could get an update on Luca I know he just had the Left SCE and left hyoid greater cornu excision a couple months ago. It would be good to hear his results.
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I personally don't think steroid injections would help, I think my tendons are simply streched and are not holding the hyoid bone at its right place therefore the bone needs to be excised. Of course I'm not a doctor and I could be talking out of my ***, but based on the fact that I've lived with this thing for the past 8 monts and based on all the research I've made that's what I think.

I totally agree on this one, my muscles and tendons feel stretched, I think that is what we all share in common is the strained muscles and tendons leading into the hyoid once the area becomes more lax and less taut following trauma the hyoid does not stay in its original place it starts shifting on other nearby structures and the local inflammation from these structures hitting and the actual muscle strain itself causes a constellation of symptoms known as the hyoid bone syndrome.
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Thanks for your informative replies, wildblue!

I used the image from your profile and put arrows pointing at the areas of the click. But basically it has started to click everywhere. The click just moves from place to place, it's as if this bone has its own mood and does whatever it feels like.

Sometimes there's no click at all. When this happens there's still some tension when I swallow, as if something is streched. 5 minutes later BAM the click is back.

My tendons are additionally damaged by a quinolone antibiotic which I had to take just two weeks after the trauma. I suffered like 60 side affects and some of them started 3 weeks post treatment. 8 months later I still suffer the toxicity. I don't know if any of you guys have heard about these antibiotics (Cipro, Levaquin, Avelox) but there are pure poison and there are tens of thousands of people damaged severly by them. One of the main side effects of these drugs is to deteriorate your tendons. And in fact for the first few months after the injury the click was only coming from 1 place, while now it just clicks everywhere depending on position, etc..

I myself don't want to try the steroid treatment as I'm  sick of drugs and their side effects. But Dr. Browning seems to be hesitant. He first wants to try the conservative treatment, while I want the surgery.

I don't know what's going on with Luka.

So if the best approach concerning the removal of the bone is NOT to excise the whole bone at once, then Adam's hyoid was not completely removed?
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http://www.surgery.medsch.ucla.edu/headandneck/contact.shtml
http://www.surgery.medsch.ucla.edu/headandneck/doctors_Berke.shtml

Scott here are the links you requested to seek more information at UCLA for surgical options.

Daniel I spoke with Adam about his decision to remove the entire hyoid bone and this was his personal decision, he told me he had had previous bad surgeries and that he was just sick of the thing and wanted it out. I remember him telling me the reason they were removing the whole thing as opposed to the sides was partly his decision and the fact he had previously had bad surgeries and also that he had clicking coming from the middle. From what I have read though if the clicking is coming from the middle I see no medical articles that recommend removing the middle portion of the hyoid, I found one that recommends trimming the thyroid lamina. It really depends on the clicking where does your doctor in the UK feel the clicking is coming from and its mechanism of cause?
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He doesn't feel anything and he hasn't explained what he thinks the mechanism is. We're communicating via emails. He just says that he thinks this is "hyoid syndrome" and that I should do the injections, which drives me crazy. :(
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Daniel I find your diagrams very interesting, when I had dinner with Adam a couple months ago the night before both our procedures I brought the same diagram to dinner and more or less what he had explained to me is the exact clicking areas you show so precisely in your photos. I think your theory is very strong that the muscles and tendons have become stretched and are lax now causing this bone to shift out of normal position Adam and I had the same theory before you mentioned this. I know Adam's surgical history only because I had a very detailed conversation with him and he was willing to share it and I know he doesnt mind me sharing but what you show in your diagram is the hyoid clicking on the thyroid lamina, and superior cornu of the thyroid cartilage, (what you dont show is the hyoid clicking on the tranverse process but you must be aware of all the possibilities) if indeed all those regions are clicking due to the same muscle tendon stretch injury I do not know surgically what the best approach would be to fix all of those areas what we do know is that Adam had the entire hyoid bone removed and has no more clicks ( He had benefit from the thyroid cartilage excision, the thyroid lamina trim, and the complete excision of the hyoid bone) I had benefit from the excision of the superior cornu thyroid cartilages but am left with clicking of the greater cornua of the hyoid. I would really discuss this with Adam since his case seems more similar to yours do you have instant messenger we could all arrange a conversation or phone call, let me know. I am no doctor but from what I have read I personally do not feel the middle portion of the hyoid bone should be removed unless it is absolutely necessary, your clicks could be coming from the thyroid lamina which could be trimmed, and the superior cornu of the thyroid cartilage, and the hyoid bone, but the reason multiple structures are clicking in many sufferers on this site seems to be a direct problem of the muscles and tendons connecting into the hyoid bone which cause it to become lax and move out of position and closer to other structures. If there was more research on the mechanics of the hyoid bone following soft tissue traumas it would be much easier to devise an effective surgical treatment. We will find answers though the surgeons at UCLA are too talented not to figure this out.
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"Ossification begins in the greater horns (of the hyoid) towards the end of intraueterine life, in the body shortly before or after birth, and in the lesser horns at around puberty."

I found this in an article called "clicking hyoid".

I find this way too coinceidental in the patients on the site without blunt trauma everyone so far has had a significant premature birth, if the greater horns of the hyoid are ossifying towards the end of intrauterine life and you are born several weeks earlier than it makes a lot of sense that the structure could be "malformed" or structurally compromised or genetically weakened. I just find this way too coincedental. Also as I look at this diagram I am reminded of Daniles 3d CT scan in which the greater horns extending posteriorly seem to be impinging on the lateral mass of the third cervical vetebrate this friction of the bones could explain a click in that region, they seem awful close in your CT, I have no clue if this is normal, just a thought I would compare the length between your hyoid and tranverse process to a control asymptomatic patient if you could find one.
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For what it's worth, my ENT told me yesterday that no one's hyoid looks exactly the same, there's no such thing as "normal", and in surgeries she's done where she's directly visualized it she always notices some kind of 'abnormality' or another. Her point was that variations and even slight deformations are far more common than people reporting these symptoms, which makes it hard to understand exactly what's going on.

She views this condition as arising because of pressure on a nerve, on way or another, and cites successful treatment of some people with drugs like Gabapentin (which I'm currently trying) as evidence of this. I still view this as a tendon/ligament issue, so I guess I've gotten to the point where I'm at a fundamental disagreement with my provider about what my issue is. I'll keep going with my conservative treatment plan for as long as I can stand, and if that fails I'll get on the phone with UCLA sometime in the spring.

FWIW she also seemed to think that doing a SCE on both sides was a dangerous idea that could leave the remaining bone without adequate support - but also was quick to point out that she's only done a half dozen or so of these, and that if Dr. Berke has done 100+ then he is literally the world's most experienced person with this. Not only did she not offer any resistance when I told her I was considering UCLA if I do decide to have surgery, she said it sounded like the prudent course of action.
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Dr. Browning is refusing to do a surgery. He first wants me to try the steroid injections.

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What its worth I can tell you my bone doesnt feel "any less supported" after the bilateral SCE. I dont think this little horn of cartilage is really important to anything I notice only a positive difference without mine so did Adam. Daniel let me know how the steriod injections go, based on past experience with steriods I doubt they will get rid of all the clicking they temporarily help the pain though.
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