History of my problem: For as long as I can remember, I have had a problem with my hyoid bone popping out and causing excrutiating pain. It is always the same - the right side of my neck. At about the age of 8 I talked to my pediatrician about it and he promptly told me it was not possible. That I was having anything "pop out" in my neck. He contended that there wasn't anything there that could pop out. So I just continued to push it back into place whenever it popped out. Back then, it was very easy to push back and only lasted a few seconds until I got it back. About 3 years ago, I noticed that this was happening more and more frequently (used to be about 2-3 times per year) Now it was happening about every month and was much harder to push back. Sometimes taking 20 or more minutes. During that time, it was extremely painful to swallow or talk. After I would finally get it pushed back into place, the pain would go away, but my whole neck would be sore up to my ear and through my jaw. It felt bruised, but no visible bruising on the outside. Over the next couple of years, this problem continued to get worse, happening weekly with some minor "slippage" on a daily basis. Throughout my life, I have talked to various family practice doctors about this problem. They all contended that it must just be a "lump in my throad" like when you get emotional. Or maybe it's just excess head conjestion. Or maybe it's just a muscle spasm. Or maybe I'm just imagining it. Whatever the case, no one had ever heard of anything like it and no one ever took me seriously. So, I started researching on my own. I could not find anything that sounded like what I had. I posted questions to "Ask and Expert" all over the web. I did get some respones. all of which started with "wow, that is interesting. Never heard of anything like that before." One physician directed me to find a good ENT. So, I did. He took me seriously. He ran tests - CT scans, swallowing x-rays, blood work, etc. I saw a speech pathologist and everything. The swallowing x-rays showed that my hyoid bone did not more in unison. It appeared that the hyoid, which I'm told forms in the womb from 3 point of origin and then fuses into a solid bone before birth, had never fused into the solid bone at all. The ENT that ran the tests did not feel qualified to handle this case, so he referred me to a colleague who does a lot of throat cancer surgery and work around the hyoid bone. He reviewed the tests and theorized that if we removed the portion of the hyoid that was not firmly attached to the rest of the bone, it should solve the problem. I ran this thought process past the head of Otolaryngology at the Mayo Clinic, who had also never heard of such a problem, and he concurred that this theory did make sense. However, there were no guarantees due to the fact that no one had ever seen or heard of anything like it before. So, I went ahead with the surgery on 10/26/06. It seemed to go well. For 3 months, I had no problems. Then on 1/23/07, it popped again, just like it had always done. I immediately went back to the surgeon who is completely at a loss of what to do. His only recommendation is to do more surgery and remove more of the hyoid bone. However, the more they take out the greater the risk of swallowing issues post-surgery. I'm not sure I'm ready to sign up for that again just yet. Since the 1/23 incident, it has happened 3 more times with the last time being only 2 weeks from the previous episode. I'm worried that this is going to continue to get worse again. If it were only going to happen a couple of times a year, I would just deal with it like I have my whole life. But if it gets back to being almost every day, I can't imagine having to continue to deal with that for the rest of my life. As long as the bone is in place, I have no problems. No swallowing problems, no pain, nothing. I just never know when it's going to pop. I do a lot of public speaking and presentations. My greatest fear is that it will happen in front of an audience. The pain is so sudden and intense that I immediatley burst into tears. This is the main reason I have been pursuing this issues to begin with. Any suggestions? I saw in your archives that a person with the nick name of "creyn" described a similar condition back on 11/22/2004 on this web site. Did anyone ever help her? Any feedback would be greatly appreciated. Thanks!
Yes I already has a bilateral superior cornu excision of the thyroid cartilage. The surgery I am having now is a bilateral greater cornua excision of the hyoid bone. I think if this board gets over 1,000 posts doctors will start taking this more seriously.
I wouldn't count on that, sadly. Dr. Berke seems to have made a career for himself out of this, but as far as ENTs in general go, we are a boring and difficult group of people to treat, and we have a condition that is both not life-threatening and also fairly impossible to understand how debilitating it can be to someone who doesn't have to live with it :-/
My ENTs alarm about bilateral removal was specifically re: the hyoid bone -- but as she was so quick to point out, she has 5% of the experience with this that Dr. Berke does, at maximum.
Most of you all get a CLICK in your neck/hyoid area. I dont have that but Im wondering if any of you get an odd sound that comes and goes more than a few times a day in your throat/neck area.I cant describe it but its like something vibrating for a half second to a few seconds. I can hear it and almost feel it( not sure if I can feel it) but Its not loud enough for anyone else to hear. I also have no idea when it will happen I just know its happening more often. It could also be that I noticed it 2 months ago and now Im paying attention to it so it might not be happening more, I just notice it more.
Sorry very odd question for all of you I just cant figure out if theres a connection between all of your CLICKs and my odd little sound. I just know before the injury this never happened.
Scott mine started out as a faint click and gradually got worse until I could pop it out with my finger, this probably does have something to do with it. You have to pinpoint where this click is coming from download the picture of the 3d ct scan with red radial circles on my profile and show me where you think this is coming with a blue arrow by inserting my photo into a paint program, post this on your profile under your photos.
I added the picture. I cant determine where its coming from. Feels like its within me and in the center part of my upper throat/ hyoid area. When this sound comes it doesnt cause more pain its just a very odd foreign sound/feeling. Ive been trying to figure out a way to describe it for over a month and I still cant. so frustrating
I think that as the video says, this is one possible explanation for the foreign body sensation and some of the other symptoms of hyoid syndrome. I see hyoid syndrome as a group of different problems with the same structures which create the same symptoms.
Some people might have muscle tension that creates this feeling -- some stuff I've posted earlier about trigger points indicates that in some cases muscle tension may actually cause the hyoid to move improperly. Other people clearly get the same symptom from a deformity or physiological problem.
Let's consider blunt force trauma. This could potentially partially tear a tendon or stretch a ligament, also causing the hyoid to not be in the proper place. However it could also cause microfractures which could cause the hyoid to shift in a subtle way.
Let's think about this video in relation to clicking - it seems plausible to me that in _some_ cases muscle tension could create clicking because again, the hyoid is not moving properly, it's being held in the wrong place. On the other hand, an overgrowth of the thyroid cartilage or the hyoid itself could create a situation where the cartilage and the hyoid are colliding, thus the click, even with normal muscle movement.
Take a look at this picture: http://www.mda.org/publications/images/q11-6_Swallowing-Illus.gif - it's worth noting that these muscles literally hold the hyoid in place, thus it's not unreasonable to suspect that if they are either overly tense or uneven laterally, the hyoid will not be in the correct place and will not move properly. It's also worth noting that there are numerous sensory nerves in this area, and if the muscle tissue is tense it's not unreasonable to imagine a pinched nerve sensation.
So, the bottom line is that I think this video explains the symptoms of some but almost certainly not all people with the "hyoid syndrome". Because my own symptoms are so similar to what you'd expect with tension in this muscle (better with swallowing, greatly alleviated by muscle relaxers like Valium, Klonopin or even alcohol, worsened by anything which increases muscle fatigue, overuse or tension) - _and_ because I know for a fact that I have systemic issues with muscle tension throughout my head, neck, shoulders and back -- I find it not unreasonable to expect that my own symptoms may be a result of or exacerbated by muscle tension. It's also worth pointing out that fibromyalgia (which is a fairly controversial disorder but certainly seems to have something to do with muscle tension) is often treated with anti-inflammatories, which opens the door to the idea that excess muscle tension, on its own, can create inflammation (and of course inflammation, on its own, can swell local lymph nodes).
I also have a long history with benzos, and some people who have come off them after being on them for a period (as I did) develop muscle tension issues that continue to plague them for years (decent info on that here: http://www.benzo.org.uk/manual/ ).
It's also worth mentioning that before I developed my hyoid syndrome, I was already fixated on throat problems owing to my history as a smoker and the risks thereof - and in fact I made my first ENT appointment _before_ I developed this problem, and then subsequently developed the symptoms before the appointment!
So, all of that information, is why I am so skeptical about having surgery. It's not that I don't think there's a very good chance that the surgery would alleviate my local discomfort -- it's that I'm far from convinced that this is either the only, or the most logical/safe/effective, way to go about it.
If I hit a point where I feel like all my other musculoskelatal probelms in my neck and head are resolved and this is _still_ kicking my ***, for me personally, that's where I'd reach for the knife.
Hi if you ever come across any case studies or any information that shows non surgical ways to alleviate this problem please let me know. It seems in your case its not as physically impeding as mine and some others here. It would be easier to exhaust all avenues for you than the ppl who are almost begging for help and relief. Have you contacted UCLA? I set up a UCLA number yesterday and spoke to someone who deals with Canadian patients. He hasnt got back to me yet but Im hoping Dr berke will see me and be able to diagnose what ever Im dealing with.
I feel like the clock is ticking for me, in terms of finding a nonsurgical way of dealing with this - but if I do, this forum will certainly be among the first to know. I've been feeling perhaps a bit better for the past week or so, but one problem is that I've sort of taken a "shotgun" approach of physical therapy, Alexander Technique stuff, and a low dose of a medication called Gabapentin.
I'm scaling back the gabapentin, to see if/how that changes the picture. In some ways, the idea of a one-time surgery intimidates me less than the prospect of a life spent taking fairly psychoactive drugs. On the other hand, any surgery ever always has an element of rolling the dice to it, since you just don't really know what's going to happen until it's done.
I should also point out that while I seem to be tolerating this to some extent now, I do think about it almost constantly, and it has driven me to periods of deep depression, panic attacks and a fairly long stint where I was using a fairly crude sort of "opium tea" to alleviate the psychic and physical distress this is creating. I backed off that simply because I did a lot of research into the long-term cognitive effects of narcotics, and found the end result potentially more frightening than untreated hyoid syndrome.
Sorry its only been 5 months for me and I know over time this can really wear on a person. Im glad you got out of your depression and havent gotten addicted to any of your meds. Im very fearful of that of being addicted. Ive never been addicted to anything but ppl lose everything from addictions so its tough not to worry about it. Ive also dealt with the depression parts. Im in councelling and no longer want to jump in front of a bus but as you are very aware this situation is very difficult and trying.
Im not very informed with different physical therapy technigues. So far Ive tried 3 different physical therapists. Ive found anything that gets my heart rate up cause the pressure in my next to get stronger and stronger to a point where it feels like someone is strangling me with all their force. No idea if you get that feeling or not. 24/7 I have that feeling of someone strangling me but its not anywhere near as bad as when my heart rate jumps up. Its tough to do physical therapy when you cant do the simplist of activities. Theyve tried different techniques with me and now are giving me a break since the doctor hasnt seen any results other than my pain being at an alltime high. We think its from the minor movement and activity in physio.
I cant remember how long have you dealt with yours? Im not sure about you but Im a little worried that since wildblue98 had 1 surgery and is now waiting for a second that we also may need more than one. Ofcourse thats if we need surgery. I dont have any insurance and havent worked for 5 months so 10,000 is tough. Hope you find answers and get back to good health sooner than later. Good luck with all this
I've been dealing with this since February 2008. From 2001-2006 I was medically prescribed Klonopin, became heavily addicted to it, and spent close to 18 months slowly weaning off it. I continued to use other non-prescribed drugs in an attempt to self-medicate my anxiety away during this period, and do feel that may have complicated my recovery. I've had systemic muscle and tension problems since coming off the Klonopin, and I do still using benzo medications occasionally on an absolutely-only-as-needed basis, either when my throat sensations or anxiety drive me into panic attacks.
I don't see any correlation between heart rate and severity per se; in fact riding my bike extremely fast is a bit of an escape for me because it provides such insane sensory stimulation that it distracts me from my throat.
My main, and only constant, symptom, is the vague sensation of something "touching" that "should not be touching" in the region of my hyoid. It feels like a vague puffiness, or a slightly swollen sensation. This doesn't sound on paper like it's something most people would even consider surgery over, but there are two complicating factors:
1) the constant nature of the sensation makes it almost impossible to ignore, which is further compounded by
2) I am am extremely anxious person, and I am prone to being "hypervigilant" about all my senses. This causes me to fixate on this throat sensation with an obsessive/compulsive cycle that's hard to escape. In turn, this fixation causes me to literally tense surrounding muscles, which makes everything that much worse.
I have a whole host of other, related symptoms, which while they are not constant, are much more bothersome:
The worst is a "pricking" sensation directly above my hyoid when I swallow (sometimes). At best it feels like a sort of rough patch, at worse it feels like being jabbed with the sharp end of a pencil and it occurs mid swallow, right before the adam's apple begins to descend.
Anything which makes overall muscle tension in the pharynx worse (such as voice overuse, smoking, or consuming dehydrating substances) causes my constant sensation to get worse -- instead of a vauge puffiness, it will swell up until it feels like there's a gosh darn golf ball wedged in there. This is practically unbearable, and when it really gets bad, about all I can really do is pop a valium and go to sleep.
So. I don't know if any of the physical therapy, alexander technique stuff, or therapy that I'm attempting, is going to do _anything at all_ to help with my constant sensation of puffiness. What I'm trying to figure out is, -- would that constant sensation, at it's mildest level, be something that I would consider surgical intervention for, in absence of all the other symptoms? Since all the other symptoms are brought on or aggravated by things I do with my body that I am in full control over, I am hopeful that I may yet be able to remove those from the equation. Because, again, when it's at it's mildest level, yeah I can always feel it, but it doesn't necessarily stop me from enjoying the things I like to do.
I've also found one thing that almost completely takes my mind off this whole thing for up to 40 minutes at a time: sexual intercourse. Becoming a sex addict is probably not a useful way to treat my condition, but it's sure a nice vacation when it works out.
last night as I was feeling around my neck as I often do when I can't control myself, I got the vague impression that the nub at the tip of the cornu on the affected side is at a more severe angle and ascends higher than the other side. Being the genius I am, I proceeded to fairly violently yank my hyoid around left to right, trying to get a good feel for the relative protrusion, and made my girlfriend do the same -- needless to say, this set off a crapload of irritation, and today feels worse than I have in weeks (with the caveat that the past week or two had been a bit better than usual, possibly owing to some combination of PT, stretches and gabapentin).
Moral of the story: keep your dang hangs off your hyoid if it's already bothering you!
Also worth note: I did a fairly extensive google image search for "human hyoid bone" last night, and decided that pretty much every hyoid I could find a picture of looked different than the rest of them in some way, and nearly all of them were asymmetrical in some way. So, while I don't discount that as a possible cause of discomfort for some, it does seem that the vast majority of humanity lives with an asymptomatic, asymmetrical hyoid.
My neck throat area is so sore that I have never been able to play around and feel my Hyoid. I have felt around in the past to see what hurt more and to try and desensitize the area. I cant imagine yanking it around like youve described. Got that sounds painful, wouldnt it swell up the area.
1 of the newspapers here did another story about what happened to me. Some of the online comments are a joke and some ppl think that because doctors cant pinpoint whats wrong that Im not actually injured and this is all a joke....do you or anyone else ever get that type of attitude from ppl or even doctors. in my case every doctor ive seen knows there is something majorly wrong with me but no one has any ideas of what it could be, or if they have ideas its still at the guessing type stage. Someone who read the article wants the guy who stomped me to sue me civily because nothing happened when I got hurt and the fact doctors cant find anything wrong with me proves that Im making this up.....sorry Im a little pissed about all this. just curious if anyone out there has ppl think they are making all this up.
I certainly had a number of ENTs tell me it was in my head or that I had acid reflux or something; I simply stopped seeing them. My family expressed some skepticism initially when I started talking about possible surgery, but at this point they realize I'm clearly in distress and mainly hope I find a nonsurgical solution because of the potential complications of any surgery (as well as the lack of certainty that it will work).
The internet on the whole does not tend to be a sympathetic place; fortunately I haven't had any news articles published about me!
Basically, if people aren't giving you any productive or valuable feedback, ignore them and move on. The world is full of ignorant, unsympathetic people -- and in many ways I was one of them until someone I was close to (my sister) was afflicted with a chronic and painful condition. Many people take what they have for granted until it's disturbed in some way, and this was true of me -- I was fairly reckless in the way I used and abused my body until this condition set it. Now I know better, but still have this stupid f'ing sensation to deal with 24/7, it's enough to drive one to drink or worse.
I agree with your last comment. Ive seen a social worker councellor for month to make sure i dont start thinking poorly. I know its difficult for everyone imagine not being able to work, walk more than a block or two, not help out around the house even doing the simplist of tasks....Even washing dishes I have to fight through the pain and take breaks before I finish them. I understand how ppl could want to drink. Personnaly I would rather take my life then escape through street drugs and effect myself and so many ppl close to me. Thats how Ive always thought about street drugs though, not a fan of them or of medication but I really have no choice with the meds Im on.
I think you said drinking helps relax you. I know it does for me and gives me a little more movement in my neck( not a lot but its noticable to others). the only problem is I pay for in the next day or 2 with even more severe neck pain.
last night as I was feeling around my neck as I often do when I can't control myself, I got the vague impression that the nub at the tip of the cornu on the affected side is at a more severe angle and ascends higher than the other side.
This is exactly what I feel and have on the effected side I have read various studies specifically, Mori et al, which shows that malformations of the hyoid are much more common than accepted and that they can become symptomatic at any time. The malformation of the greater cornua I have found my hyoid to have is exactly how you describe the end of the greater cornua on the side with intense foriegn body sensation is at a severe angle (abnormal lateral curvature) and it ascends noticeable higher than the one on the other side. This exact abnormality was cited in mori et al in several patients who reported abnormal curvature and a hyoid bone that was located superiorly closer to the internal carotid artery. I am convinced in my case this is the abnormality because I can feel it between my index and thumb finger and push it out the side of the neck like the women in mori et al. You should have a look at this study I think ggcb, me ,and you are dealing with a malformation of the hyoid bone at the end of the greater cornu. there is no way it is coincidence we notice such a profound difference on the effected side, the hyoid bone certainly can become altered at the greater cornua reigon and project upward towards the ICA artery. Mori et al shows this in various patients I think this study done by a Japanese team explains what you and I are feeling, as well as GGCB.
If you havent read over this study its "Reconsideration of the hyoid syndrome"
Have a really detailed look at the 23 year old patient mentioned in case 2, this could be our exact abnormality. Out of the 1,000's of pages of reseach I have read on the hyoid bone syndrome this is the one that I feel sheds light on our possible hyoid bone abnormality most accurately and explains symptoms between all three of us with hyoid bones that are assymetrical to the touch.
- An xeroradioagram reveaveled that the left greater cornu was positioned much more superiiorly and upwardly than normal, in the direction of the carotid artery (closeness and inflammation to the carotid artery explains the headaches and vascular pressure in ggcb and my heads even from walking)
- A 2.2 cm length of the greater cornua was excised, as suggested by Kopstein.
-After surgery the patient noted immediate improvement and has remained asymptomatic for 1 year. (again excision of this region of the hyoid bone shows promising relief in all 4 patients outlined in the mori et all study.
- The exaggerated horn shape of the greater cornu of the hyoid resulted in severe pain mimicking glossopharyngeal nueralgia. (this exaggerated horn shape is something GGCB, me, you and I can tangibly feel in the side of our neck see Figure 1 in the same study to get a visual of what I mean here)
- Marked tenderness at the tip of the greater cornu of the hyoid bone was an essential clue in the formulation of the diagonis. (All of us have tenderness to a degree over the nub of the tip of the greater cornua)
This study shows me that most likely that intense foriegn body sensation shared by all three of us is explained by a malformation/structural alteration of the hyoid bone that has become asymptomatic. Patient 1 noted the occurence during a long conversation with a friend ( she resembles GGCB the most and when GGCB gets the email I hope you turn to the second page of the mori et al study I sent you and look at this ladies picture and case history. Patient 2 resembles what miskatonic and I are feeling on a structural level as the tip of the hyoid bone is positionted much more superiorly and upwardly than normal this would explain the constant dull pain in the left side of the pharynx and in the neck region that all three of us feel constantly. I hope that once scott cant palpate his own hyoid bone without pain he will find a similar abnormality. This will only make the case stronger that the thing we share most in common is malformation of the greater cornu of the hyoid bone that has changed position causing forieign body sensation along with other disturbing symptoms.
This study shows me that most likely that intense foriegn body sensation shared by all three of us is explained by a malformation/structural alteration of the hyoid bone that has become "syptomatic" is what I meant.
I should point out that the person who would do this locally has done it a half dozen times, and it relieved the problem in all cases but one, and had no complications in any of those cases. Still, someone with more experience is reassuring.
My plan is to keep going with PT and alexander technique stuff and medication until the end of January, and try like hell to think about this as little as possible in the mean time. If I don't see any improvement by the end of January, I'm going to go ahead and schedule the surgery, either with my local doc here or with Dr. Berke if that turns out to be a real option with my insurance.
I will probably try to read this thread as little as I can possibly stand to in the mean time, because I find that in a real way reading about this stuff just makes me obsess about my symptoms, which makes me anxious and tense which makes the symptoms experientially worse.
Good luck with your operation, WildBlue - I do look forward to hearing about how awesome you feel once you get through the ~3 week post-op recovery period!
"I have this...I don't even have to press it. All I do is turn my head to the left, and when I turn it back to the right, my hyoid stays protruding out the left side of my neck and it can be felt...like a bony knob. One of the ENTs I went to said to me to "leave it alone, it belongs there"...ya right... " -GGCB
What you describe is the exact same greater cornua hyoid malformation that I feel it makes a lot of sense you would also feel clicking in the region coming from this abnormal laterature, and experience severe headaches resulting from the tip of the greater cornua putting pressure on and inlfaming the internal carotid artery. The fact that you can literally push this piece of bone out of the side of the neck from the oppossing side like me and miskatonic really shows there structurally something similar between the three of us that is abnormal. I am interested if you could self examine yourself again with reference to the mori et all study and see if you think the bony knob has abnormal lateral curvature or feels as though the tip is more superior and upward then it should be located, if it is this would be the strongest theory we have come up with on the site to date to explain the foriegn body and disturbing relations that occur when this bone becomes malformed and altered in the direction of the internal carotid artery. I think this could very well be the actual explanation behind our years of suffering and excision of this portion of the bone the final answer.
I was wondering if anyone has a rough idea how many additional tests Dr Berke generally needs done after the original consult visit and how much those test cost. His office told me the consult would be 1200$ and if they need to do any additional tests you would have to put a deposit down on them. I have not picked a date to go down in January yet. Before I do I just need to know roughly how much someone should bring if they dont have any insurance. Im bringing CD copies of my Xrays, CT and MRI so hopefully they wont have to do those tests again.
If anyone out there knows or has a educated/experienced guess it would be greatly appreciated.
Good luck, Stress and worrying about this type of stuff or anything will always cause you to tighten up. Its just unfortunate than in our cases that tightening from stress causes harsher symptoms and a lot more pain. Hope you find answers which ever you you go about things.
Thanks. I just want to be prepared when I end up going down there. If I was wealthy these questions would never have come up. They also told me to be available the day of the consult and 2 full days after just in case tests needed to be done.How long were you there in hours or days with your consult?
Look at how much the hyoid bone elevates and thyroid cartilage changes position during a swallow this really helps visualize what is possibly creating a click when you swallow http://www.youtube.com/watch?v=0jRGvM-J42A
IMAGING CASE STUDY OF THE MONTH HYOID BONE FRACTURE
Article from:The Annals of Otology, Rhinology & Laryngology Article date:April 1, 2004 Author:Gross, Menachem ; Eliashar, Ron More results for: hyoid bone fracture
Blunt neck trauma is fairly commonly encountered in otolaryngology practice. However, hyoid bone fracture (HBF) secondary to blunt trauma is an uncommon condition. ' The patient's history, mechanism of injury, and physical examination are important sources of information in the evaluation of neck injuries. Imaging studies are required for making the diagnosis of HBF. A case of isolated HBF secondary to sports trauma is presented.
A 17-year-old boy was referred to the trauma unit after sustaining a cervical trauma while playing basketball. he complained of local pain, dysphagia, and discomfort on rotating his neck. The findings on physical examination were normal other than tenderness on the right side of the neck; there was no external evidence of injury or crepitus. Flexible laryngoscopy revealed swelling and hematoma at the right tongue base. The larynx appeared normal. A computed tomography scan of the neck revealed a displaced fracture of the right greater horn (lateral crus) of the hyoid bone (see Figure). The patient was hospitalized for observation and was treated conservatively by rest, analgesia, and restriction of head movements. His symptoms subsided within 1 week.
The hyoid bone is located below the mandible and has a U-shaped structure. It is suspended superiorly by the suprahyoid muscles and the stylohyoid ligament, and is attached inferiorly to the infrahyoid muscles.
Hyoid bone fractures are rarely diagnosed for 2 reasons: 1) the hyoid bone is a very mobile structure and is well protected by the mandible at rest; and 2) when the fracture is relatively asymptomatic, the in jury is easily missed.
Whereas strangulation and hangings were the most commonly reported causes of HBF in the past, the most common cause today is motor vehicle accident.2 Other causes are gunshot and knife wounds and sports trauma. In cases of sports trauma as in karate or basketball, the protective effect of the mandible is diminished while the neck is extended during contact, and the hyoid bone is more prone to trauma. In HBFs resulting from strangulation, the squeezing forces push the two horns together, and the fractured segments dip inward. In cases of hanging or in other anteroposterior compressions, the hyoid bone is forced against the C2 vertebral body and the fractured fragment is displaced outward.
Hyoid bone fractures may be divided according to the mechanism of injury into fractures due to inward compression, fractures due to anteroposterior compression, and avulsion fractures.2,3 Another classification is according to the anatomic site of the fracture: fractures of the body (due to direct trauma to the bone), fractures of a lesser horn, and fractures of a greater horn.2 This classification is further subdivided into inward-displaced or outward-displaced closed fractures, and compound fractures.
Hyoid bone fractures usually present with pain in the anterior upper part of the neck or sore throat that is aggravated by swallowing, coughing, or nose blowing. The patient may experience neck discomfort or pain while rotating the neck. In more severe cases, dysphagia, dysphonia, dyspnea, and stridor may appear. Physical examination reveals swelling in the affected area, tenderness on palpation over the hyoid bone, and upper neck pain aggravated by turning the neck from side to side. When the fracture is complicated by pharyngeal lacerations, neck crepitations and subcutaneous emphysema may appear. Mirror laryngoscopy or flexible laryngoscopy is recommended and may demonstrate swelling, hematoma, or lacerations in the pharynx.
The diagnosis of an HBF requires a high index of suspicion. It can be confirmed by a low-voltage lateral cervical radiograph or by a computed tomography scan that demonstrates the HBF on bone windows and other abnormalities on soft tissue windows.
Patients with closed HBFs and mild symptoms should be observed for 48 to 72 hours and should be treated with analgesics and restriction of neck movement. However, in cases of compound HBFs with soft tissue injuries, in cases with associated injuries to the larynx or cervical spine, or in cases of rapid deterioration, proper intervention is indicated. Hyoid bone fractures with pharyngeal lacerations and massive subcutaneous emphysema require endoscopy, cervical exploration, and drainage. Suturing of the pharyngeal mucosa is not indicated, because mucosal continuity is usually restored in 10 days. External compound HBFs require debridement of the wound and fixation of the fractured fragment by wires or miniplates.
In summary, an isolated HBF is rare and is caused by a considerable force to the neck. Any case of HBF should be thoroughly investigated to eliminate associated neck injuries.
A case of external carotid artery pseudoaneurysm from hyoid bone fracture
Article from:The American Surgeon Article date:June 1, 2003 Author:Campbell, Amy S ; Butler, Allen P ; Grandas, Oscar H More results for: hyoid bone fracture
Carotid artery pseudoaneurysms are detected most commonly after acute traumatic injuries to the head and neck. Pseudoaneurysms of the carotid artery are rare after blunt trauma. The most common site of injury occurs in the internal carotid artery with greater than 70 per cent of those injuries resulting from motor vehicle collisions. We report a case of external carotid artery pseudoaneurysm secondary to chronic arterial trauma. The patient presented with a one-week history of left ear pain and a pulsatile left neck mass. Radiologic studies revealed a 2.8-cm neck mass compatible with a pseudoaneurysm of the external carotid artery. Primary repair of the aneurysm was performed. Exploration of the pseudoaneurysm cavity at the time of surgery revealed a fracture of the hyoid bone. We believe this to be the contributing factor to the formation of a pseudoaneurysm in this patient. This is the first reported case of external carotid pseudoaneurysm caused by chronic arterial injury secondary to hyoid bone fracture.
Report of a Case
The patient described here is a 53-year-old man who presented to the emergency department with a one-week complaint of pain and a sensation of fullness in his left ear. He said he had had no recent trauma, infections, dysphagia, or dyspnea. On physical examination he was noted to have a pulsatile left neck mass. He demonstrated no neurologic deficits at any point during his evaluation. All laboratory data obtained were within normal limits. Otolaryngology and vascular surgery specialists were asked to see the patient in consultation after the patient underwent a CT scan and MRI of the neck. MRI exhibited a mass in the parapharyngeal space (Fig. 1). Magnetic resonance angiogram revealed a 2.8-cm neck mass consistent with a pseudoaneurysm of the external carotid artery that was confirmed by digital substraction (DS) angiography (Fig. 2).
The pseudoaneurysm was repaired by direct closure of the arterial defect of the external carotid artery just distal to the common carotid bifurcation. Exploration of the psuedoaneurysm cavity at the time of surgery revealed an old hyoid bone fracture. The sharp edge was in direct contact with the external carotid artery at the level of the arterial defect. At the conclusion of the procedure an otolaryngologist removed a portion of the hyoid bone and covered the defect using the strap muscles of the neck. There were no postoperative complications. Follow-up at 3 months with a carotid duplex demonstrated no recurrent pseudoaneurysm, a stenotic external carotid artery, and a normal internal carotid artery.
A pseudoaneurysm can be defined as a localized arterial wall disruption caused by blunt or penetrating trauma, vascular intervention, or anastomotic disruption. Blood is contained within the space of the pseudoaneurysm outside the arterial lumen by adjoining tissues and fibrous reaction. Carotid artery pseudoaneurysms are detected commonly after acute traumatic injuries to the head and neck. The most frequent site of injury occurs in the internal carotid artery with greater than 70 per cent of those injuries resulting from motor vehicle collisions. Mechanisms of injury involve trauma to the head and neck region including hyperextension/rotational, blunt intraoral trauma, direct compression of the neck, and injury to the base of the skull. The physical findings associated with carotid injury include expanding hematomas, audible bruit, pulsatile neck mass, palpable thrill, or any neurologic symptom not explained by another injury.1 The incidence of carotid injury among trauma patients was shown to be 0.27 per cent in a retrospective review of Kraus et al.2 with one-quarter of those patients having an associated pseudoaneurysm. Despite the relative infrequency of carotid injury the mortality rate can be as high as 33 per cent.1 It is imperative that carotid injuries receive immediate treatment to prevent long-term neurologic sequelae. Angiography is considered the gold standard for diagnosis of carotid injury. If a carotid injury is suspected on the basis of the mechanism of injury a screening examination can be performed using Doppler ultrasound. Recent studies have shown Doppler ultrasound to have a sensitivity of 92 per cent for detection of blunt carotid injuries.2 Alternative screening modalities such as CT scan are not always reliable as they may be confounded by other injuries and on initial evaluation appear normal.
Management options for carotid injury have been reviewed extensively in the literature. It is felt by some that dissection injuries alone may be managed conservatively with the institution of early anticoagulation.2, 3 Conversely the recommended management for those patients with a pseudoaneurysm component is surgical intervention when anatomically amenable to repair.1, 2 We performed a direct repair of the arterial defect.
Changing technology and the increasing application of endovascular techniques for the treatment of vascular disease allows one to give consideration to minimally invasive procedures for the treatment of traumatic carotid disease. A study by Coldwell et al.4 has reviewed the use of endovascular stents for the treatment of posttraumatic internal carotid artery pseudoaneurysms. All patients with pseudoaneurysms were stented and shown to have no signs of occlusion post-procedure. These patients were monitored for a 16-month period with no increased morbidity secondary to stent placement. The results at this time have been positive, but patients will require further follow-up before routine stenting can be considered for traumatic carotid injuries. Endovascular repair in this case was not indicated because of technical considerations associated with stent deployment near the takeoff of the internal carotid artery.
Although pseudoaneurysms of the external carotid artery are rare they must be considered in the differential for patients who present with a pulsatile neck mass. As we have seen with this patient a history of neck trauma or neurologic deficit may not be present at the time of evaluation. A high index of suspicion should lead to a screening Doppler ultrasound to be confirmed by angiography. The current treatment recommendation is for immediate anticoagulation followed by primary repair of the pseudoaneurysm. If treated expeditiously these patients can be spared the neurological sequelae that can evolve over time.
Traumatic fracture of the hyoid bone: Three case presentations of cardiorespiratory compromise secondary to missed diagnosis
Article from:The American Surgeon Article date:September 1, 1999 Author:Kaufman, Henry J ; Ciraulo, David L ; Burns, R Phillip More results for: hyoid bone fracture
Hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounting for only 0.002 per cent of all fractures. The world literature reports only 21 cases. Surgical intervention involves airway management, treatment of associated pharyngeal perforations, and management of painful symptomatology. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missed diagnosis. We submit three cases with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients required emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was managed conservatively. After fracture, the occult compressive forces of hematoma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning, leading to cardiorespiratory collapse. With endotracheal intubation prohibited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion based on mechanism of injury is mandated.
COMPLEX, LIFE-THREATENING injuries to the trauma patient mandate strict adherence to systematic assessment. Inherent problems exist, however, with rapid assessment of the trauma patient. Subtle, life-threatening injuries may be missed. One such injury is fracture of the hyoid bone. We present three trauma patients who suffered fractures of the hyoid bone. One of these injuries necessitated emergent cricothyroidotomy in the field. Another injury was missed during the initial resuscitation and assessment, resulting in cardiorespiratory embarrassment en route to the operating suite and required an emergent tracheostomy. The third injury was missed on initial presentation to the emergency department and was diagnosed on the patient's return for dyspnea. The discussion addresses the rarity of this fracture, mechanism of injury, treatment, and potential life-threatening ramifications of missed diagnosis of hyoid bone fracture.
A 34-year-old male was a backseat, lap belt-restrained passenger in a military vehicle that struck a tree head-on at a moderate rate of speed. Paramedics on the scene noted stable vital signs, facial contusions, and lacerations with no reported loss of consciousness.
The patient was admitted to the emergency department with a chief complaint of severe lower back and abdominal pain. The patient was noted to have an adequate airway and stable blood pressure, but remained tachycardic despite a 2.5-liter crystalloid resuscitation. A laceration to the bridge of the nose and an abdominal contusion with lap belt distribution were observed.
Under Advanced Trauma Life Support protocols, a diagnostic peritoneal lavage was performed and found to be grossly positive. Chest and cross-table cervical spine films were normal. Pelvic films revealed a fracture of the third lumbar vertebral body. The cervical collar was removed under manual cervical stabilization, and the neck was examined. No disfigurement or swelling was observed. No crepitus or tenderness was elicited, and the collar was replaced.
En route to the operating suite, the patient complained of shortness of breath, accompanied with frequent multifocal premature ventricular contractions. The patient arrived in the operating suite without further incident. While attempting intubation, difficulty was encountered secondary to obstructive edema and swelling of the hypopharynx. With the patient hypoxic and bradycardic, needle cricothyroidotomy was performed, followed by emergent tracheostomy. With the airway secured, the patient's hypoxia, bradycardia, and ventricular irritability resolved. At operation, a mesenteric and sigmoid tear were treated by Hartman's procedure without incident.
Postoperatively the patient underwent further radiological examination. CT revealed swelling in the trachea and hypopharynx. A fracture of the right lateral aspect of the hyoid bone with associated massive soft tissue swelling was diagnosed (Fig. 1). With conservative care, the swelling resolved and the patient was decannulated before discharge with no further complication.
The second case involved a 35-year-old male unrestrained ejected driver in a rollover motor vehicle collision. The air medical crew arriving at the scene found the patient unconscious with obvious facial trauma and an obstructed airway. The airway was suctioned, an oral airway was placed, and bag-valve-mask ventilation was initiated. Chest rise was shallow, and air movement inadequate. The patient was chemically paralyzed in preparation for endotracheal intubation. Two attempts at intubation were unsuccessful due to inability to visualize normal anatomical landmarks, and a cricothyroidotomy was performed.
The patient was transported to the emergency department without event. After initial resuscitation and evaluation, CT revealed extensive mid-facial fractures and a fracture of the greater cornu of the hyoid bone with obstruction of the hypopharynx due to tissue edema and hematoma (Fig. 2). The patient was transported to the operating suite for conversion to a tracheostomy. After a 12-day hospitalization, the patient's tracheal cannula was removed. No further airway intervention was required, and there were no longterm sequelae as a result of the hyoid bone fracture.
The third patient was a 36-year-old male with a past medical history significant for seizure disorder and medical noncompliance. The patient was initially evaluated in the emergency department after a witnessed seizure. The patient reportedly fell forward from a standing position, striking his anterior neck on the cabinet of a television set. An initial assessment was made, and a cervical collar was placed. Blood levels of the patient's anticonvulsants were drawn, found to be low, and treated appropriately.
Routine radiographs of the patient's neck were found to be free of fracture. Clinically, the patient complained of high anterior neck pain. Tenderness could be elicited medial to the angle of the jaw; no dyspnea was noted. The patient's neck was cleared, and the collar was removed. The patient was discharged from the emergency department after neurology consultation.
Eight hours later, the patient returned to the emergency department with complaints of dypsnea, dysphonea, and odynophagia. The patient was admitted and underwent CT of the neck, which revealed a fracture of the lateral mass of the hyoid bone (Fig. 3).
Surgical consultation was obtained. The patient was admitted to the intensive care unit, given intravenous hydrocortisone with a tapering schedule, and tracheostomy tray and intubation supplies were placed at the bedside. By the following morning, the swelling had clinically stabilized.
The patients was observed another 24 hours on the surgical ward and discharged on hospital day 3.
Obstructive injury to the airway is the second most common cause of death associated with trauma to the head and neck.' Hyoid bone fractures, in isolation or in conjunction with laryngotracheal complex injuries, are rare,2 accounting for only 0.002 per cent of all fractures. The low incidence is presumed to be secondary to the protective position of the mandible and the elasticity of the muscles associated with this structure.3 The elderly are particularly at risk due to osteoporotic changes.4 The difficulty in diagnosing this injury contributes to its rarity in reported literature. CT is essential in the diagnosis of hyoid bone fracture because subtle findings on plain radiographs may be obscured by the patient's jaw and soft tissue mass.
An assessment of injury mechanics has identified two plausible scenarios, direct impact to the laryngotracheal complex (Fig. 4, A and B) or avulsion fracture secondary to either sudden hyperextension (Fig. 4C) or forceful swallowing.2 An unrestrained or lap belt-- restrained occupant of a motor vehicle is particularly at risk when rapid deceleration hyperextends the neck and throws the subject forward against the steering wheel, dashboard, or seat back.2,5,6 This exposure of the laryngotracheal complex places the hyoid bone in a position of vulnerability.2,5,7,8
The first case report presented a lap belt-restrained backseat occupant. In that incident, the hyoid bone is believed to have been fractured as a result of pendular motion of the torso and head during deceleration, causing the neck to come in contact with the back of the front seat. It is apparent that lap belt restraints are inadequate in preventing these types of injuries, verifying the importance of additional restraining devices.
Hyoid bone fractures are easily missed during the initial evaluation and resuscitation of the trauma patient.3 In the presence of a stable airway, negative cervical spine radiographs, and adequate cervical stabilization, attention is often given to more apparent injuries, postponing physical inspection of the neck. Patients with potentially life-threatening neck injuries may be asymptomatic on initial presentation.5,8 Therefore, a high index of suspicion for laryngotracheal complex injury must exist if the patient involved in a motor vehicle collision was unrestrained or wore a lap belt restraint.2 Patients presenting with trauma to the anterior neck, dysphonia, dyspnea, or dysphagia warrant immediate evaluation of the laryngotracheal complex.8,9
Objectively, examination of the neck may reveal ecchymosis, edema, or crepitus, raising the concern of airway perforation.2,3,10 However, physical examination may reveal no gross abnormality despite the presence of substantial laryngotracheal injury.' Palpation of the laryngotracheal complex, in the presence of hyoid bone fracture, will usually elicit severe discomfort in the alert patient.1,3,8,10
The American College of Surgeons Committee on Trauma has emphasized the importance of airway management in the multiple-injured trauma patient. The primary survey mandates airway control as the initial phase of resuscitation. The aforementioned case presentations demonstrate how subtle injuries can complicate airway acquisition. Recognition of subtle clinical and/or physical findings are critical in the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances.
I have been reading through the last of the articles I have collected in researching the hyoid bone and I noticed that fractures in this area can actually lead to a collapse of the cardio respiratory system, I do not know about you but since my injury I have noted chest pain, high blood pressure, and intermittent twinges and spasms in my chest my ekg was normal but I really wonder if a more minor hyoid bone injury can interfere with the cardio respiratory system when the bone begins to put pressure on the internal carotid artery. I was wondering if you have had an discomforting sensations involving your cardiorespiratory system or pain in the lower left sternum the operation does not scare me at all besides this one symptom of intermittent chest painI have been having I cannot figure it out one doctor felt it was inflammaton of my rib cage but I think there may be a connection with the internal carotid artery. I was interested what you guys felt on this.
I've had intermittent stabbing pain in the lower right sternum, but I'm quite sure that's unrelated because it matches the symptoms of gall bladder attacks exactly, and an xray that I had prior to hernia surgery last year revealed that I had a distended gallbladder.
Traditional Chinese Medicine holds that gallbladder / liver problems can cause "Plum Pit Qi" which is essentially the TCM condition that explains hyoid syndrome -- but that sounds more than a little like quackery to me. My blood pressure is completely normal, as well.
That said, by all appearances I have a more minor variation on this condition than most of the people in this thread.
Additional comment - my alexander technique lessons seem to have a short lived but fairly dramatic effect on reducing the degree of discomfort I experience, so i will certainly continue to plug ahead with that for another six weeks or so before making any decisions about surgical intervention.
Daniel I need to ask a huge favor I am scheduled for surgery and have my ct soft tisse of the neck topograms 1.0 T20s I just posted it on my profile. Do you have any CT images from this angle that we can compare to get a better look at the left greater cornua of the hyoid in the anterior region my hyoid bone looks like the abnormality in the mori et all study I posted to left of my ct scan in which the xeroradiogram shows a similar superiorly and upwardly bent greater cornu in the direction of the internal carotid artery.
Just relax and don't worry about it. Get some of that sore throat lozenge stuff, and see if you can get some codeine (suppresses cough and helps with pain, it's OTC in VA and many other states and any reasonable doctor should be willing to give you a bottle of codeine cough syrup if you're legitimately sick).
In any case, don't worry about it much; whatever is causing your discomfort, muscle tension can and will make it worse, and anxiety is a direct cause of muscle tension. You will get sick, and then you will get better, and that's all there is to it.
Excuse my English.
Have been operated by Dr. Berke August. The operation went well: the foreign body sensation in the throat is decreased. There remains the feeling of something stuck in my throat when I speak, in the midst hyoid bone.
My worst symptom has always been difficult to speak loudly.
My hyoid bone appears to be moving towards the left but do not remember if it was so even before the operation.
I suspect that my condition, in addition to the hyoid bone asymmetry, is similar to Eagle's syndrome because all my problems started after tonsillectomy but by CT scan not seen any calcification of stilohyoid.
I can not go back to Los Angeles because it is too expensive, I'm looking for an ENT in Italy that can assess my condition.
I have no pain, just feeling very uncomfortable when I talk on the left side of the throat, especially in the low notes.
Someone 'else has similar symptoms?
My operation with Dr. Berke went well he removed both sides of my hyoid bone greater cornu about 3 cm on each side. I have had some mild swallowing problems but am getting better, I still have a feeling of foriegn body on both sides where the bone was removed, there is a lot of inflammation, so it is too soon to tell anything meaningful but I will keep everyone posted. After having the operation I am convinced the symptoms are coming from the region where the the muscles and tendons insert into the greater cornua of the hyoid bone and are inflamed. The recovery time for this operation is 3-6 weeks at the least so I dont think any thing I say now is meaningful I hope this works for all of us who have to live with it.
for anyone trying to go the drug route, Neurontin (Gabapentin) seems to be mildly effective for me. Benzos are highly effective, but are a lousy long term solution owing to tolerance and addiction issues.
Alexander Technique lessons have been somewhat helpful, but it will be another month at least before I can say how well that's working.
congrats on your surgery I hope the results are what we all want.
Im heading to see Dr Berke at UCLA monday Jan 11. The consult visit is 1200 with a possible deposit if they need to do more tests. For anyone who hasnt seen Dr Berke I will write my experience here once Im done and back in Canada. Hopefully the visit is helpful to me and what ever experience I have can be helpful to others thinking about flying to LA.
Hmm, this is somewhat interesting. There are a few related symptom complexes to the hyoid syndrome, being variously described as Eagle's Syndrome, Ernest Syndrome, etc. Something I was reading about Ernest/Eagle's indicates that "prolotherapy" can be useful. This is a connective tissue therapy, so it's only going to be useful to people who have problems arising from tendon/ligament problems. I'm not sure who else on here this applies to, but I've long suspected that my own problem is essentially a tendinitis like problem (having essentially the same symptoms, and having started shortly after a dental procedure that strained the hell out of my neck/jaw muscles).
Prolotherapy had been in the gray zone of alternative medicine for a while, but it looks like over the past ~decade it has gained some degree of medical acceptance for some conditions. Amazingly, there's a pain management clinic 3/4 of a mile from my house that has some experience with this. The basic idea is that they inject a mixture of anesthetic and dextrose directly into the affected ligament group, which causes an increased inflammatory response, causing the affected cells to generate more cellulose and heal completely in a way that the body has been unable to do on its own.
This seems a little flaky, but doesn't really seem to have any risks associated with it (compared to surgery, or even steroid injections which directly damage the tissue they target).
If I get anywhere with this, I'll be sure to update the group.
Hmm! Looking back a couple pages, I see you're quick to dismiss prolotherapy as pseudoscience BS - but you also mention "needles in the spine". The limited information I can find on this suggests that using prolo to treat Ernest/Eagle's involves spiking the stylomandiular ligaments directly, and not the spine. Are we talking about the same thing?
Regardless of how useless it may or may not be for this condition, I'm not willing to dismiss the whole idea as the same sort of pseudoscience bs you get with Chrio, because several peer-reviewed studies (including the mayo work I mentioned above) have cropped up over the past ~five years indicating it's more effective than placebo for certain ailments.
One thing to keep in mind with all that -- if you have a muscle problem to start with, or if you have a strained/stretched ligament/tendon that causes the muscles to tighten up reflexively (which is what happens with a ligament strain, muscles tighten to compensate for a slack ligament), then this will no doubt cause connected structures (in this case the hyoid) to be held in the wrong position, which can probably lead to it colliding with things.
I remain to be convinced that chopping up bones is the be-all end-all solution to all of these problems. In my case, major muscle relaxants all but make the problem vanish, because it forces abnormally tightened muscles to relax. I'm not suggesting that a lifetime of sedatives is a good solution, either -- but if this was (for me) arising from a purely structural problem with the bone, you would not expect muscle drugs to make one whit of difference.
Scusa il mio cattivo inglese.
Io mi sento meglio con qualche goccia di clonopin (clonazepam).
Io credo che per alcuni di noi il tutto è cominciato da un uso sbagliato della muscolatura della gola. Io ho un passato di gerd e muscle tension dysphonia che, in seguito al trauma dell'operazione alle tonsille, ha modificato i legamenti. Infatti ho dolore e tensione anche quando non parlo o deglutisco, soprattutto la mattina al risveglio. Sembra proprio una tendinitis.
Io ho fatto la surgery a ucla ma non ho risolto tutti i problemi perchè penso che quando sono compromessi muscoli e legamenti è davvero difficile diventare completamente asintomatici.
I made a mistake!
I published my post in Italian! Sorry! :-))
Excuse my bad English.
I feel better with a few drops of clonopin (clonazepam).
I believe that for some of us it all started from a wrong use of the muscles of the throat. I have a history of GERD and muscle tension dysphonia, following the trauma of the operation of the tonsils, has changed the ligaments. In fact I have pain and tension even when I do not speak or swallow, especially in the morning upon awakening. Sounds like a tendinitis.
I did the surgery at UCLA but I have not solved all the problems because I think that when they are affected muscles and ligaments is very difficult to become completely asymptomatic.
I agree with both of you guys completely after having two surgeries one to remove both superior cornuas and both greater cornua it has become obvious to me that this is mostly a ligament or tendon injury that has rendered the already mobile hyoid segment hypermobile causing it to bump into its nearby structures and cause painful symptoms. Cutting away the parts will help the symptoms but it is not addressing the actual problem which is tendon/ligament laxity. The most likely structure to lead to a chronic debilitating condition in this area would not be the muscles, and since I have the ligaments removed completely along with the hyoid bone, I suspect the intermediate tendon of the diagastric muscle could still be causing the symptoms of foreign body in the throat. The hyoid bone excision is currently considered in medical journals one of the best and most effective treatments to improve this insertion tendinitis condition that resembles tendinitis in other areas of the body where an inflamed tendon passes under a synovial sheath which is the pivot point for the hyoid bone, this area of the hyoid bone is noted to be the point of maximum mechanical strains and anatomically would be the most likely place to develop a chronic and symptomatic tendinitis. One can only hope that a hyoid bone excision will provide enough relief of this painful tenosynovitis which is seen secondary to overuse in other tendons with synovial sheaths. I feel very strongly that the pain arising from the greater cornu of the hyoid bone is due to tendinitis or tendinosis of one of the muscles inserted into this anatomical structure must likely being the intermediate tendon of the diagastric muscle other studies have also cited a degenerative injury of the middle pharyngeal constrictor muscle. Since there are nine muscles, 1 tendon, and 1 ligament it would be impossible to truly know which one of these or combination of them is creating a hyoid bone syndrome that is why cutting out the entire greater cornua with its ligament attachments and muscle insertions may still be the best solution at this point in time. I have already noted some improvements in my 2 weeks since the surgery (speak for longer periods of time with less pain, no more clicking of the hyoid against the tranverse, and reduced intensity in foriegn body sensation and increased flexibility of the neck) hopefully it will heal itself to a point it is not so bothersome.
I am so glad you are feeling improvement after this last procedure. I still have a dislocated rib that nobody seems to be able to fix as of yet, so my trip to UCLA is off until I can get that resolved since it would be too painful to travel like this.
Since you have been through both procedures, I do have some questions for you (and more coming):
Out of the two surgeries you had, which one made you the most uncomfortable after surgery?
How bad was the swelling caused by each of the procedures?
Which one of the two procedures do you feel made the biggest improvement in your condition?
You mentioned some swallowing issues after this last procedure...did the doctor say that it was normal to have swallowing issues after this surgery?...what were the issues, are they resolved, and how long did it take the swallowing issues to resolve? Did you have to do something special (PT) in order to make it resolve or does it just resolve on its own?
Which of the two procedures have the longest recovery time?
Which of the two procedures have the most risks involved?
Keep me informed on how your recovery goes and how your symptoms resolve over that time.
Out of the two surgeries you had, which one made you the most uncomfortable after surgery?
The second surgery was a little more difficult since both greater cornuas were removed at the same time along with the attaching muscle insertions it was done under general anasthesia, but since I knew what to expect from the first surgery the overall experience ended up about the same in terms of pain. They are very similar procedures and the actual excision of the bone also feels like a very bad strep throat but nothing devastating.
How bad was the swelling caused by each of the procedures?
The swelling was a little worse from the second procedure I could not seem to get barely any water down my throat for the first two days so I got dehaydrated.
Which one of the two procedures do you feel made the biggest improvement in your condition? The hyoid bone excision has definitely made a bigger improvement although it is really too soon to tell how much bigger because the recovery time takes 4-6 weeks.
You mentioned some swallowing issues after this last procedure...did the doctor say that it was normal to have swallowing issues after this surgery?...what were the issues, are they resolved, and how long did it take the swallowing issues to resolve? Did you have to do something special (PT) in order to make it resolve or does it just resolve on its own? Yes swallowing issues is normal for everyone after this procedure because of the region they are operating causes inflammation of the swallowing muscles and will make it difficult to swallow liquids, this lasts for a couple days and then will subside, No PT is needed the issues should resolve on there own.
Which of the two procedures have the longest recovery time?
The hyoid bone greater cornua procedure has a 4-6 week recovery time and it can take up to 3 months to notice full results. I can say though after 2 weeks you should feel good enough to return to work.
Which of the two procedures have the most risks involved?
They have very similar and comparable risks the exact risks should be discussed with the surgeon.
I just wanted to thank everyone who ever posted here and all the ppl that tried helping and giving me added information. I saw Dr Berke and his team on Jan11. My consult lasted 3 hours and was scoped 3 times. My condition is somewhat similar to some of you but I stood out like a sore thumb once I was there. Theyve concluded I have no issue what so ever with my hyoid, cricoid and everything in the front part of my neck. Now I have to see more doctors to figure out why I have these sypmtoms and why they seem to be controlling my life.
For anyone thinking about going to see Dr Berke all I can say is that He and his staff treated me with class and was a pleasure to deal with.(the 3 scopes and him playing with my neck was aweful but its nothing I didnt expect) Im from Canada so maybe every Doctor is like that in the US. I couldnt believe how well I was treated and how much effort they were willing to go to rule things out. If I had been in LA longer and had the Money they would have even referred me to 2 other ppl in hope of figuring out my condition. I would recommend Dr Berke to everyone even though I didnt get a diagnosis.
I wish everyone here the best of luck in their recoveries and in their lives.
I find it really interesting they could find nothing wrong with you with that level of debilitation. I posted a new picture I am curious as to where your pain coincides to the muscles and tendon insertions into the hyoid bone and where you feel that weird popping sound. If I were you I would be looking towards a possible injury to the carotid artery or intermediate tendon of the diagastric muscle as possible source of your pain. I can say after the surgery to remove both sides of the hyoid bone it has helped my speech and have noted improvement in my baseline symptoms but I remain with the foreign body sensation, I feel strongly this is being caused by the chronic inflammation of the synovial sheath and the intermediate tendon that passes through this sheath. When this tendon becomes inflamed it creates tenosynovitis which as you can see in the diagram posted the tendon is right next to the carotid artery it could inflame the outer sheath (sympathetic complexus) of this artery and create devastating symptoms. Inflammation of a tendon or the lining of a tendon sheath. This lining secretes a fluid that lubricates the tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering. There are three main reasons I suspect this tendon as the primary source of pain and I hope that you gaining a better understanding of this structure could lead to a possible cure.
1. My identical twin brother has developed the same clicking in the exact region of the anterior neck, foreign body sensation, and stroke like headaches though to a slightly lesser degree not warranting surgical intervention at this moment in time. We have been playing tennis at a national level since a very young age and subjected our necks to excessive torque and rotation repeatedly for hours a day (The service motion being most violent). This slowly and silently weakened the tendon segment and then one day we each had a trigger episode that sent it over the top he was doing pushups and I was lifting something heavy, and in the same course of a year we have both come down with the same constellation of debilitating symptoms. The only thing that has not been cut out of me that fits this criteria of an overuse injury and is known to cause chronic pain and that I share in common with my identical twin who serves as a scientific control and has all the same symptoms to me is the intermediate tendon of the digastric muscle and this is where all my residual pain lies in this very focal region.
2. Tendons unlike muscles which repair quickly have a very poor oxygen supply once they are damaged they do not repair well, coupled by the fact that they are composed of millions of nerves even a micro tear in a tendon structure could lead to a debilitating condition. The inflammatory cells released from the intermediate tendon of the digastrics muscle are in close enough proximity to the carotid artery that they can create migraine stroke like headaches, repeated hyoid bone suffers on this site have sought MRA’s thinking they had a tumor, or possible aneurysm when these tests come back normal it shows that this headache symptom many suffers I spoke to share in common is mostly likely resulting from the irritation of the delicate nerves along the sympathetic complexus of the carotid artery. I believe it takes only a small microtear in this tendon to inflame the adjacent sympathetic complexus of the carotid artery to the point it creates a headache.
3. The condition resembles tenosynovitis in other parts of the body. These include pain on palpation, pain on passive tension, and pain on muscular contraction. I do not hear clicks when I am up and walking during the day but when I am laying down it bed at night or to rest and turn my head in the right manner I feel a distinct friction between two structures my pain emanates from this region of friction as it does in my identical twin brother who once again serves as a control. No, this weird constellation of foreign body sensation, headaches on exertion and anterior neck pain are not in our imagination there is a mechanical deficiency though not directly recreatable by palpation it is often felt and heard especially in instances of stress on the joint (like lifting the head up from the couch). I strongly believe this distinct mechanical grinding/catching/ noise is the friction of the inflamed tendon mechanically dysfunctioning as it tries to smoothly path through the sheath, like other cases of tenosynovitis it has lost its fluid motion because the tendon has become inflamed and now cannot glide smoothly through the sheath.
I suspect my residual pain is from microtears in this tendon (the only tendon in the hyoid bone region) and only soft tissue structure with poor oxygen supply and poor healing capabilities that remains in my hyoid region. I have had tenosynovitis in other parts of my body from overuse injury and the residual pain feels very similar. I would look into getting your arteries checked for a possible dissection (at least to rule that out) and maybe some diagnostic lidocaine and steroid injections into that tendon if that is where your pain is coming from. They hyoid bone procedure has been shown to completely cure the tenosynovitis and I know that it has only been 4 weeks for me, but I feel strongly that the inflammation of a tendon in the hyoid bone region which serves as the pivot point and area of greatest mechanical strain for this apparatus could be responsible for several of the debilitating chronic pain conditions described on this site. .It is a vicious injury because what happens is once this tendon gets stretched the supporting hyoid apparatus which is already mobile can become hypermobile this can create the clashing of nearby structures with head rotation. I know our cases may be completely different but I just want to let you know based on my research that I completely agree with three of the other sufferers Luca, Adam, and Tristan that this is most likely a tendon injury ( a chronic tenosynovitis), most likely microtears in the tendon that has loosened the tensile strength of the tendon (damaging the correct alignment of collagen fibers) leading to a chronic inflammatory cycle that is difficult to break and has the potential to inflame nearby arteries and the adjacent throat tissues creating that distinct foreign body sensation and stroke like headaches. I strongly suspect a micro-tear tendon injury in many of the sufferers on this site has rendered the hyoid apparatus hypermobile and is inflaming nearby structures.
I am not sure if I am suffering from the same thing. I have some similiar symptoms.
Two days ago, I felt like something was stuck in my throat - like a popcorn shell. I started to cough/gag to get it out but I don't think anything was really there. I began massaging my throat in case the feeling was due to muscle tension. The feeling then went away but it looked like my one tonsil started to swell a bit (not sure since I never really look at my tonsils). It felt like a lump in my throat when swallowing. The next day, I was sitting at the computer and it felt like a bone in the front of my neck keep popping. I felt my mother's throat and hers pops too, but not as often as mine did. If I swallow, then turn from left to right the bone (I believe the hyoid) keeps popping. It doesn't really hurt, but I feel it. If I don't turn my neck to pop it, I get pressure in my throat. Could I have done something to my neck by massaging it? I did not do it really hard. I had an endoscopy done today and nothing was blocking my throat.
I have been reading all your posts and not sure if this is the same thing. You all say that you are in so much pain, where as mine is more of a tension build-up in the neck until the bone pops. Note that it does this on it's own, I do not have to pop it back in to place or anything.
Also, I forgot to mention. When I stand straight, and move move my arms diagonally in a punching motion, my windpipe seems to become somewhat not aligned. I don't feel anything, but my breathing changes to more of a weezing type sound. I can breath fine, but it feels a bit different and sounds funny. Not sure if anyone else has experienced this.
there seems to be a wide spectrum in terms of severity of these symptoms. My principle complaint is a foreign body sensation in a very localized area in the rear left of the throat, more or less behind and slightly below the tonsil on that side. That tonsil has been slightly larger than the other side for at least as long as this is going on (since Feb. 2008). I can strongly identify with the "urge to burp more", and often doing so provides some degree of momentarily relief.
When I over stress these muscles (especially through vocal overuse), then I get a bunch of pain and lose my voice quickly. Other than that, I have intermittent pain sensations radiating to the left ear and the top of my skull on the left side, but nothing like what some people have described.
I'm going to be seeing a pain clinic that specializes in various newfangled nonsurgical interventions next week; I've more or less given up on ENTs, for anything besides surgery, which I am not yet ready to do.
I suspect that removing the intermediate tendon of the digastric muscle entirely may not really be an option; that's the only thing that holds the digastric muscle together at that point, and I don't know that the mandible can function properly without it.
My pain is more in the center part of my throat in what Dr Berke said was the Cricoid area/right around my adams apple. When they played with my neck the hyoid bone wasnt that painful but the center part of my neck brought on so much intense pain. They scoped me 3 times and all 3 doctors concluded that I have no injury to any part of the front part of my neck. They know I have pain and sensitivity to the front area but their thoughts were these.
1- I have a spinal cord injury and I have referred pain in the front of my neck from that. So I should see a orthopedic doctor and get a CT of the cervical spine.
2- I have a brain/psychological trauma injury which makes my body shut down and its still trying to protect itself from the severe assault and injuries I received. They thought Hypnotherapy would help and eventually I would recover.
I told that to 2 of the doctors that deal with me the most here. 1 said its neither of those but has no idea what it is and Im seeing ppl more qualified than he is so he unfortunately cant help me. The other said my CT and MRI which Dr Berke looked at were normal and showed no abnormalities so he was going to dismiss Dr Berkes first thought on a spinal cord injury.To his defense this doctor is a sports medicine doctor and deals with pro athletes so I trust him. I just find it all very odd.( the differences in opinions)
Im seeing a hypnotherapist on friday and am going down that route for now. Ive been told the Mayo clinic use to Guarantee a diagnosis but I dont know if they still do and Ive been quoted 2 different prices 1 13-15000 and the other 25000$ on average. Since I dont have the clicking sound and Ive seen Dr Berke I think I can say I dont have the same injury as some of you, I really thought your symptoms and mine were so very similar minus mine were more severe and physically restricting and that you had a click and I didnt. I might check in later to see how you are recovering.
I found that article on muscle fiber aberrations of the diagastric and stylohoid very interesting. The fact that these muscles can create a strong constellation of symptoms similar to Eagle's and what some of us are experiencing is something that should be taken into consideration. I also found it interesting that the diagastric and stylohoid are what keep the hyoid bone from being hypermobile so if the intermediate tendon involved in the support of these structures was weakened it could technically render the entire hyoid bone apparatus hypermobile. I think there may also be degenerative changes in the tendon or muscles before something sets it off which would explain why some people have had such minor trauma create such a long cycle of pain, the structure was probably weakened to begin with just not to the point it was symptomatic.
So the pain you say you are experiencing is coming from where this lady is pointing? http://homepage.mac.com/changcy/globus.htm
I found this very interesting it says that this muscle can hypertrophy and scar and cause that lump in the throat feeling. This might be something for you to take into consideration.
Yes I would say thats the spot for me.Dr Berke played around in that area with his hands and made something move back and forth. The Pain I experienced after was more intense than I can describe. In that middle area and under my jaw like someone was strangling me to death. Even my Jaw bones closer to under my ears but more to my face/cheek area felt like the bones were being crushed in a vice. I do have a lot of pain in the back of my neck and on the sides but it feels like a muscle strain and that hurts but as someone that use to be athletic muscle strains are normal to deal with. What Im getting at is eventhough my neck hurts like a whiplash patient my real pain is all in front part of my throat right where that lady was pointing in that link you sent me.The pain Does seem to move upwards when i get my heart rate up. Im at a loss of what this is. Dr. Berke as you know is probably one of the most qualifies doctors in this field in the world. If he and his staff dont think I have an injury in the front part of my neck I have to agree with them. Now its just finding why I have these symptoms, and more importantly how can I overcome them so I can walk more than a block or 2 a day ontop of all the other issues(and get back to work). I still cant turn my head to the left or up and I can barely turn it to the right. None of this makes sense but ppl in Haiti and all over the world are dealing with worse issue than i am and we are so I have no right to b-tch and complain.
Sorry Andrew I wish I could help everyone here but I cant even help myself and Im losing faith fast.
I wanted to tell you that I saw a hypnotherapist on friday. 15min after the session I could turn my head, 90% of my pain went away and I could walk more than 1-2 blocks for the first time in over 6months..I actually somewhat ran. I have new muscle pain all over but man its a great pain. It was the best day of my life. I dont know if that would work for anyone else here since my injury was an assault/trauma related injury but its worth trying. All this happened because Dr Berke mentioned it as a possibility. And since you and this site and my research convinced me to go see Dr Berke you deserve some credit for my improvement. Thank you.
I Hurt like a Bleep Bleep but it also feels soooo good I cant explain it. Removing all that immobility and severe pain makes everything feel beyond amazing.
I have the same problem like alot of ppl on this board. I am 29 and i have had a clicking throat since 2008. Does anyone have any idea on how to get this to go away. I relly get so sick of this sensation in my throat.
I have no idea how the hypnotherapy worked and I have never tried it before. It took a doctor in LA to even bring it up as an option. The hypnotherapist doesnt even know she helped me after 1 session. Everyone I see is blown away. I will still have a lot of physical therapy to do but atleast I have my life back. I honestly dont know that much about hypnotherapy but if you have any other questions feel free to ask.
Sorry I cant help you since I never had any form of click in my throat/neck area, but there are a lot of great ppl here that can help you. Not every ones is online everyday but Im sure soon enough someone can help you. Maybe not physically but with information and advise. Some ppl here have gone through a lot and continue to go through a lot with their clicking throat issues. Hopefully someone can help you. good luck
Can you be more specific about your symptoms. Many things could cause a click in that area some of them have been covered in the last 670 posts on this forum. You may also want to see the "clicking when swallowing" forum if this applies to you.
Thank you. I dont like sounding selfish when ppl are still suffering but everyday since friday has been the best day of my life. I hurt but the pain is different and its odd to say but it and everything feels sooo good. I havent had an actual doctors apt so Im curious to know what they think and if I have a long or short recovery time with this. I know its not a miracle but they do happen and this was pretty close to one for me.
I hope you can see Dr Berke and he can help you or guide you in the right direction so you dont have to keep suffering.
I'm sorry if this has already been covered within the previous comments. I admit, I got lazy after a few pages in and all the more curious.
I am wondering if I'm suffering from the same. For many years I've been experiencing the oddest/scariest feeling in my throat/neck area and can't figure out what it is. It started maybe 10 years ago, only back then and even up until recently it only happened rarely. Maybe only a couple times a year. Now, however, it seems to happen much much more frequently and lasts much longer.
I can't tell you when, or what makes it happen, as I'm not sure. It feels as though there is a bone in my throat that moves into the center of my throat. I basically have to take my index finger and move it back into place by massaging that area on my neck in the direction the bone needs to move back to. If the bone doesn't move back, I can't swallow, and start panicking pretty bad. I have a very hard time breathing during this time but I can't tell if it's just because I'm panicking or because of the bone movement. Before, After and definitely during this whole bone movement thing, I have a dull but lingering pain in that area of my throat. Not a soar throat, just a dull lingering ache. I do have TMJ and I do notice that they both seem to work together so I'm not sure if this is just TMJ related, or maybe it's the Hyoid bone which I never even knew about, until my sister mentioned it to me today. I only developed TMJ about 5 years ago. This other feeling has been going on quite a while longer.
I have an appointment with an Ears, Nose and Throat specialist coming up in March for this problem, but any information that anyone could give would be greatly appreciated.
Hi, I haven't talked to you for a while and was wondering how your healing process is going. I have just started to get a foreign body sensation in the right side of my throat now, plus right ear and right head pain (this has not happened before). I am hoping that in a week or two it will go back to the usual left-sided issues (I am used to that and can handle that better than these new symptoms). Anyway, it made me start wondering how you were doing. Is you pain better? Gone? Do you still have foreign body sensation in your throat? Any swallowing problems left over? Does it feel like a normal swallow now without any strange feelings in your throat? I hope you are back to doing some of the enjoyable things you used to do. I am much closer to getting out there than last year, I have some insurance that will pay for 80%, now I just need to get together some money to get there. My hope is I should be able to get out there by sometime in April for a consulation. Talk to you soon!
Yes the Pain is better to a degree I can talk for longer periods of time and no longer can push in on the right and left sides and get a crazy left right hyoid click going and I no longer have extreme episodes of shortness of breath. However, there is still a small and noticeable click coming from the left intermediate tendon of the diagastric muscle my foreign body sensation remains, slightly improved from the surgery, I still get headaches I believe they are coming from the inflamed tendon that can irritate the artery in the area. The surgery was of benefit but it definitely did not take all my pain away I am seeking options to cure the chronic tenosynovitis that seems to be the residual cause of the headaches and foreign body, malfunctions of the intermediate tendon of the diagastric are known to cause these symptoms and I have spoken to several professionals since the surgery who agree that it is very likely my residual pain is coming from the tendon. I feel in the end the surgery was worth it, similar to Adam and Luca's experiences we all received some benefit but we are all left with the foreign body sensation in that area of the intermediate tendon of the diagastric muscle the tendon here has very poor blood supply and would be prone to such a chronic cycle of pain. I am seeking and researching several treatment options to hopefully ameliorate these annoying tendon issues.
1. A Dr. in Chicago by the name of Ross Hauser has had experience injecting this anterior neck region and tendon with tendon proliferants (hypertonic dextrose) to strengthen the lax tendon and eliminate the pain.
2. A Dr. Ira Klemons of New Jersey states to have high success of treating malfunctions of the diagastric with a three phase program: physical therapy, injections, and RFA surgery.
3. Dr. Edward Ernest (who discovered that the hyoid bone syndrome was due to a degenerative tendinosis of sorts in 1991) thought a steroid injection may be beneficial in promoting a healing response of this chronic tenosynovitis.
While the medical literature shows strong promise in the hyoid bone excision as a rational and effective treatment of choice, it seems to be that with the other two patients I spoke with in detail who had greater cornua excisions from Dr. Berke also had a tendon (soft-tissue) component to their injuries that causes the foreign body sensation and that has not healed. I think Proliferation Therapy, Radiofrequency Ablation to this focal area, and Steroids are all possible things to consider in addition to the hyoid bone excision procedure if you are in pain.
I wish that the surgery had given you complete relief, but I am glad that you have found some other options to try to get rid of the residual pain and discomfort.
Hey, last weekend I had a really bad throat weekend and I fooled around with my hyoid a lot...I know, I really shouldn't, but I can't help it and I always regret it...I never learn...anyway, Wednesday night, I started getting the sensation of head numbness and crawly feeling in the upper half of my head from behind my ears and up to the top. It is EXTREMELY annoying and driving me crazy, I have had it for 4 days now with little relief (I know that is not very long, but I have very little tolerance for anything anymore). I am hoping that it will just go away on its own and I really don't know why it started, but do you know if the hyoid bone can cause a sensation of numbness to that extent in that area of the head (almost the whole thing)? It doesn't make sense to me, but I did not injure my neck (I thought about a pinched nerve maybe) and the only thing I could think of was the bad time I had with my hyoid bone just 3 days earlier. Also, it did not make much sense to me that the numb feeling on my head would start so long after that weekend, but I just thought I would take a stab at asking you if you have had this experience or if you know anything about it from Dr. Berke. Sorry I am going on for so long, but I am not sure what to think and thought you could help me to put it in some perspective. I have seen my GP, but she says it sounds like a pinched nerve (but I have absolutely no neck pain). Unfortunately, because my hyoid issue is so obsure to them, they never consider the effect that it may have on my health complaints. I am also getting an increase in the amount of headaches on an off throughout the day ever since the numb sensation started. I am calling it a numb sensation because when I touch my scalp, I have no actual loss of feeling. I know that the hyoid pressing on nerves can refer pain to a lot of places in the mouth, neck, face, ear, but I doubted it would make an entire head numb. Let me know your thoughts. I really hope that it is not being caused by the hyoid because I have no idea as to how to stop it. Getting nervous now because I don't want to have to live the rest of my life with this very disturbing feeling on my scalp...I know, I am blowing it out of proportion right now, but I am not able to tolerate very much lately.
It is so good to hear from you. Your words always have a very calming effect on me. Talk to you soon.
Wednesday night, I started getting the sensation of head numbness and crawly feeling in the upper half of my head from behind my ears and up to the top. It is EXTREMELY annoying and driving me crazy, I have had it for 4 days now with little relief.
Unfortunately this is definitely a symptom that I myself experience and other people I have spoken with aggravating the inflammation will certainly make it worse, Ibuprofen and eating meals seem to help this sensation I think it is due to nerve irritation from the the weakened degenerative tendon that is releasing biochemical irritants. Me and my brother both suffer with this same symptom and it started with a slight click in the anterior neck hyoid region. I also want to show you a picture of where all my residual focal symptoms lie to see if this is the concentrated center of your pain also. I will post it under my pictures. I know you don’t like experiments but Tristan and I are seriously considering Prolotherapy for the intermediate tendon of the diagastric muscle, the theory is that if you reinflame it using hypertonic dextrose, you can tighten the joint and relieve the pain like tightening lugnuts on a car. There Dr. Ross Hauser in Chicago who is considered the best in his field and has experience with this region of the anterior neck and may be worth your time. There seems to be a strong tendon component issue to this injury as I read one of your ENT'S had mentioned, the tendon becomes loose stretched out and does not heal completely due to its poor blood supply. I know the residual area that afflicts me, the epicenter of my pain, is no larger than the tip of a standards pencil's eraser but it is devastatingly bothersome, this area of the tendon somehow needs to repair to free itself from chronic pain.
A nerve block (lidocaine) injected directly into the muscles that insert into the hyoid near its greater cornu on the affected side provided some temporary relief. This was done as an experiment to determine if there's any potential value in doing prolotherapy to the same spot. I'm going to proceed with that in the next month or so, and 3-6 weeks after that I should be able to gauge if it's helped at all. I'll let you know.
Either way, the block convinced me that I'm right about where the discomfort is coming from, which makes something like radiofrequency thermoneuralysis more of an option if prolo and any other more conservative measures fail.
GGCB and wildblue98. Just thought I would check in Hope you all are doing well and having better days. I finally got my file from UCLA. I guess my psychological trauma was actually something called a conversion disorder that can paralyze parts of your body along with many other symptoms. GGCB I really hope Dr Berke can help you as much as he has helped me. Going to LA probably saved my life and was the best decision Ive ever made. Wildblue gets all the credit for that decide without your help and information I would have never gone. thank you.
Hi I'm Mary from Italy, i have the same problems as you. Can you help me. I am from italy and for me it is impossible to do a trip to LA to do a visit.
Which kind of ct scan I have to do for hyoid syndrome?
Is there any from italy that can help me?
I have seen 5 ENT without any answer for my problem.
Can you please tell me what is the best way to contact Dr. Berke? I live in NJ and would like to fly there to show him my throat problem. I have a clicking noise in my throat and I am pretty sure that my thyroid cartilage is hitting the cervical vertebral body. It has been confirmed by ENTs here but they don't think the problem can cause dysphagia or Dysphonia. I want to make sure if I can get some attention from him since no doctor until now has been able to resolve it.
there is some one of you that can send me article on hyoid syndrome and
the article "Hyoid Syndrome: A Pain In The Neck". Can you send me o send me the link, i want to print to give my ENT because in Italy hyoid syndrome is not known so i want show him.
I have been having a serious sore throat and clicking in my throat...when this happens it is only on my left side and it is very painful to my throat and ear. I am very scared and fustrated since 3 ENT says it is nothing. Well the CT scan came bk neg so I went to another and they didn't see nothing either. I am in so much discomfort and I need help. I live in NY and willing to travel I need to correct this I can not live like this anymore!!!!!
I am glad I found these posts and have enjoyed reading them. Like most people with neck and throat symptoms who cannot seem to get a straight answer from a medical professional, I have reluctantly resorted to searching the internet. It is nice to know that others out there have similar symptoms and have had difficulty in trying to obtain a diagnosis. I have to mention that I am a veterinarian who specializes in diagnostic pathology, so my medical training and knowledge are a little beyond "average" to say the least.
My throat/neck symptoms began about 4 months ago, out of the blue. It began with a strange mild pressure sensation in my right submandibular region. I thought at first it might have been my submandibular salivary gland but I experienced no visibly obvious swelling or pain associated with the gland. About 2 weeks after the initial symptoms, in addition to the pressure sensation, I developed the persistent and annoying globus sensation (foreign body in the throat sensation), which is limited to the right side of my throat. I also developed an intermittent popping on the right side of my throat when I swallow. This popping can actually be felt when I place my fingers under the right side of my jaw when I swallow, and it is often more noticeable if I turn my neck to the left. At times the pressure sensation in my neck extends all the way down to the region of my right collarbone and upper chest. Occasionally, I have very mild pain in my right deep inner ear and submandibular region, but I have experienced no throat pain or tenderness. I do notice mild twinges of pain in my neck muscles sometimes when I am talking, which is really strange. At times, I feel my voice is straining when I talk and sometimes it just “fades out” while I am talking. My symptoms vary in intensity from day to day, but never completely go away.
About a month after initial onset, the symptoms became pretty consistent, and while not affecting my ability to eat or breathe, had become quite uncomfortable. So, I made an appointment to see my GP. She palpated my neck, looked in my throat, said that she didn’t see or feel anything definite and it didn’t look like anything bad (such as cancer). She suggested that it may be “something like Eagle’s syndrome”, although I have no history of tonsillectomy. She then referred me to an ENT. I waited almost 6 weeks to see this ENT, and all he did was palpate my neck and look at back of my throat with a dental mirror for all of about 10 seconds. He told me he saw similar cases all of the time, never could really figure out what it was. He told me the popping when I swallow “could be tendonitis” but that he never saw any appreciable calcification on x-rays. He basically told me to just “live with it” because it was nothing bad, and sent me on my way. I could not believe how dismissive he was. He did not elaborate on the “tendonitis” theory, nor did he suggest anything to alleviate the symptoms. Perhaps he was acknowledging that it may be tendonitis of my digastric muscle, but never even mentioned the possibility of hyoid syndrome.
Disillusioned with this ENT experience and still seeking an answer, I decided to go to a chiropractor. I went there thinking maybe this was something related to a pinched nerve in my neck or possibly something related to my head and neck posture, as I easily spend 8-10 hours a day looking in a microscope. He listened to me explain my symptoms, told me that he thought my problems were TMJ related, and suggested I go to an orthodontist. I have had clicking in my TMJ since I can remember (15+years), but have never had any type of globus sensation or pressure sensation in my neck or throat associated with it and have never had popping in my throat when I swallow before this. Nor do I have any of the typical jaw pain/soreness, headache or facial pain that is often described with TMJ disorders. While I considered and appreciated the chiropractor’s opinion, I felt like no one had really done anything to rule out the possibility that there was something IN my neck or throat causing these symptoms. I wanted to do that before going to an orthodontist or oral surgeon and pursuing the TMJ route. On top of that, neither my insurance nor my husband’s insurance will cover treatment for TMJ disorders (go figure).
As my frustrated internet searches began, I started to wonder if my symptoms could be associated with atypical GERD. I took a 2 week trial of Prilosec OTC for the heck of it and took antacids 2-3 times a day, but it didn’t alleviate the symptoms. So I returned to my GP, who thought that it still could be atypical GERD and she then referred me to a gastroenterologist. The visit to the gastroenterologist led to an endoscopy, and he said I had a small hiatal hernia, a few gastric polyps (incidental finding), and he “thought” I had GERD. He did not say that he saw definitive esophageal erosion or damage. He told me to try omeprazole 20mg (same drug as Prilosec OTC) for 90 days and to return in 6 weeks for a follow up appointment. It has been several weeks, and I am frustrated to say that the same symptoms are still present with no change.
To this point, not one physician has done any diagnostic imaging of my neck, not even a simple x-ray. As a veterinarian, this really baffles me. While I understand that imaging may not provide all or any of the answers, it seems to me like it could definitely rule out a few things, if nothing else.
I have had a few people suggest that my symptoms are probably just due to “anxiety” and I am sure some of you out there have had a physician tell you the same thing. It is my thought that a diagnosis of “anxiety” is a diagnosis of exclusion only. Until all the appropriate diagnostic tests are performed, and it is proven without a doubt that there is nothing physically causing a symptom, then a diagnosis of “anxiety” should be considered unacceptable.
GERD? TMJ? Tendonitis? Anxiety (:o)? Which is it?
So now I have found the information on hyoid syndrome and wonder if this is not something I should pursue with a different ENT or would I just be wasting my time….????? It is no wonder so many people just give up…..
Anyway, thanks for "listening" sorry for my verbose post.
Well I have my ENT appt at one of the best hospitals in NY (westchester Medical Center) they said they have dealt w hyoid bone diseases and disorders and this sounds like a problem that I have. It has been over 6 months and no antibodic and treatments have worked and I will NOT live w/ this. I am in such pain sometimes I don't want to swallow because I am scared it is going to pop out on me and not go bk into place. I will keep everyone posted and hope to give you some knowledge on this misdiagnosed problem I see a lot of people suffering from. I wish everyone good health!!!
I had met Dr. Burke regarding a clicking voice in my throat. He confirmed me that my right superior cornu is clicking against cervical vertebral body. But he did not try to draw a correlation with my other symptoms, such as voice problem and right nasal congestion, though he said it's quite possible that they will be relieved. As per him, it's a simple outpatient 20 minutes surgery to excise the right superior cornu and there is no potential downside.
I would like to know if any one has any such experience (for superior cornu excision) in this forum. Before, I decide to go for it I just want to make sure if there is any downside or any other side effects.
a hyoid nerve block was done to see if 'prolotherapy' might be useful. you can google prolotherapy and decide for yourself if you think it's a scam. I'll just relate my own experience. The basic idea is that when you have a long-standing chronic inflammation, it means something at an earlier date did not heal properly. So, you go in and "hurt" the tissue by injecting an irritating but harmless sugarwater solution. This will kill some cells, and trigger the inflammatory process.
It's simple, and there is some science to back it up: Blinded studies with rabbits demonstrate that ligaments which are prolo'd grow back thicker/stronger. It's still very debated what this means and what place it has in pain management. Mayo clinic was doing some studies last I heard.
Anyway, I went back ~2 months ago and had the prolo, one session, cost $375 out of pocket. It was not a miracle cure, but I do feel that the severity and frequency with which I am bothered by my symptoms, has decreased -- enough that I will probably give it one more go.
My conclusion is that I have damage to the muscles or connecting tissues directly in the region of the hyoid. Likely culprits are the diagastric or longus colli muscles, or the tissues that tie those muscles to bone. I do not believe that this is a bone problem, and to the extent it's a physiological issue I do not believe it is necessarily possible to visualize, short of cutting in, excising tissue and biopsing it.
I remain wary of the almost-typical greater hyoid excision, just because there seems to be a large amount of cases where it does not work or provides incomplete relief.
A regimen of relaxation, stretches, self-applied manual trigger point therapy and the like have gone a long way towards making the condition easier to live with.
I have had the same problem.. emarassingly I have a pale neck and I put some make up on it. At the end of the day I wiped it off by rubbing it off, apparently I rubbed too hard, I heard a crack on the left side where that bone next to my throat and paniced. A day or two later I have this pressure all around my neck, its turned into pressure and pain reaching under my jaw to my ears to my cheeks. I want to know. So bad why this pain won't go away, I read all this and it sounds like what I got.
KL from Ottawa Canada... I have been suffering with the exact same symptoms for the past 15 yrs. The symptoms that everyone is describing is the exact that I experience. I can't tell everyone how happy I am to hear that I'm not alone! It first occured for me when I was in High School, my father took me to the ER & they told me it was muscle spasm. It has been occuring more frequently I would say the past 6 yrs the "popping" occurs more frequently. I'm going to make an appointment with my doctor on Monday. She is extremely proactive, I'm going to show her my discoverings and see what she has to say. Wish me luck... if anyone has any advice or good questions to ask... please let me know.
Hi there, I wanted to put my story out there as I believe (and have been diagnosed) as having hyoid syndrome. I have been suffering with intermittent pain in the right side of my neck in my hyoid region since summer 2008. At first I thought I had just pulled a muscle in my neck - it would ache chronically and I'd also have a pain and straining sensation when talking. After a few months of this going on and being referred to an ENT specialist I was diagnosed as having a thyroglossal duct cyst and the cyst and mid portion of my hyoid bone were removed. At this point I believed my ordeal was over as the pain immediately went after the op and I thought I could get on with my life...
Alas, no, 4 months later the pain was back and worse with a constant throbbing sensation where my hyoid bone is and this awful sharp pain when talking. This coincided with getting pregnant so I had to wait until I was into my 2nd trimester to get an MRI scan...this, along with other blood tests, neuro analysis etc all came back normal. This flare took 6 months to settle down and since then I can go a few months with being fine with no pain at all and then the neck flares up and can give me chronic pain for months at a time. It is truely awful and debilitating.
I managed to get through 2 more ENT specialists until I discovered that one of the authors of 'Hyoid syndrome - a pain in the neck' actually worked an hour away from where I live in the UK and since last year I have been under his care. From having to conduct my own research the only thing that I could find that seemed to fit was hyoid syndrome - especially as the pain radiates up into my head/ear/shoulder etc but the epicentre appears to be where my hyoid bone is.. I read with interest Wildblue's comments re the diagastric muscle as my consultant has explained to me that the syndrome is caused by pain coming from the diagastric tendon that binds the diagastric muscle onto the hyoid bone. This does seem to make sense for me due to the pain when speaking symptom - this tendon is under immense mechanical strain and therefore everytime I speak it moves hence the pain. I have had 2 injections into the area of a steriod and anesthetic but unfortunately this just made the neck more sore.
Although we have spoken about excising the greater cornu of the hyoid bone we believe that this may not hold much relief as it isn't dealing with the tendon itself- our plan of action therefore is when the pain comes back to have an op to release the tendon. This is where I am today - my pain is coming back but I am scared to have the op in case it somehow makes things worse. It is such a strange problem that has been undiagnosed for such a long time in me that I wonder whether it is even this that is causing the pain as the symptoms are so rare and odd.
I have no popping or foreign body sensation just aching and throbbing pain in the right side plus pain speaking and aching that travels around the surrounding nerve. Would love to hear from anyone who is in similar situation as it really is the strangest thing I've ever experienced.
I have the same problem only mine happens in my sleep and of course wake me up. I'm an 18 year old female and it first happened at a friends house around 4 years ago. Like I said it happens in my sleep and wakes me up with its excruciating pain. My pain is in the right side of my neck and radiates into my right jaw area and teeth. Every other time I have been able to pop it back in no problem and go back to sleep but tonight was different. It happened and my neck swole up and was as hard as a rock. I kept pushing it like usual and it would move but I had no relief, then finally I decided to get something to drink thinking the movement of swallowing a liquid would help. Which it did but I never felt it go back into place. I'm still sore around that area but I can swallow without pain again. I had never heard of anyone having the same problem. Also I do have acid reflux really bad and after I got it to go away acid came up my throat in a burst, weird. I'm just glad to finally find this as I became pretty worried thus last time. If anyone finds a cure please let me know!
I am a healthcare practioner and a professor of pulmonary medicine. Approximately, 2 years ago, I had a fall and struck my "adams apple." That was followed by minimal pain that aleviated quickly. 2 days later at dinner, I swallowed, heard a pop (crepidus) and then came the pain that is very similar to what everyone is describing. The pain radiates to the left, right, bilaterally, and to the anterior upper chest and posterior scapula. Severely disabling at worst, annoyingly painfull at best. I cannot sleep on my sides because when I wake up, I can feel the hyoide move and it is painfull. I am located in New England and most of the ENTs, even in Boston, don't have a clue. The only person that has come close with a diagnosis was a speech pathologist and the physician argued with her that I was fine and that the pain and clicking in my throat must have been always there, and I just never noticed it? Great advise from another ignorant MD. If anyone has any good MD's/ENTs that specialize in the treatment of hyoid bone injuries, please list the names and contact numbers. Thank you.
I was fascinated to come accross this site covering hyoid problems that were exactly the same as mine: I have been expereincing this problem for about 20 years. The only medical explanation I have ever recieved was 'possible calcimated ligament' - it is like no-one has heard of the hyoid bone (myself included until recently). I have a handful of what I call 'full dislocations' were it is impossible to swallow or speak and extreemly painful. On a couple of occasions I have had to visit the Emergency Department where the doctors have scratched their heads and sent me away. The longest time it 'popped out' was 14 hours which was very distressing for both me and my family. I was referred to an ENT surgeon who injected the area with steroids. Touch wood, since then, I have only had minor 'mini-pops!'. It is something that has caused great distress and is always present. Because it affects the left side - by avoiding turning to the left while speaking or yawning I can have more control. Not knowing when this can happen again makes this a worrysome condition.
It is not nice knowing others have the same condition but it does bring reassurance that it is a 'real condition' - and judging by what I read is not 'life threatening' as it has always frightned me that it could be my breathing affected next.
Hi, My name is sydnee. I'm 15 years old and I am having this same problem. I feel like my throat is popping out of place. I have to push it back in with my fingers most times. When its not popped out of place I can still feel soemthing in the back and side of my throat. It's really painful to swallow all the time and almost impossible to swallow when it is popped out. I have told my parents and am going to a doctor soon. Is there anything that can help ease the pain of swallowing?