hyoid bone problems

[shell k]

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!

[miskatonic]

bottom line, i don't nor have i ever felt a notable click in the area of my discomfort. my primary symptom is foreign body/sense of swelling, which turns into dysphagia and dysphonia when the symptom gets very bad or when i abuse my voice. very curious if i am trying to create the "click" in the right way?
* push on greater cornu from right, until left greater cornu is visible through skin on other sie
* using other hand, push left side back -- slide horizontally, no click
* then push inwards with both hands, pushing hyoid into neck
*this creates a choking sensation, but, no click.

[miskatonic]

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

So, it sounds to me -- that when you hold your hyoid between your thumb and forefinger, and slide it horizontally, you hear and feel a click? This simply is not true for me, unless I'm doing it wrong?

[miskatonic]

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

does that make me different than you?

I should also point out that i've had muscle tension problems for years, ever since I came off Klonopin.

[alexander83]

PLEASE READ THIS!!!

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

there is my vent...

i sympathise with you all

[wildblue98]

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

[miskatonic]

Just some more info I've come across. I note that I am different from a lot of people in this thread, in that I do not have a significant amount of actual "clicking", and when I do hear a click it is usually unrelated to swallowing. Given how much muscle tension seems to have to do with my problems (not saying this is the cause, but it's clearly a factor), I've started to research muscle tension disorders and trigger points. I found this literature:
http://www.round-earth.com/HeadPainIntro.html

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

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

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

So, for the moment, I am going to attack this as a muscle tension problem which has my hyoid in the wrong place, and see if 6 months of combined PT, alexander technique, and treatment to stay off drugs, is at all successful in alleviating my discomfort. I will certainly  keep everyone posted with my progress.