@JimFromAlabama - Welcome to our forum!
These symptoms strongly point to vagus nerve irritation or damage. Painful, sharp, electric, pulsating, stabbing type pains are how unhappy nerves make themselves known. Tingling, numbness, & a sense of pressure when nothing is pressing, can also be manifestations of nerve irritation/damage.
It’s well known on this forum that nerve pain/symptoms can come & go w/o explanation. With ES, sometimes particular head positions or activities are noted to trigger symptoms whereas other times there seems to be no particular cause. Symptoms can go away for weeks at a time then return w/ a vengeance, & often w/ additional new symptoms, then disappear again for a while. We don’t know why this happens, just that it does.
Nerves don’t show up in imaging except for FIESTA or CISS MRIs which can be difficult to obtain & expensive & don’t always provide conclusive results. The vagus is the largest & most extensive of our 12 cranial nerves. It affects quite a number of the body’s functions from swallowing, vocalizing, heart rate, blood pressure, anxiety/depression, body temperature, breathing, gastrointestinal function & even down to bowel, bladder & sexual function. It’s one of the cranial nerves most often irritated by elongated styloids & symptoms vary from person to person. I predominantly had heart rate & blood pressure issues w/ a little intermittent “vocal fry” added in, but we’ve had a number of members who’ve had vocal issues & coughs as their main symptoms.
Based on your symptoms & the fact the hyoid bone resection didn’t help, I think ES is highly suspect in your case. Here’s a post by a member who had good recovery from her vagus nerve symptoms after her styloidectomies: Successful Surgery for severe Vagus Nerve Compression - #15 by GrnyAny