I have posted here half a year ago for potential Eagle’s syndrome (Classic eagle or Vascular symptoms)
After much discussion and medical consultations, I decided not to go ahead with the styloidectomy (yet).
I now am looking into Hyoid bone syndrome. It seems to have similar symptoms as Eagle’s.
My symptoms are mainly
unexplained tachycardia (control by propranolol)
Chocking sensation + cough front of throat when looking down in standing
headaches at end of day
somewhat difficulty with swallowing dry stuffs. (able but takes a lot of effort)
at time Globus sensation in throat
I am thinking hyoid over Eagle’s mainly because firm palpation at the hyoid kinda reproduced the Chocking sensation and can trigger that cough.
Does anyone know what is hyoid bone syndrome surgery?
I’ve heard some says it is an easier/safer surgery than Eagle’s? Is there any harm to have the surgery done? After two years, I’m tempted to just go ahead and try it.
We’ve had quite a few discussions about hyoid bone syndrome, the symptoms do overlap so it’s hard to say for sure, but often strangled feelings, globus sensation & choking seem to be worse with HBS. With hyoid surgery the greater horns/ processes of the hyoid bone are shortened. It has risks the same as with a styloidectomy, but having a skilled surgeon can lessen those risks… Your hyoid bone processes look a bit longer than average maybe, (although obvs not an expert), it’s hard to say with the angle of your images, but it looks like the right side in the image with contrast could be close to the carotid sinus , which can cause cardiac arrythmias. So this could potentially cause your tachycardia, vagus nerve compression can also cause this. Here’s a couple of recent discussions about HBS, there are more if you use the search function & have plenty of time! Is this Hyoid Bone Syndrome or ES? (Need Help) - General - Living with Eagle Anyone have surgery with Dr. Dewan? Did hyoid reduction help ES? - General - Living with Eagle Anyone seen Dr. Dewan? Clicking larynx - General - Living with Eagle
Who were you thinking of seeing for surgery? Not all doctors who do styloidectomies do hyoid surgery, I’m not sure of doctors in Canada, but there are several in the US; Dr Dewan at LSU has done surgeries recently, Dr Dinesh Chhetri, UCLA we believe has, Dr Cognetti in PA apparently has started doing the surgery, Dr Brad deSilva, OSU Wexner Hospital, and also Dr Marshall Smith, Salt Lake City.
Ive read a few people on Facebook whose styloidectomy did not do much. Hence, I’ve been a bit more hesitant on the styloidectomy considering that my styloids are only around 3cm (but quite thick). I’ve just been having quite a bit of trouble finding images/examples of normal hyoid VS pathological hyoid.
How would the physician differentiate between Eagle’s and hyoid. But yeah, I do have a lot of consistent chocking/strangling and Globus sensation. I just don’t seem to have the clicking that everyone seems to talk about.
How much of the hyoid horns do they usually cut off? What should I ask the surgeon for? Nerve monitoring? Which nerve are around that area?
I had an appointment with Dr Cognetti end of January but he had to rescheduled to end of February. Which was disappointing considering I’ve booked the appointment 6 months ago.
That’s a shame about your appointment being rescheduled, we have had some members get earlier appointments with doctors by asking to go on a cancellation list if you’d be available at short notice, it might be worth ringing his office to ask?
With the hyoid, the hyoid bone processes can be elongated, or thick or angled, just the same as the styloids & cause symptoms because of that. Also the stylo-hyoid ligaments can become calcified at the hyoid end, and even the whole length, so the hyoid can’t move as freely as it should, which can cause symptoms. Some members’ hyoid processes have been so long that the can touch against the spine when their head is turned, & some have had them toughing the carotid artery which can cause symptoms.
I’m not sure how much of the hyoid is removed, that would be something you’d have to ask your doctor…Because the symptoms overlap it is hard to differentiate between ES & HBS unfortunately. I would guess that they would monitor nerves, usually it’s the facial nerve monitored I think, again you’d have to ask Dr Cognetti.
Yesterday, the pain clinic gave me an temporary Lidocaine injection at the sternocledoimastoid muscle lasting for 8 hours. During that 8 hours, It kinda relieved the Choking sensation and the cough reflex when I look down in standing. It also relieved the end of day headaches.
But I can still feel a pressure pushing at the throat. If I stand and look down for a long time (1 hour +) I still get that malaise (nausea, pressure headaches top of head, palpitations) with the injection. They say they were numbing the superficial cerebral plexus.
What do you think could explain this?
I’m wondering if I should ask for a nerve block.
Obviously not a doctor, so this is just a personal opinion, but if you look at the SCM muscle, and from members’ experiences and symptoms, it could be affected by either ES or HBS, so I’m not sure that the injection rules either in or out? Here’s an image of the SCM muscle:
Some members have tried nerve blocks, sometimes they help but not always, ultimately it’s a personal choice but it won’t cure ES, it’s a temporary fix…
Do Eagle’s usually give pain at the styloid area on palpation? I don’t feel any pain when I press around the styloid area. But my hyoid is pretty painful on palpation when I’m sitting up/standing.
Which nerve do they usually try to block off?
Do you think it is safe to try acupuncture/dry needling on the myohyoid muscles under the chin?
I have gotten a lot of headache relief from dry needling. She does the SCM and works on my traps. It has helped quite a bit to release the tension from the surgery as well. Good luck!
The styloids do often cause pain if you push gently on that area, so that’s interesting yours don’t & your hyoid area does! It depends which nerve is causing pain to which they do a nerve block to - so it could be the Trigeminal nerve, or the Glossopharyngeal nerve, some members have had an Occipital nerve block for pain that the back of the head too. Not sure about whether they would do one into the facial nerve as well…
I am just wondering, unlike the styloid being fixed in position, the hyoid is more mobile.
Could the symptoms be from the hyoid being too downward? Or is it because it is too upwards? I’m going to try to massage and stretch it. But I’m do to know which direction /muscle to stretch.
Yes, the hyoid is certainly more mobile, but I wouldn’t want to give you any advice about trying to shift it’s position, that could maybe do more harm than good?
I’m wondering if my hyoid could have potentially moved /shifted because of my 4-5 years of braces/invisilign treatment (pulling my teeth inward bc of overbite)
@Alice - We had a member several years ago who thought she had ES from having braces on her teeth & thought the way her bite shifted could have put more stress into her neck causing ES. Her thoughts do make a lot of sense, & thus, so do yours. I would think ES more likely than a hyoid bone shift, but if having Invisalign caused your s-h ligaments down at the hyoid end to calcify, which tethers the hyoid, & can cause pain & the other symptoms you have then it’s a possible cause. Sadly, there is no way to prove ligament calcification is/was due to Invisalign though we do know that anything that puts extra stress on the bony tissues in the neck or elsewhere in the body can cause the body to sense instability & thus lay down extra calcium to try to stabilize the area. Unfortunately, the extra calcification itself often causes problems.