Post - surgery journal

General
1

So I thought I would create a new topic for my post op journal.

Just briefly explaining my past: a trauma from an elbow to the throat while playing basketball

Symptoms after the trauma were that talking caused excruciating pain, and any physical exertion (with the exception of running) also caused severe pain. Important to note I could actually talk, but it caused so much pain, I just didn’t for about 3 years

Both Styloids elongated (around 6cm and has calcifies ligament), but right one especially long. Not too sure about angle, but I could feel right one protruding around my tonsil area.

I had surgery in London with Dr Hughes on 29th Nov at 2pm to remove the right styloid process. Here is post surgery

IMG_20241129_165548
IMG_20241129_1655481920×2560 209 KB

Day 0 -

So Dr Hughes spoke to my wife just after the surgery and said the surgery itself was a ‘success’ as they have definitely reduced the styloid process
(although I do not know how much as I personally haven’t seen Dr Hughes post surgery). However, I am not sure I I have any symptoms relief The nurse (not Dr Hughes) asked me to talk to see how talking is. At the moment, I still get pain in the same area where I used get pain, so currently, don’t feel too much (if any) improvement…but I’m hoping that’s cos the styloid was pressing it for so long,and it needs a bit of time to heal before I can talk without pain. However, it was thought that the styloid process was impinging on something (like a muscle or nerve) to cause me the pain while phonating or exerting, but now that the styloid is gone (i have felt within my mouth, and that protruding styloid has definitely gone), it may be the case that this wasn’t the issue, and then I would be back to square one :disappointed::disappointed:

Other general post surgery stuff seems ok (I am on pain meds) in that I can move my neck a little; I can smile (seemingly no facial nerve injury), and had a big solid meal (chewing and swallowing seems normal)

Did anyone else whose styloid went into the tonsil area have this area relieved immediately post op, or the pain still lingers for a bit?

1 Like
2

As I mentioned in my other reply to you, it may take several months for your nerve damage to recover & also ability to speak more pain free,

1 Like
3

Yeah, I’m hoping it’s this.

My worry was that if the pain I was feeling before was caused something being impinged on by the styloid, it now clearly isn’t being impinged on by the styloid anymore, so why the pain on phonation (in exactly the same area)

So I am hoping that slowly recovers.

I asked Chatgpt about this too:

" You’re absolutely right that theoretically, if the styloid process was the sole issue—directly impinging on a nerve, muscle, or other structure—its removal should alleviate the mechanical cause of pain, allowing you to speak without discomfort. However, persistent pain post-styloidectomy doesn’t necessarily mean the surgery wasn’t effective. Here are some potential explanations why the pain during phonation persists despite the styloid being removed:

Why Pain Might Persist Post-Surgery Despite Styloid Removal

  1. Nerve Damage or Irritation from Chronic Compression

If the styloid had been impinging on a nerve (e.g., the glossopharyngeal or vagus nerve) for years, the nerve may still be inflamed or hypersensitive, even though the physical compression is gone.

Nerve recovery can take weeks to months, depending on the extent of the previous irritation or damage.

In some cases, nerves can develop a condition called neuropathic pain, where they continue to signal pain even after the source of irritation has been removed.

  1. Residual Inflammation or Swelling

The surgery itself can cause temporary inflammation in the surrounding area, which may mimic or exacerbate pre-existing pain.

Swelling from the surgery may also indirectly press on adjacent structures, such as muscles or nerves, causing discomfort during phonation.

  1. Muscle Dysfunction or Habitual Tension

Over years of avoiding speaking due to pain, the muscles involved in phonation (e.g., the suprahyoid muscles, pharyngeal muscles) may have developed dysfunctional patterns or tension.

These muscles may still react with pain until they’re retrained through speech therapy or gradual use.

  1. Scarring or Adhesions

The trauma from the initial injury or the surgery itself could result in scar tissue formation. Scar tissue may:

Irritate nearby nerves or muscles.

Restrict movement of structures in the throat, causing discomfort during phonation.

  1. Secondary Issues Overlooked

While the styloid process was likely a major contributor, other structures (e.g., hyoid bone, suprahyoid muscles, or nearby ligaments) might also be involved in the pain mechanism.

The CT scan noted slightly prominent greater cornua of the hyoid bone, which could theoretically cause pain if interacting with surrounding tissues.

Other possible contributors like chronic inflammation of the muscles or nerves might not have been fully addressed by the surgery.

  1. Pain Memory or Central Sensitization

After years of chronic pain, your nervous system may have developed pain memory, where your brain associates specific actions (like phonation) with pain, even if the physical cause is removed.

This is known as central sensitization and can persist until the nervous system “unlearns” this response.

  1. Time Needed for Recovery

While the impinging styloid is gone, the surrounding structures (e.g., muscles, nerves) may take time to heal from years of compression or irritation.

Recovery is rarely instant, even when the mechanical cause has been resolved, especially if chronic pain has altered how the body functions."

2 Likes
4

Chat GPT sure is smart :wink: & gave you a more complete answer than I would have. As a mod of many years on this forum, however, I would emphasize the answers in #1, 2, 3, & 7 especially this statement: “Recovery is rarely instant, even when the mechanical cause has been resolved, especially if chronic pain has altered how the body functions.”

If your pain on phonation continues beyond 4-6 months post op, it would be worthwhile looking into speech therapy. It’s far too early for scar tissue/adhesions to have occurred & to consider that secondary issues may have been overlooked.

2 Likes
5

@virenlondon Definitely early days still. #6 is a real thing. Experiencing pain actually becomes a habit of mind and can be unlearned. But before you get there, your body needs time to recover and heal. Best wishes to you.

3 Likes
6

Day 1 (30/11) So today I am in pain because of the nurse’s stupidity yesterday. Had a call with Dr Hughes, and he has told me to rest my voice; the complete opposite of what the nurse made me do yesterday (try and talk a lot) -… so yesterday, i talked for about 2 minutes with my family (at the nurse’s insistence. after 15 seconds, I told the nurse it was causing pain, but she told me to carry on. It has caused me a lot of pain (even 24 hours later, really hope it doesn’t affect my long-term recovery, and is just a short -term thing (2 or 3 days).

All the time, even though I was reluctant to do it, she said that she needs to report back to the doctor about symptoms, so I did it. Dr Hughes today said to me she doesn’t know what she is talking about, and told me to rest as much as possible. He was saying there is likely to be edema which may cause pre-surgery symptoms, and that it is way too soon after surgery for any improvements.

So I am rather annoyed with that nurse (not that I can say anything). I just don’t know why she pushed me so much, especially just after surgery.

Anyway, they sent me home and gave me 3 drugs (paracetamol, DIHYDROCODEINE, and ETORICOXIB).

1 Like
7

So pleased that you’ve been able to have your surgery! A shame that the nurse was so insistent on making you speak when it was painful, I can’t imagine why any medical professional would think that was helpful- maybe they were very ‘old school’ , and believe pain helps healing, I remember Mum saying how she was made to eat dry toast after her tonsillectomy :scream:
I agree with ChatGPT about the possible reasons for speaking still being painful, I’m sure it must be very frustrating for you & you must be desperate to be able to talk to your family normally, but with ES surgery patience is definitely needed… So take care of yourself, rest, ice & keep propped up. Praying your surgery is successful :pray:

2 Likes
8

Thanks for the wishes!

Toast after tonsillectomy… Ouch!

I have seen quite a few people recommending ice; I did ask Dr Hughes in my pre op meeting last week about this.

He said not to ice or do warm compress. I didn’t ask why, but either way, I think I should listen to him.

Looking online, most medical sites are saying to intermittently ice after surgery, so I don’t know why he has told me not to. I am sure he has his reasons.

At the moment, I’m not in a great deal of pain, except for the pain due to forced speaking for 2 mins yesterday. I am taking the meds I was given.

2 Likes
9

Strange, most doctors do recommend it to reduce swelling- not directly on the wound but an ice pack wrapped in a towel over the area, maybe he thought you’d put an icepack directly onto the incision?
Good idea to keep up with the pain meds for now, otherwise if pain increases it can take a while to get it under control… depending on what you’re taking if they cause constipation don’t forget a remedy for that :wink:

1 Like
10

Oh, also, is there any vitamins you recommend to take generally while going through this?

11

@virenlondon - B vitamin complex & magnesium have both been suggested as the B vitamin can promote nerve healing & topical magnesium has helped some members with muscle relaxation. Magnesium taken orally can also help with sleep.

Here’s a quote from a post by @KoolDude regarding magnesium:

(I'm back - surgery with Dr Axon - #24 by KoolDude)

2 Likes
12

Yes, I took B group vitamins for nerve healing, I don’t know if they made a difference, but worth a try!
Thinking of you…

2 Likes
13

My family doctor also recommended for me to take B vitamin complex & magnesium after my surgery. I generally take the magnesium l-threonate as Isaiah mentioned. Also, my surgeon did not recommend icing because he put a drain in after the surgery which I think helped keep the swelling down.

3 Likes
14

Snap! Yes, I had a drain also. Guess that explains it.

2 Likes
15

Day 5 (4/12)

I had my wound check today, and the nurse praised the surgeon for doing an excellent job with the incision and stitching.

IMG-20241205-WA0006
IMG-20241205-WA00061600×1200 196 KB

Unfortunately, I haven’t noticed any improvement with phonation yet (and I won’t be attempting any physical exertion for a few weeks). I spoke for about 10 seconds earlier and immediately felt the same discomfort, so I stopped.

I emailed Dr. Hughes if the styloid was impinging on or irritating anything and, if so, what exactly. I also asked if he had shaved the hyoid bone, as my CT noted a slightly prominent greater cornua. His response was:
“It looked like it was impinging vessels and muscles in the vicinity. The hyoid wasn’t causing difficulties and wasn’t shaved.”

While I would have liked more detail about exactly which structures the styloid was affecting, I don’t want to push too much. I hope he is correct about the hyoid not being a factor. I’ve read posts on this forum where patients experienced pain during phonation, and shaving part of the hyoid bone led to significant improvements, so I can’t help but wonder if it’s contributing in some way.

For now, the most frustrating part is that there’s been no change in my phonation symptoms so far. However, I know it’s still early—less than a week since surgery—and patience is key in the recovery process. For those who have had surgery, and then did see a positive change, after how long roughly did you notice a change after surgery??

Hoping to see progress in the coming weeks.