I’m so sorry that things improved & then went backwards, so frustrating for you… We’ve had other members who’ve had pain when speaking or weakened voice, but I think yours is the most severe case from what I recall. Other members have had relapses possibly from overdoing things, so that’s not uncommon, usually this resolves again with time, but not always. @Luckee7 has had a relapse following surgery, although completely different issues to yours for example.
As @MGORNEAU suggests, an MRI might help. A FIESTA MRI shows compressions on nerves in more detail, although more at the skull base so maybe not so helpful if something is compressed in your hyoid or larynx area. I’ve not heard of any stylo-hyoid ligament being left in & then calcifying, although I guess it’s possible from the hyoid end up. Scar tissue would be my guess though…
I don’t know of any other doctors who would treat the throat issues in the UK if you don’t get any answers from Mr Hughes, I guess you would have to make enquiries to see if you wanted to have a consultation with the doctors on our list…there must be doctors specialising in this area, I think @Callmestar1 has struggled with finding someone to help with her throat issues. If you google larynx surgeons UK it does come up with some possibilities…
I don’t know if you could get a referral to here:
Voice Clinic | UCLH Royal National ENT Centre for Voice Disorders
Thinking of you…
Thanks for yours and MGORNEAUs response. I just really wish he had taken it out from base to hyoid. But alas, what to do. Don’t really want another surgery, but will probaby have to. i have studied the research, and if not calcified, a steroid has helped with throat pain, but I still havent found any literature where the symptoms are close to mine.
Yes I will problaby get some more imaging done. Will try privately first though, as the one Hughes would send me to is more than double the price of one where you can sort of self-book, and then take results to Hughes.
The other new thing is, just recently (last 5 weeks or so), got this permanent sort of strange feeling somewhere towards the base of tongue. I have read up on globus, but don’t think its that. Its not painful at all, but just like a very dull sort of nerve static. The strength of the tongue is completely fine and I can stretch it, but potentially a nerve is being slightly disturbed? I read on Cleveland clinic website that this also could be a symptom of Eagle’s syndrome. In the 5.5 years since injury, this is the first time I am feeling this symptom. As said, its not painful at all and just somewhat annoying, but still worrying that I am getting new symptoms.
@virenlondon I have nerve pain on the right side of my tongue put it isn’t painless unfortunately. It ranges from mild annoyance to really intense electric/burning sensation. 
From what I’ve learned, that lines up with glossopharyngeal or lingual nerve irritation, both of which run right along the styloid. So even a remaining segment can still cause symptoms like that.
@virenlondon - 
Reading your update made me so sad! I was very excited for you to be able to finally communicate with your voice to your children & wife after so long. What a disappointment & how discouraging for you to be back at square one plus adding a new symptom.
I also had a weird to tongue symptom in the same location as yours. I felt like there was severe pressure on the back of my tongue, but only on the left side. It didn’t hurt but was uncomfortable. As @MGORNEAU said, your tongue symptom could be caused by the glossopharyngeal or lingual branch of the glossopharyngeal nerve. The pressure sensation went away for me when my left styloid was shortened so it seems there must be something still going on w/ your styloids or scar tissue from your surgery. I recall you only had one elongated styloid or at least only one surgery. If so, is your other styloid also elongated? If it is, you may want to look into getting that one resected as well because it could be contributing to or causing your current symptoms.
@Jules & @MGORNEAU gave you a thorough suggestions regarding follow-up scans you should consider. I will be praying that you’re able to get referred for the scan(s) that will uncover the cause of your current symptoms so you can proceed with whatever remedy will restore your voice & reduce/stop your pain. 
@Jules I hope you are doing good. It has been a while! just kind of got used to being ‘little speak, little exertion’…but now that thats all gone, I decided I need to get fixed (or try my best to). Even if i can get to half of how i was before injury in Apr 2025, I will take that.
But of course, it’s so frustrating, like so many here have experienced. It’s strange, as there is a lot of literature about ES, HBS and other closely related syndromes - yet so many ENTs just don’t know about them.
Just been analysing my prevoius images to look at my previous stylohyoid and lesser horn pics. It confused me because it seems as if it is anything that is calcified, it is my left stylohyoid that is slightly calcified, not my right - ALL my symptoms are on my right (and thats where i had the external trauma). Like check these photos. Unless I am mistaken, you can see part of the ligament on the left, whereas right doesnt. So perhaps it is not the stylohyoid… THEN WHAT!!! Sometimes, this whole thing just makes me want to scream (which I can’t!!!) 
@virenlondon - I’ve annotated your hyoid bone & believe it could be why you’re still so symptomatic. Here are things I noted:
- Hyoid is tipped to the left
- Left greater horn is quite thick in width & curved inward
- Stylohyoid ligament at left hyoid lesser horn is calcified & extremely pointed (as you noted)
- Right greater horn is also thick in width & is basically straight (not curved like the left one) & has a “foot” at the end of it vs a blunt end like on the left.
I think you need some work done on your hyoid bone i.e. removal of the spike of s-h ligament calcification & perhaps a bit shaved off the tip to shorten it. It’s possible the “foot” on the end of the right greater horn is creating an imbalance in your hyoid’s position which is why you’re more symptomatic on the left. The sad thing is we don’t know of a doctor in the UK who does hyoid bone surgeries. That’s not to say there isn’t one or more, but we just don’t know of anyone. There are several doctors in the US who treat hyoid bone problems.
I agree with what @Isaiah_40_31 has said, looking at those images, as well as some calcification on your left side, the right looks really chunky! Difficult to know next steps though I think maybe try contacting one of the private healthcare organisations if you’re able to & see if there’s anyone who specialises in HBS, & try contacting UCHL voice clinic as well?
Left side is not symptomatic, so not planning on touching that at all. However, I have had a change in thought process. I think you are right about the tip on the right though, becuase:
I purposely spoke a little (just a few seconds) and exerted a little (by exertion, I mean light exertion like lifting a 5kg weight and walking around for 2 minutes) over the weekend, just to invoke some pain so I can really really pinpoint it to exact location and I can start to get towards finding the actual problem, so then can work to finding a solution. I also palpated the various points in and around throat region after phonation and exertion to see which are the most tender. And I think the results are pointing away from the stylohyoid chain and more towards the hyoid bone greater cornua area. It’s very sore near the tips and middle of the right cornua.
CT did note the tips, but docs didn’t think much of it.
I looked at some literature, it may well be Hyoid bone Syndrome, or more accurately, Hyoid Bone insertion tendonitis. It makes a lot of sense if it is. Early stage intervention include a steroid injection, but seeing as mine has been 5.5 years, i have very severe symptoms,and I have had so much repetitive strain (ie. it gets better a bit, then i overdo it), I doubt it would help, but I think it is worth a try. Failing that, the literature talks about resecting the greater cornua which has had relatively good results. But I am not sure if that would work for me. Cross that bridge when I get there, I suppose
Only issue is none of the literature I have found lists ‘pain on exertion’ or ‘pain on physical activity’ as one of the symptoms, so it may not be that. But I have now switched to this being my no1 theory. Will go and see Dr Hughes next week, and see what i can do. But probably be the waiting game.
Hyoid Bone Syndrome: A Comprehensive Medical Review
I am not sure if it is this, but it maybe another piece in this mystifying puzzle. Like i said before, so stupid to only restart this process when at very severe symptoms.
Also, just want to say thank you for your really thoughtful and considerate replies. You are amazing people. I am lucky to have a supportive family, but none of them get what this is like.
Our bodies are typically good healers even when a problem has been present for a long time. The healing process may be slower for problems that have been more enduring, but I think once the cause of the irritation is removed, healing will occur to at least some extent. Trying the cortisone injection is a fine idea, however, with the large size of the tip of your right greater cornu, I don’t think you’ll get relief until that thing is shaved down to normal size - kind of like an elongated styloid, which needs to be resected to get it away from the nerves (& sometimes vascular tissues) it is irritating in order for healing to begin.
Our bodies each react differently to physical irritants, especially internal ones (note the diverse variety of symptoms that can be seen w/ ES yet no one person has them all) thus I suggest that your pain on exertion/physical activity are simply the way your body is expressing its displeasure with the invasive right hyoid cornu.
Thank you for the Hyoid Bone Syndrome medical review. It’s quite interesting.
I think with any sort of tendonitis, exertion is going to make it more painful, so just because it’s not mentioned in the report, doesn’t mean it’s not what you have…and as @Isaiah_40_31 says, syndromes are a collection of symptoms so you don’t need to have them all.
I hope that Mr Hughes can help you…
Other thing I noticed, that I could easily tell by just touching both sides is the gap between superior horn of thyroid cartilage is much smaller on the right (due to abnormal right hyoid bone tip).
There still is a gap on right, but maybe this is also contributing? What do you think. How does this gap compare to other greater cornua / superior horn gaps?
The greater cornua are certainly uneven & oddly shaped, and there’s a very small amount of calcification on the left side lesser cornua by the look of it, they look very needle-like! I don’t know what gap is normal between the thyroid cartilage and the hyoid, it’s not as calcified as some thyroid cartilage images that we’ve seen but does look uneven, there looks to be a much thicker piece on the right… We don’t know of any doctors who do thyroid cartilage surgery in the UK if this is the issue, might be worth researching…
I think how much space there is between the greater horns of the hyoid & the thyroid cartilage is significant, unfortunately, I’m in @Jules camp & don’t know what is normal vs abnormal. I suspect the amount of space between your right greater horn & thyroid cartilage is abnormal & may be a major contributor to your symptoms. Also, that needle like section of stylohyoid ligament on the left looks pretty dangerous, too.
Thank you both again for looking and analysing my scans.
When you say my cartilage is calcified, do you mean my cartilage superior horn, or other bits of the cartilage?
The superior horn… looks very thick compared to images online…
Besides the odd shape & thickness of your right superior horn, you have a needle like projection of calcified stylohyoid ligament from the inferior horn on the left side. I have a hard time believing it’s not also causing some pain.
Thanks for confirming on the thryoid cartialge. I doubt left side is causing issues, as i have no left sided symptoms. I actually naturally have long calcifieed styloids on both sides.. they are on both sides..but my issues only started after i took an elbow to the right neck while playing basketball. issues are only right sided, so for now, I will stick to the right side issues. Perhaps later if no improvement, will look at left.