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hyoid bone problems
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!
I just arrived here via Google. The back ends of my hyoid and the whole surrounding area, from rock-hard swollen lymph nodes through to the scars where my tonsils were removed at age six, have been sore forever. Not suddenly and dramatically like you describe, just a constant aching that varies as I move my head.
For me there is no "back in place". I can put my hand to my throat and grab my hyoid between thumb and forefinger at any time, and feel both back ends right under the skin. They are just about exactly as wide as the vertebrae behind them, and they seem to bump up and down along the muscles surrounding the spine as I swallow. Without pulling forward, I can twist the hyoid from side to side, causing one end or the other to protrude from the side of my neck far enough to get a fingertip behind the protruding end. Each end itself seems sore, but it doesn't appear to be attached to anything on the spine behind it, or restricted in movement. I can twist either end up or down by over an inch.
You seem to be saying that your hyoids have a specific normal position, and that any other position causes severe pain. I can't find any mention of any structures that would enforce such a position. At
they show the hyoid and all its connections. From each free back end "greater cornu" there are the hyoglossus muscles running up to the sides of the tongue, the constrictor pharyngis medius muscles that wrap around and meet at the back of the throat, and the thyrohyoid ligament running downward to the thyroid cartilage, but nothing that would anchor the cornu or any other part of the throat to a specific location. Most of this is shown in detail at
(The constrictor pharyngis medius has been removed; it would wrap around the right side of what is shown, from the wedge between the stylohyoideus and the great cornu.)
I've never asked anyone else about their hyoid... Maybe mine is unusually flexible. But it looks to me like the whole throat is just hanging there along the front of the spine, suspended from the jaw and skull. Could you previous posters be unusual in having become accustomed to keeping your hyoid in some particular relationship to some other muscle or structure? What would it be? Can you describe the experience of having your hyoid "out" in more detail?
Loren
For me there is no "back in place". I can put my hand to my throat and grab my hyoid between thumb and forefinger at any time, and feel both back ends right under the skin. They are just about exactly as wide as the vertebrae behind them, and they seem to bump up and down along the muscles surrounding the spine as I swallow. Without pulling forward, I can twist the hyoid from side to side, causing one end or the other to protrude from the side of my neck far enough to get a fingertip behind the protruding end. Each end itself seems sore, but it doesn't appear to be attached to anything on the spine behind it, or restricted in movement. I can twist either end up or down by over an inch.
You seem to be saying that your hyoids have a specific normal position, and that any other position causes severe pain. I can't find any mention of any structures that would enforce such a position. At
they show the hyoid and all its connections. From each free back end "greater cornu" there are the hyoglossus muscles running up to the sides of the tongue, the constrictor pharyngis medius muscles that wrap around and meet at the back of the throat, and the thyrohyoid ligament running downward to the thyroid cartilage, but nothing that would anchor the cornu or any other part of the throat to a specific location. Most of this is shown in detail at
(The constrictor pharyngis medius has been removed; it would wrap around the right side of what is shown, from the wedge between the stylohyoideus and the great cornu.)
I've never asked anyone else about their hyoid... Maybe mine is unusually flexible. But it looks to me like the whole throat is just hanging there along the front of the spine, suspended from the jaw and skull. Could you previous posters be unusual in having become accustomed to keeping your hyoid in some particular relationship to some other muscle or structure? What would it be? Can you describe the experience of having your hyoid "out" in more detail?
Loren
Oops... They stripped out my links to the anatomy illustrations! I don't see any help items about how to include links.
Maybe I can disguise them?
The first one was
education.yahoo.com reference gray subjects subject 45
You can add the http prefix, and the slashes in place of spaces, or Google that phrase and edit the first result to end with "45".
For the second one, Google
FIG. 1019– Extrinsic muscles of the tongue. Left side
and it should be the first hit.
Hope this works,
Loren
Maybe I can disguise them?
The first one was
education.yahoo.com reference gray subjects subject 45
You can add the http prefix, and the slashes in place of spaces, or Google that phrase and edit the first result to end with "45".
For the second one, Google
FIG. 1019– Extrinsic muscles of the tongue. Left side
and it should be the first hit.
Hope this works,
Loren
Your situation sounds interesting. From all the research I've done and ENTs that I've seen, the hyoid bone is NOT connected to any other bone. It is the only floating bone in the body. The only thing the bone is attached to are the muscles and tendons that you mentined. That is why physicians find it so hard to believe that it "pops" out. Theoretically, there is nothing it can pop out from. I've been told that for a bone to dislocate, it must first be located, meaning attached to another bone.
GGCB's note above is interesting too in the theory of the muscles being stretched. I did have a physician once tell me that the right side of my neck muscles must be weaker than the left and that when the left side was flexed, they actually pushed the hyoid right through the other side. That made sense, but has never been confirmed by an ENT.
My hyoid bone is in fragments, according to some swallowing x-rays. It does not move in unison. The radiologist nor the ENT had ever seen anything like it before. That's why I had surgery to remove the fragment on the right side - to be exact, they removed the right lateral aspect of the bone. It seemed to work for 3 months. But then it all started happening again. Now the question is, now what? That's something no one seems to have the answer to.
It's amazing to me that no doctors have ever seen or heard anything about any of this, but apparently, I'm not really the only person in the world to ever have this problem.
GGCB's note above is interesting too in the theory of the muscles being stretched. I did have a physician once tell me that the right side of my neck muscles must be weaker than the left and that when the left side was flexed, they actually pushed the hyoid right through the other side. That made sense, but has never been confirmed by an ENT.
My hyoid bone is in fragments, according to some swallowing x-rays. It does not move in unison. The radiologist nor the ENT had ever seen anything like it before. That's why I had surgery to remove the fragment on the right side - to be exact, they removed the right lateral aspect of the bone. It seemed to work for 3 months. But then it all started happening again. Now the question is, now what? That's something no one seems to have the answer to.
It's amazing to me that no doctors have ever seen or heard anything about any of this, but apparently, I'm not really the only person in the world to ever have this problem.
Ouch! I can't imagine having my hyoid in pieces.
My suspicion is that the hyoid is part of a complex feedback system that is involved with one's sense of "personal space", along with the obvious functions of breathing and swallowing. Or at least mine is...
The pressure of the ends of the "greater cornu" against the muscles of my neck depends on how my head is turned, raised, or lowered. I think my subconscious looks at those sensations to help decide what the visual (and emotional) perspective in my view of the world around me should be.
Of course my jaw can modify those sensations, too, and I often find myself tensing my jaw or holding it in odd positions to adjust how my hyoid feels. Visual stress and tension in my neck muscles also feed into this intersection, and any of them can seemingly be exchanged for any other.
As a child I was subjected to supposedly therapeutic but painful to wear bifocal glasses, dental braces, the tonsillectomy, and parents who were extremely determined that I never appear arrogant. All those tensions focused around the hyoid area, and something had to give. Each new opportunity to modify the sensations, like your surgery, seemed to be a blessed release, but after a couple of months my feedback system adjusted to the change and the tension began building again.
If this all sounds too "new age", that's not because I wouldn't rather be scientific, it's just that I'm only beginning to unwind all the tensions and compensations that got me to my current state. And I'm not finding anyone else talking about the kinds of experiences I'm exploring.
Does any of this make any sense to you?
Loren
My suspicion is that the hyoid is part of a complex feedback system that is involved with one's sense of "personal space", along with the obvious functions of breathing and swallowing. Or at least mine is...
The pressure of the ends of the "greater cornu" against the muscles of my neck depends on how my head is turned, raised, or lowered. I think my subconscious looks at those sensations to help decide what the visual (and emotional) perspective in my view of the world around me should be.
Of course my jaw can modify those sensations, too, and I often find myself tensing my jaw or holding it in odd positions to adjust how my hyoid feels. Visual stress and tension in my neck muscles also feed into this intersection, and any of them can seemingly be exchanged for any other.
As a child I was subjected to supposedly therapeutic but painful to wear bifocal glasses, dental braces, the tonsillectomy, and parents who were extremely determined that I never appear arrogant. All those tensions focused around the hyoid area, and something had to give. Each new opportunity to modify the sensations, like your surgery, seemed to be a blessed release, but after a couple of months my feedback system adjusted to the change and the tension began building again.
If this all sounds too "new age", that's not because I wouldn't rather be scientific, it's just that I'm only beginning to unwind all the tensions and compensations that got me to my current state. And I'm not finding anyone else talking about the kinds of experiences I'm exploring.
Does any of this make any sense to you?
Loren
2 Comments
Wow, Loren, you've described similar expereinces, including surgeries, that you've helped me realize are the main underlying cause of this phenomenon that has plagued so many of us. How is it for you now? Any change? Mine seems to be getting worse.
Brian, Sorry for the delay, my eMail changed and I rarely check the old one. Tried to update it here but now I can't login at all... Changes have been dramatic recently! I've "Mewed" my lower jaw forward so my teeth meet, instead of the lower ones sliding up inside the upper ones. My head has moved back dramatically over my spine instead of jutting forward. My hyoid is now up much closer to my jaw, and the back of it tucks inside the neck muscles on both sides. And the main factor in all of this is learning to inhale by expanding the front of my chest, instead of "back breathing". The required posture is exactly that required to flaunt one's breasts... Stacey vs. Becky...
Wooow!!! I have exactly the same problem! I have been searching for ages trying to find something to give me answers! The doctors dont believe me and say i have dental problems or acid reflux or its in my head, or its just my glands! But when your driving along, Yawn! And all of a sudden you feel like something is about to explode out of the side of your neck! Its scary! And god it hurts! I have nothing wrong with my thyroid either! When this happens to me...I am in so much pain....it feels like it is constricing over my wind pipe...i cant speak from the pain...i am just frozen!
The one thing i have noticed from reading these blogs are..we all seem to do jobs which use our voices. I am a singer....I work every weekend...fri,sat and sunday nights....
Thet told me i need to have speech therapy that im not using my voice properly....Its all rubbish! So, even in this age there are things the doctors do not know! But how i wish they did! This has only happened to me around 5 times in the last year. But it terrifies me. My doctor almost had me convinced its all in my mind! Now i know thats just what they say when they dont know....
Does anyone have any advice on what to do when this happens? It does seem to happen to me only when my voice or i am very tired.
Regards, Kayley (u.k)
The one thing i have noticed from reading these blogs are..we all seem to do jobs which use our voices. I am a singer....I work every weekend...fri,sat and sunday nights....
Thet told me i need to have speech therapy that im not using my voice properly....Its all rubbish! So, even in this age there are things the doctors do not know! But how i wish they did! This has only happened to me around 5 times in the last year. But it terrifies me. My doctor almost had me convinced its all in my mind! Now i know thats just what they say when they dont know....
Does anyone have any advice on what to do when this happens? It does seem to happen to me only when my voice or i am very tired.
Regards, Kayley (u.k)
I've done some more exploring of my neck and of the anatomy book, and found an interesting feature. Pulling downward on the back (toward the spine) ends of the hyoid are the omohyoid muscles. They run downward and then behind the sternocleidomastoids (the muscles that contract into action between your skull and your sternum and clavicles when you lean your head backward or take an extremely deep breath).
In the middle of its run each omohyoid becomes a tendon for some variable distance, sheathed in fascia that attaches it to the clavicle and first rib. As it exits this corner and becomes a muscle again, it is running sideways in the triangle between the clavicle and the upper border of the scapula. It normally connects along the top edge of the scapula (shoulder blade), but apparently in some people it connects to the clavicle or other locations in that area.
If I put a finger just inside the acromion (that bone that sticks up on top of my shoulder), and roll it backward and down into the notch between the outer end of my clavicle and the top of my scapula, I can feel the end of the omohyoid. It is extremely sore - on the order of the pain other people are describing here. Of course I have the simple option of not pressing on it...
Here is the interesting part that may apply to many of us:
(education.yahoo.com reference gray subjects subject 112#20)
-----
The Omohyoidei not only depress the hyoid bone, but carry it backward and to one or the other side. They are concerned especially in prolonged inspiratory efforts; for by rendering the lower part of the cervical fascia tense they lessen the inward suction of the soft parts, which would otherwise compress the great vessels and the apices of the lungs.
-----
When you yawn, or take a really deep breath, the omohyoids work to expand the lower airway, pulling sideways as well as downward against the hyoid. Since the other ends are attached not to some local structure but way out at the ends of your shoulder blades, your posture and arm and shoulder positions can easily lead to uneven tension on the hyoid and a sideways displacement.
I mentioned this thread to a friend who had in the past been a spousal abuse victim, subjected to violent throttling, and she was amazed to discover that there is no "proper" position for the hyoid. She occasionally finds hers displaced sideways, apparently hung up on scar tissue from past trauma, and had acquired the belief that it would be harmful to try to move it back to a more comfortable position. After I explained the anatomy to her, and she confirmed the actions of her own muscles, she was quite relieved to feel free to move her throat around to a comfortable position.
Loren
In the middle of its run each omohyoid becomes a tendon for some variable distance, sheathed in fascia that attaches it to the clavicle and first rib. As it exits this corner and becomes a muscle again, it is running sideways in the triangle between the clavicle and the upper border of the scapula. It normally connects along the top edge of the scapula (shoulder blade), but apparently in some people it connects to the clavicle or other locations in that area.
If I put a finger just inside the acromion (that bone that sticks up on top of my shoulder), and roll it backward and down into the notch between the outer end of my clavicle and the top of my scapula, I can feel the end of the omohyoid. It is extremely sore - on the order of the pain other people are describing here. Of course I have the simple option of not pressing on it...
Here is the interesting part that may apply to many of us:
(education.yahoo.com reference gray subjects subject 112#20)
-----
The Omohyoidei not only depress the hyoid bone, but carry it backward and to one or the other side. They are concerned especially in prolonged inspiratory efforts; for by rendering the lower part of the cervical fascia tense they lessen the inward suction of the soft parts, which would otherwise compress the great vessels and the apices of the lungs.
-----
When you yawn, or take a really deep breath, the omohyoids work to expand the lower airway, pulling sideways as well as downward against the hyoid. Since the other ends are attached not to some local structure but way out at the ends of your shoulder blades, your posture and arm and shoulder positions can easily lead to uneven tension on the hyoid and a sideways displacement.
I mentioned this thread to a friend who had in the past been a spousal abuse victim, subjected to violent throttling, and she was amazed to discover that there is no "proper" position for the hyoid. She occasionally finds hers displaced sideways, apparently hung up on scar tissue from past trauma, and had acquired the belief that it would be harmful to try to move it back to a more comfortable position. After I explained the anatomy to her, and she confirmed the actions of her own muscles, she was quite relieved to feel free to move her throat around to a comfortable position.
Loren
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