Hyoid Bone Syndrome: A Retrospective Review of 84 Patients Treated with Triamcinolone Acetonide Injections

Stern, Noah; Jackson-Menaldi, Cristina; Rubin, Adam D.

doi:10.1177/000348941312200303

Cited by 28 publications

(37 citation statements)

References 10 publications

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“…The shortened thyrohyoid distance, as demonstrated by patients in this cohort, was hypothesized to be the source of pain by Counter et al Potential causes include friction between the superior cornu of the thyroid cartilage and hyoid bone, shortened distance between the hyoid bone and thyroid cartilage or impingement of an enlarged greater horn of the hyoid bone on the cervical spine, or abnormal bone formation in the thyrohyoid ligament . Stern et al demonstrated histopathologic evidence of microscopic foci of necrosis within the hyoid bone at points of contact and friction . Finally, Ernest et al showed hyaline chaining of centrally placed multiple nuclei and elongation of muscle fibers consistent with myopathy of middle pharyngeal constrictor muscle in hyoid bone syndrome .…”

Section: Discussionmentioning

confidence: 67%

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments

2019

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Objective Anterior cervical pain syndromes (ACPS) are a poorly understood entity associated with lateral neck discomfort when talking, chewing, or yawning, and with occasional excruciating pain and dysphagia. This investigation aims to describe patients with ACPS presenting symptoms and treatments. Study Design Retrospective chart review of all patients with ACPS presenting to a tertiary care laryngology practice in 1 year. Methods All patients diagnosed with ACPS for 1 year were reviewed. Patient gender, age, body mass index (BMI), and pain triggers were documented. The hyolaryngeal complex was measured on computed tomography (CT) scans of the neck. Treatments were recorded. Results Nine patients were diagnosed with an ACPS in a 1‐year period. Sixty‐seven percent were female with an average age of 47.3 years ± 16.6. The average BMI of a patient with ACPS was 24.8 ± 3.69. The most common symptom was point tenderness at the lateral aspect of the hyoid or superior cornu of the thyroid cartilage (89%). Pain triggers included speaking (67%), head turn (56%), chewing (44%), yawning (56%), and swallowing (56%). On CT imaging, eight of nine patients had abnormalities of the hyoid bone or the superior cornu of the thyroid cartilage, correlating 100% with point tenderness location. Treatments include physical therapy (33%), steroid injection (44%), lidocaine injection (22%), and surgical intervention (56%). Conclusion ACPS is a frustrating condition for patients and physicians. Evaluation of anterior cervical pain with point tenderness should include imaging measurement of the thyrohyoid complex. Effective treatments include local steroid injection and surgical resection of the abnormal structure. Level of Evidence 4 Laryngoscope, 130:702–705, 2020

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Section: Discussionmentioning

confidence: 67%

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments

2019

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“…9 We can assume that the excess strain placed on the laryngeal ligaments and muscles, via the Lombard effect, has contributed to an insertion tendonitis on the hyoid bone. Stern et al 10 have recently described a high prevalence of dysphonia (51%) in patients with hyoid bone syndrome. Their article accounts for this finding as a secondary result of pain from the hyoid bone tendonitis, leading to increased muscle tension from a ''guarding'' effort to reduce pain.…”

Section: Discussionmentioning

confidence: 99%

Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology

et al. 2014

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“…A second possible mechanism for pain persistence is cartilaginous or ligamentous inflammation involving the laryngeal framework. This includes hyoid, thyrohyoid, thyroid ligament, and cricoid syndromes depending on the location of the pain . Most patients have pain triggered or accompanied by swallowing or strenuous neck movement, with a subset reporting pain precipitated by excessive voice use.…”

Section: Discussionmentioning

confidence: 99%

“…This includes hyoid, thyrohyoid, thyroid ligament, and cricoid syndromes depending on the location of the pain. [16][17][18] Most patients have pain triggered or accompanied by swallowing or strenuous neck movement, with a subset reporting pain precipitated by excessive voice use. A third possible mechanism is myofascial pain involving the intrinsic and extrinsic laryngeal muscles as described by Jung et al 6 A fourth possible mechanism for pain persistence is suggested by the failure sometimes of localized injections to achieve long-term pain relief.…”

Section: Possible Mechanismsmentioning

confidence: 99%

Primary odynophonia: When pain is out of proportion to dysphonia

et al. 2019

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Objectives/Hypothesis Odynophonia is generally regarded as a symptom of a voice disorder. However, a subset of patients with odynophonia have debilitating pain out of proportion to the relatively mild degree of dysphonia and are not responsive to voice therapy. The goals of this study were to 1) describe the symptomatology of this subset of patients and differentiate it from typical odynophonia, 2) propose alternate models to explain this phenomenon of primary odynophonia, and 3) present a new treatment paradigm based on the proposed models. Study Design Case series. Methods Inclusion criteria were complaint of persistent pain associated with voicing, normal vocal fold mobility, complete glottic closure, and limited or lack of response of pain to voice therapy. Presenting symptoms, voice evaluation, and treatment outcomes were reviewed. Results Eleven patients fit the inclusion criteria. The degree of pain did not follow the trajectory of vocal improvement with therapy. The pain was stagnant or worsened with voice exercises. The most dramatic improvement came about in one patient who received false vocal fold Botox injections, and another who received thyrohyoid lidocaine/triamcinolone injection. We propose that these patients had developed primary odynophonia, in which the pain had become self‐sustaining and no longer responded to correction of hyperfunctional vocal behavior. The mechanism of pain persistence may involve superior laryngeal neuralgia, cartilaginous or ligamentous inflammation, and/or central sensitization. Conclusions A minority of patients have primary odynophonia distinct from typical odynophonia. Direct treatment of pain may be advisable prior to or in conjunction with voice therapy. Level of Evidence 4 Laryngoscope, 130:E183–E189, 2020

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Hyoid Bone Syndrome: A Retrospective Review of 84 Patients Treated with Triamcinolone Acetonide Injections

Cited by 28 publications

References 10 publications

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments

Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology

Primary odynophonia: When pain is out of proportion to dysphonia

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