Tenderness Over the Hyoid Bone Can Indicate Epiglottitis in Adults

Abstract

Adult acute epiglottitis is a rare but life-threatening disease caused by obstruction of the airway. The symptoms and signs of this disease may be nonspecific without apparent airway compromise. We encountered 3 consecutive cases of adult patients with this disease in a single 5-month period in one physician's office. In all cases, physical examination revealed tenderness of the anterior neck over the hyoid bone. These observations assisted us in identifying this rare disease quickly. We suggest that tenderness over the hyoid bone should raise suspicion of adult acute epiglottitis. Adult acute epiglottitis is an inflammatory disease of the epiglottis and adjacent structures resulting from infection. It can be a rapidly fatal condition because of the potential for sudden upper airway obstruction. Early recognition of acute epiglottitis is therefore of the utmost importance in minimizing morbidity and mortality.Unfortunately, misdiagnosis occurs in 23% to 31% of the cases of adult acute epiglottitis.1-3 During a single 5-month period, we encountered 3 cases of the disease in our physician's office. Physical examination revealed tenderness of the middle anterior neck, especially over the hyoid bone, in all patients. This sign enabled us to diagnose this uncommon disease quickly. All the patients steadily improved without the need for interventional airway support. Here we propose that tenderness over the hyoid bone should be considered a major sign in the diagnosis of adult acute epiglottitis. Case ReportsCase 1 A 55-year-old woman presented to the Ehara Clinic in July 2004 complaining of a severe sore throat that had begun the previous day, and with a fever of 37.5°C. She complained of dysphagia and odynophagia. She experienced a loss of vocal power, and talking aggravated her sore throat. At admission, the patient did not seem to be critically ill. Her voice was neither muffled nor hoarse. The vital signs indicating the nature of her condition were as follows: body temperature, 37.0°C (axillary); blood pressure, 90/64 mm Hg; pulse, 64/min; respirations, 24/min; peripheral oxygen saturation, 97%. At this point, these findings were not sufficient to indicate any serious diseases. The pharynx was slightly erythematous. Dyspnea, stridor, and drooling were not found. The bilateral upper cervical lymph nodes were mildly swollen. Careful neck palpation revealed tenderness of the anterior median neck. The lungs were clear. The results of the remainder of the physical examination were within normal limits. A lateral neck radiograph revealed an enlargement of the epiglottis and a narrowing of the vallecula.The patient was referred to the hospital to be seen by an otolaryngologist. Fiberoptic laryngoscopy revealed that the lingual surface of the epiglottis was swollen, but the laryngeal surface and the arytenoids remained unswollen. The patient was given hydrocortisone sodium succinate intravenously (300 mg/day) and instructed to take 60 mg of loxoprofen sodium 3 times a day. Here, it was assumed that the patient was very u...

Acute airway obstruction, an unusual presentation of vallecular cyst

“…Other symptoms and signs include hoarse or muffled voice, tenderness over the hyoid bone, cervical adenopathy, fever, cough, and ear pain. [5]…”

Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology

“…A few articles in the medical literature have shown a clear association between hyoid bone tenderness and various pathologies [1][2][3][4] ; however, none have looked at the correlation of this sign with abnormalities on flexible nasal laryngoscopy. It was first described by Brown 5 in 1954, as part of the hyoid bone syndrome.…”

“…More recent articles have suggested that it is a useful clinical indicator for the early detection of epiglottitis in adults. 3,4 In this study, we aimed to compare the laryngoscopic findings of patients having hyoid tenderness against patients who presented to voice clinic without signs of hyoid tenderness. The primary outcome of the study is to assess if there is any association between hyoid tenderness and laryngeal pathology.…”

Acute epiglottitis: a retrospective review of 47 patients in Kuwait

“…Hence, securing the airway is of utmost importance. In adults although the symptoms and signs of the disease may be non-specifi c, most cases can be managed conservatively yet the potential for sudden airway obstruction still exists [5]. Early recognition of acute epiglottitis is therefore of Symptoms like fever, sore throat, odynophagia, drooling of saliva, stridor, change of voice and shortness of breath were recorded.…”