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Suggest Treatment For Hyoid Bone Pain

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Posted on Wed, 16 Dec 2015
Question: That I have an inflammed hyoid bone. The pain is literally unbearable at times. Feels like i hae extrememly swollen lymph glands, or tumor in neck (had CT -clear), with pain that goes to jaw, severe referral pain to ear, cheekbone. My ENT thinks from clenching, but this started kind of suddenly about 4 months ago; it feels like my cheek muscles are constantly spastic, likely pulling on my hyoid ligaments all the time. Talking, laughing, smiling, and ironically, saying the word "Hyoid" aggravates my condidtion, and I basically "talk" for a living as a financial advisor. I am in absolute misery. It hurts to even kiss my husband more than a "peck." I am eating soft foods only for the most part.
I have a theory though - i have had a lipoma removed from my right forehead (good size)in the past. Seems like maybe another small lipoma is there, and I am theorizing that this one may feel small, but run deep, and is possibly pressing on my auriculotemporal nerve of similar, causing the spacicity in the massister, and pulling on the hyoid bone; further supporting this is that the pain gets worse when I wear my glasses and there is any pressure against my temporal lobe - causes the neck/jaw/ear pain to get worse. I have been treated with acupuncture, cold laser, two rounds of triamcinolone acetonide (i think this is what the ENT used - tiny needles into my neck), and botox into the massiter in the cheek and temporal lobe..... I really need help!
doctor
Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer:
This requires further evaluation.

Detailed Answer:
Hi,

Thank you for your query.

1. There are a number of causes of pain in the area of the hyoid bone. Some of these are uncommon. A direct examination and palpation of the site should help in locating the cause. It is good to hear that the CT is normal. This rules out many known causes. An MRI Scan would not miss a large lipoma.

2. The following conditions mimic each other. Symptoms are similar to those that you describe:
a. Hyoid bursitis
b. Eagle's Syndrome
c. Pharyngeal constrictor muscle pain

3. Palpation through the mouth can reveal these painful areas. Review the CT Scan images for Eagle's syndrome (Elongated Styloid Process). A Neck vessel colour doppler study should be done. Some causes have already been ruled out in your case and some treatments have already been tried.

4. A local nerve block at these suspected sites will settle the diagnosis.

5. Let me know the results of the search for the above mentioned conditions to continue the discussion for treatment options.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sumit Bhatti (8 hours later)
Thank you so much, I really appreciate it. Would you think it would be a good idea then for me to get an MRI of that area? Can they do the vascular die during that time?
doctor
Answered by Dr. Sumit Bhatti (4 hours later)
Brief Answer:
Yes, you can go ahead with the MRI Scan.

Detailed Answer:
Hi,

Thank you for writing back.

1. Yes, you can go ahead with the MRI, preferably on a 3 Tesla machine.

2. Contrast enhancement can be done if there is any abnormal finding.

3. Some MRI Scan machines have software capable of enhancing blood vessels without using a contrast XXXXXXX

4. Remember that most MRI Scans would be normal, considering that the CT Scan is normal. Only subtle changes and the suspected lipoma can be ruled out. Also a normal MRI will rule out many other causes. Hence even a normal MRI is of immense value.

5. The MRI Scan can rule out structural defects, not functional defects. This will require a multi-speciality approach.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
Answered by
Dr.
Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2685 Questions

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Suggest Treatment For Hyoid Bone Pain

Brief Answer: This requires further evaluation. Detailed Answer: Hi, Thank you for your query. 1. There are a number of causes of pain in the area of the hyoid bone. Some of these are uncommon. A direct examination and palpation of the site should help in locating the cause. It is good to hear that the CT is normal. This rules out many known causes. An MRI Scan would not miss a large lipoma. 2. The following conditions mimic each other. Symptoms are similar to those that you describe: a. Hyoid bursitis b. Eagle's Syndrome c. Pharyngeal constrictor muscle pain 3. Palpation through the mouth can reveal these painful areas. Review the CT Scan images for Eagle's syndrome (Elongated Styloid Process). A Neck vessel colour doppler study should be done. Some causes have already been ruled out in your case and some treatments have already been tried. 4. A local nerve block at these suspected sites will settle the diagnosis. 5. Let me know the results of the search for the above mentioned conditions to continue the discussion for treatment options. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.