Hyoid Bone: Internal Carotid Artery Impingement

I am still waiting for referrals from my doctor. My appointment with the interventional radiologist was canceled because I was not a patient in the University health system.

During my appointment the other day with my PCP, she felt the prominent clicking in my throat when I swallow. I can also move whatever it is in my throat back and forth when my throat is relaxed.

It is likely either the hyoid bone, thyroid cartilage, or bone spurs. Based upon my symptoms, I think one of two things is happening. Either my internal carotid artery is being compressed by my hyoid bone or stylohyoid ligament or I have a spinal fluid leak caused by cervical osteophytes.

Perhaps @Greg Sacramento or somebody else might have some ideas and perhaps this post might help somebody in the future.

 

@Russell Grimes, for what it's worth, I had an Eagle syndrome surgery and it improved my tinnitus, but didn't fully resolve it. That being said, my hyoid bone is completely jacked up and still clicks when I swallow. Probably have to do some muscular rehab to correct it. But if the stylohyoid ligament is calcified, there is probably a reason and it's possibly (likely?) because your body was trying to stabilize the hyoid bone from uneven forces.

 

Maybe - First bite syndrome - parotid region. Can happen after Eagle syndrome surgery involving the infratemporal fossa, parapharyngeal space, and/or deep lobe of the parotid gland. This should resolve. Muscles - maybe correct. Online videos for this.

A while back, I'm almost positive, I mentioned that a shortened hyoid muscle may be causing your pulsatile tinnitus. This can also cause a click during swallowing.

Hyroid bone could be impinging on cervical vertebrae. Prior trauma to neck? Other association cause with pulsatile tinnitus could be hyroid bone rubbing against thyroid.

Muscles that attach to the hyoid bone? Online video's for hyroid release, but for you, I wouldn't try this before getting a CT.

Did you get a high resolution CT?

This should be an easy fix - resolvement of pulsatile tinnitus.

 

Thanks for the response, Greg. I have an appointment with a vascular specialist tomorrow and with a neurologist on the 21st. I will mention these possibilities to the doctors. I am hopeful I can find the etiology of my problems by Spring so I might work upon a resolution. I have no doubt whatever is plaguing me can be fixed. It has just taken me a while to get the required referrals.

 

i am glad to hear you were able to get some corrective surgery. Knowing the origin of one’s problems is half the battle. Getting them resolved is the other half.

 

I saw the vascular specialist. He looked at the MRI and MRA of my neck vessels and essentially told me any further testing there would be a waste because an MRA would show impingement or occlusion of the carotid artery. He also said the cause cannot be venous, which completely diminished his credibility, in my opinion.

I was under the impression an MRA would not necessarily show impingement of an artery but I guess he is the expert. He also has no idea why bouncing up and down causes rhythmic tinnitus, how the clicking in my throat might relate to the pulsatile tinnitus, or why I can greatly reduce the rhythmic, reactive tinnitus and the pulsatile tinnitus with strong constriction of my neck muscles. Essentially, these doctors are useless.

I am writing a lengthy, certified letter to the neurologist before my appointment that explains my symptoms and the possible origins in great detail. I will also explain my expectations regarding testing.

 

Best to see an interventional radiologist as mentioned by all of us on this site with pulsatile tinnitus knowledge and having or having had pulsatile tinnitus.

When we first talked some time ago, you mentioned all the above, except clicking in your throat. I mentioned possible hyoid bone - hyoid muscles. Now, in this thread, you mention clicking in your throat. Tell this doctor, to research why someone with pulsatile tinnitus, has clicking in their throat, besides your other mentions.

Let me guess. This doctor did not perform a stethoscope auscultation study for internal blood flow sounds. Any vascular doctor or neurologist that does not perform a complete body stethoscope study, including neck, for a patient with pulsatile tinnitus shows no credibility. Been told this by ER and other practitioners many times.

Yes, again, agreed, no credibility. Many studies also available.

→ What is causing a clicking sound when I swallow?

Read first line:
→ Carotid artery entrapment by the hyoid bone

 

Thanks for the response and the links. I plan to share some valid and reliable, peer-reviewed studies both by certified mail and at my appointment on the 21st of December.

 

@Russell Grimes, since reading @Greg Sacramento's response I have been looking at the musculature a lot more and trying to find the reason why my hyoid was tipped. This may not be the case with you, but it might be worth looking. In my case the right side of my hyoid was tipped down and it turns out my hyoglossus on that side was not activating properly (the muscle that connects to tongue to the hyoid).

Overall this means I was swallowing incorrectly or at least favoring one side, the digastric was super tight on the right side as well, which is responsible for mandible retraction to some extent. What this meant was everytime I would swallow it would jam the TMJ into the socket. Guess which ear has the bad tinnitus? If you guessed right, you are correct. I also have ETD on that side and that is takes a LOT of pressure to open the Eustachian tube. It is reactive, hissing and eventually becomes a tone when exposed to a lot of noise. When it gets really bad, it spreads to the left side as well. It resets at night for the most part. It also sounds rhythmic when I run like a water going up and down through a pipe or hose. Likely the jaw joint jamming into some nerve. It also becomes pulsatile/rhythmic when it gets really bad.

However, when I manually or consciously activate the hyoglossus on the right side and swallow correctly, I no longer get the hyoid click when swallowing and the hyoid is level on both sides.

My guess would be this might be the case with you as well. I found that focusing on proper TONGUE posture and posture in general improves it. It is not an overnight fix for me because there are multiple layers that need to be overcome...

1. correct tongue posture and relieve muscle tension (needs to become habitual)
2. reduce swelling in the TMJ, neither side has ACTIVE pain, but if I touch the joint it is definitely tender, with the right side being worse
3. once swelling is down, work on the Eustachian tube
4. once everything else is clear, probably do sound therapy as the brain needs to readapt to normal sound levels and frequencies because all of the above effects different frequencies ranges and excitability
5. hope for the best

This is my current theory. There have been times where my tinnitus is completely gone and a cold would always bring it back. My right ear would always take a long time to clear and during the progress I would always notice a slight pain under the right corner of my jaw. It was the digastric and my guess is that also puts some pressure on the Eustachian tube because if I would run the area I would feel a bunch of warm mucus run down my throat and the tinnitus would instantly calm down.