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Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology

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Michael-Jean Zinni

on 14 November 2014

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Transcript of Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology

THE PROBLEM
LIT. REVIEW
It's brief. The introduction lacks the kind of detail expected of a peer reviewed journal article.

Brown (1954), part of hyoid bone syndrome
Steinmann (1968), form of insertion tendonitis
Ernest (1991), confirmed via histopathologic evidence

The author references 2 recent articles that suggest hyoid bone tenderness as a useful clinical indicator.

One is a case report involving 3 patients within a 5-month period at a physician's office.

Improvements
~ More precise description of hyoid tenderness
~ Detailed complaints of hyoid tenderness
sore throat, tonsillitis, neck pain, dysphonia
~ Why laryngoscopy?
A method of evaluating the larynx/throat disorders by passing a scope through nose and looking into throat. What are the benefits?
~ Brief description of key path under investigation
- hyoid bone syndrome
- epiglottitis
- insertion tendonitis
RESULTS
Dysphonia and neck pain are
SIGNIFICANTLY
associated with hyoid bone tenderness.
WEAK + STRONG
-- No supporting research
-- Limited findings
-- Largely female participants
-- Just one physician (influence pt. report), one clinic
-- Vague criteria, defs' (subjectivity of pain scale)
-- Multiple presenting complaints unaccounted for
-- Limited control of extraneous factors
-- Published for the online journal
THE STUDY
†Saunders, J., & Fenton, J. E. (2014). Hyoid bone tenderness as a clinical indicator of laryngeal pathology. Journal of Voice, 1-3. dx.doi.org/10.1016/j.jvoice.2014.02.012
O’Rourke, C., Sarwar, A., Ur Rehman, A.,
Citation
Was this a worthwhile problem to examine?


Determining additional clinical indicators for laryngeal pathologies:

point to potentially life-threatening conditions (i.e. acute epiglottitis)
indicates the likely presence of vocal fold nodules or nasopharyngitis
provides clinicians with quick and cost-effective screening method
Will it make a contribution?
This study contributes to a small body of literature linking hyoid tenderness to laryngeal pathologies.




See Ehara 2006, in which hyoid tenderness was linked to 3 confirmed cases of adult acute epiglottitis, a life-threatening disease in which the victim’s airway is obstructed by his or her own epiglottitis. Acute Epiglottitis has few signs and symptoms before it occurs.
REVIEW?
Investigated the relationship between
Sampling
RECRUITMENT
Pt.'s who presented to the researchers’ ENT clinic across a 5-year span (January 2006-December 2010)

CONTROL GROUP
Pt.'s who presented to the clinic during the given period, without evidence of hyoid tenderness on examination.

CASE GROUP
Pt.'s with "clearly documented" hyoid tenderness on clinical findings were included.
Method
MATCHED
for age + sex to exclude confounding factors
SENIOR AUTHOR
performed every physical examination
flexible nasal laryngoscopy
palpation; pressure applied to the greater cornu
any tenderness/discomfort was considered positive
INCLUDED IN CASE GROUP:
Pt.'s with incidental finding of hyoid bone tenderness on examination (without tenderness elsewhere)
Pt.'s who noted symptoms of neck pain on detailed history
EXCLUDED FROM STUDY:
Any pt.'s with a pre-existing neck pain syndrome
neck pain as sole symptom
Author stated, “This method helps to eliminate hyoid bone syndrome as a confounding variable.”
Analysis
data are represented as
median
N
=
number
of pt.'s included in analysis
Differences in distribution of clinical data were evaluated using
two-sided Fisher exact test
(categorical variables)
independent samples t test
(mean comparison of independent groups)
P < 0.05
considered statistically significant
All calculations used
SPSS, 12.0
(statistical software product)
retrospective
VF pathology was the MOST common finding through flexible nasal laryngoscopy in patients with hyoid tenderness.

The authors reported that hyoid tenderness may be a positive predictor of VF pathology.
Nasopharyngitis was ALMOST significantly associated with hyoid bone tenderness.

The fact that some patients presented with nasopharyngitis and postcricoid edema indicates possible laryngopharyngeal reflux. The authors stated that although this would not likely directly cause hyoid tenderness, it could be a possible secondary effect due to throat clearing.
The authors also concluded that ALTHOUGH hyoid bone tenderness may be an indicator of epiglottitis when it presents in acute cases, in more chronic cases is likely due to voice misuse/abuse.
Hyoid Bone Tenderness as a Clinical Indicator of Laryngeal Pathology
Do these relate to the initial problem?
Yes. The purpose of the study was to determine if there was a relationship between hyoid bone tenderness and laryngeal pathology. It was determined from the study that a relationship did exist.
+ First study of its kind
+ Valuable results
+ Matched for gender and sex
+ Reliable, consistent reporting
+ Representative, inclusive sampling
+ . . .
+ Mentioned it.
+ Formal ethics approval granted
+ Shouldn't diminish the validity
O’Rourke, C., Sarwar, A., Ur Rehman, A., †Saunders, J., & Fenton, J. E. (2014).
Hyoid bone tenderness as a clinical indicator of laryngeal pathology. Journal of Voice, 1-3. dx.doi.org/10.1016/j.jvoice.2014.02.012
Published online June 18, 2014
Publication stage: In Press Corrected Proof
Hyoid bone tenderness refers to patient reported discomfort or pain upon touch of the anterior aspect of the neck on or above the greater cornu of the hyoid bone.
HYOID SENSITIVITY
: LARYNGEAL PATH'
Pathological processes involving any part of the LARYNX which coordinates functions of voice production, breathing, swallowing, and coughing.
In a suspected case of murder, a fractured hyoid strongly indicates throttling or strangulation in an adult. However, this is not necessarily the case in children and adolescents, where the hyoid bone is still flexible as ossification is yet to be completed.
U-shaped
1 membrane
1 ligament
1 tendon
9 muscles (2x)
Hyoid Bone:
All tendinous insertions are in action during swallowing, respiration, and articulation.
YES.
Hyoid bone syndrome: degenerative injury of the middle pharyngeal constrictor muscle. Symptoms are generally caused by trauma at the greater cornu of hyoid bone with pain radiating to nearby structures
Formal ethics approval was sought and granted by the regional hospital ethics committee.

All investigations were carried out according to accepted clinical practice and compliant with the medical principles of the Declaration of Helsinki.
looks back
examines factors in relation to an outcome that is established at the start of the study
two groups differing in outcome are identified and compared on the basis of a supposed causal link
compare subjects who have that condition (
cases
) with pt.'s who do not but are otherwise similar (
controls
)
case-control
study
= a larger and multicenter controlled case series is necessary to reinforce these observations
= [the study] is an analysis of single surgeons’ experience, which may introduce some selection bias
= no specific attention was given to supraglottic laryngeal activity in this study

IS THE CONCLUSION VALID?
IT'S A START.
Hyiod Bone Tenderness as a Clinical Indicator of Laryngeal Pathology
Ashley Degelos | Bianca Havel | Michelle Neumann | Molly O'Dowd | Michael-Jean Zinni
Voice & Related Disorders
SPTHAUD6212
LSU Health Sciences Center
November 13, 2014
...YES?
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