Clicking Larynx Syndrome: When the Hyoid Bone and Thyroid Cartilage Collide

Figure

Lateral views of the 3D-reconstructed computed tomography at rest (left, standard-dose technique) and in the intradeglutitive phase, that is, during swallowing (right, low-dose technique). The hyoid bone and the ossified portion of the thyroid cartilage are shown in white, while the cartilaginous portion is reconstructed in brown. The distance between the edge of the thyroid cartilage and the hyoid bone at rest is marked with a dashed line. Upon laryngeal elevation during swallowing, the superior border of the thyroid cartilage rubs against the hyoid bone from the inside (arrow), providing the imaging correlate of the clicking in clicking larynx syndrome. Under normal circumstances, the hyoid bone and thyroid cartilage move harmoniously upward and forward together during swallowing, without coming into contact with each other. Foto: Institut für Neuroradiologie, Charité – Universitätsmedizin Berlin

A 35-year-old female amateur singer presented with a clearly audible clicking sound that occurred every time she swallowed. The noise manifested without any apparent trigger, was associated with a painless sensation of laryngeal resistance, and was perceived as very bothersome by the patient. Videolaryngostroboscopy and ultrasound of the neck were both unremarkable. Functional computed tomography confirmed the palpatory suspicion of intradeglutitive contact between the hyoid bone and thyroid cartilage as the correlate for the clicking (Figure). The other anatomical structures were normal. Clicking larynx syndrome is a very rare anatomophysiological phenomenon, with approximately 20 cases reported worldwide to date. Postulated causes include a short hyoid–thyroid distance, a displaced superior horn of the thyroid cartilage, an enlarged greater horn of the hyoid bone, and—in cases of unclear etiology—abnormal ossification in the thyrohyoid ligament. If an anatomical cause can be identified, surgical treatment is possible. In the present case, an explanation of the underlying etiology of the clicking was sufficient to reassure the patient; hence, to date, she has not requested thyroplasty with resection of the upper thyroid cartilage.

Prof. Dr. med. Philipp P. Caffier, Klinik für Audiologie und Phoniatrie, Charité – Universitätsmedizin Berlin, [e-mail]

Prof. Dr. Dr. med. Mike P. Wattjes, Prof. Dr. med. Eberhard Siebert, Institut für Neuroradiologie, Charité – Universitätsmedizin Berlin

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Caffier PP, Wattjes MP, Siebert E: Clicking larynx syndrome: when the hyoid bone and thyroid cartilage collide. Dtsch Arztebl Int 2026; 123: 288. DOI: 10.3238/arztebl.m2026.0033