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Clinical Note |

Clicking in the Throat Cinematic Fiction or Surgical Fact?

Marshall E. Smith, MD; Gerald S. Berke, MD; Steven D. Gray, MD; Heather Dove, MA; Ric Harnsberger, MD
Arch Otolaryngol Head Neck Surg. 2001;127(9):1129-1131. doi:10.1001/archotol.127.9.1129.
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The complaint of a clicking in the throat when swallowing is uncommon but very discomforting and painful for those who experience it. It is such an unusual complaint that symptoms may be dismissed as psychogenic because a cause for the problem may not be readily apparent. We present a series of 11 cases in which all patients had an audible clicking or popping noise in the throat associated with neck and throat pain when swallowing or turning the neck. The most helpful diagnostic procedure was careful examination and palpation of the neck while the patient swallowed to localize the side and source of the clicking. Laryngeal computed tomographic (CT) scans helped in some cases to demonstrate thyroid-cartilage and/or vertebral body asymmetry. Each case was treated with surgery of the neck and larynx to trim the portion of the thyroid cartilage causing the clicking. In most cases the superior cornu of the thyroid cartilage projected posteriorly and medially. Surgery was successful in all cases to eliminate the symptoms. Though an uncommon complaint, our experience suggests that the clicking throat is a surgically treatable problem.

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Figure 1.

Larynx anatomic sketch with the regions marked where structures were trimmed to alleviate symptoms of laryngeal click. Patients had symptoms involving the superior cornu of the thyroid cartilage, the superior cornu and lateral thyroid ala, superior margin of the thyroid cartilage, or the greater cornu of hyoid bone.

Graphic Jump Location
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Figure 2.

A, Axial plain computed tomographic scan of the larynx in the neutral position reveals an elongated posterior margin of the thyroid cartilage perched on the anterior surface of a cervical vertebral body transverse process (arrowhead). B, Axial computed tomographic scan with the head turned to right shows the thyroid cartilage posterior alar margin has "jumped" off the transverse process (arrow).

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