Skeletal tuberculosis is a well-known disease entity. We report the first case involving hyoid bone and the use of polymerase chain reaction-based test in detection and management. A 62-year-old male presented with neck swelling of a 20-day duration along with change of voice and dysphagia. Examination revealed a cystic, osteolytic lesion of the hyoid bone which histopathologically demonstrated features of granulomatous infection. A polymerase chain reaction test confirmed the diagnosis of tuberculosis.