@Jules You are right. I just hope type 2 nerve pain can go away if ES is succesfully operated.
It is motion what usually triggers my pain. Situations shuch as getting/getting off in the car, stanting up suddely, turning down my head in the morning. So there is a mechanical component in my sickness, no doubt.
@Algobe - Mechanical components are very typical initiators or perpetuators of ES nerve pain as the styloids do move in the neck as well as the hyoid bone & stylohyoid ligaments thus any motion in that area can increase nerve irritation & increase symptoms/pain.
I think that makes a lot of sense. @Isaiah_40_31
One of the many questions I have is about the next step in treatment, depending on what the doctor says. When I have mentioned to people around me the possibility of surgery, everyone immediately thinks about how dangerous an operation in that area could be. However, from what I have generally read online, styloidectomies seem to have a relatively high success rate.
I do not know what your opinion is, but I am trying to understand when it becomes appropriate to move from conservative treatment to surgery. Sincerely, after more than two years of dealing with this pain, at what point does someone begin to think that surgery may be the best option?
What level of pain or severity usually makes surgery a priority, and at what point is conservative treatment considered ineffective?
I read one of the many conversations you can find on this forum, and I noticed that some of the symptoms described there are very similar to mine. @musclecarguy
The pain I experience feels as if it is located around the cricothyroid area. It is very similar to the burning or inflamed sensation one can feel in the throat after running very fast in the winter, except in my case that inflammation-like sensation is almost constant.
I should also mention that I had a crown placed on a lower molar on the left side, and I have always suspected that something in that area could have been the original cause or the starter or could still be contributing to the problem.
We suggest that when symptoms are detracting from a person being able to live a normal life, it’s time to consider surgery. We know that as time passes, symptoms tend to increase & become more severe because the styloids continue to grow &/or ligaments continue to calcify. If there are other variations of the styloid apart from length, those become more exaggerated. I would say that since you’ve been uncomfortable enough to seek out more information about ES & join our forum, you’re at a point where considering surgery would be a good idea.
The surgery does take place in a well vascularized & well innervated part of the body, but the surgeons who are very experienced w/ ES surgeries (some have done hundreds of surgeries by now) have the experience to know how to navigate around the nerves & blood vessels so as not to damage them. These doctors most often produce excellent outcomes. That said, no doctor can predict how a patient’s body will respond to a major surgery, & no doctor can guarantee nerves will heal even once they’re decompressed or irritation is relieved. Nerve recovery is slow & can be painful as well, but for many of us here, the risks of surgery outweighed the suffering ES had caused, so we took that “leap of faith” & surgery gave us our lives back.
Level of pain that makes surgery a priority is individual since we each have a different level of pain tolerance. Conservative treatment becomes less effective as time passes i.e. nerve pain meds & other types of pain meds become less effective & doses often have to be increased. This is another place where the consideration of whether conservative treatment is effective is very individual i.e. how much pain can you live with, or is it time to consider taking the plunge to eradicate the cause of the pain/symptoms entirely?
We’ve seen many members who’ve has symptoms start after an extraction or major dental work- sometimes instantly, sometimes building up over time. Whether this is because people already have asymptomatic but elongated styloids and the awkward head position during dental work or maybe the pulling & tugging a dentist needs to do shift the neck structures slightly and then symptoms start (the neck is such a tight space with so many important blood vessels and nerves, that even a couple of millimetres can make the difference between a nerve being pinched or not), or perhaps during dental work the nerves get sensitised and then there’s more pain from the styloids, who knows… MY pain started in one molar, and turned out to be nothing to do with that tooth, but I did have some jaw and ear pain as well that I’d thought were caused by wisdom teeth- I never got those removed & that pain went after surgery…
Thank you @Isaiah_40_31 @Jules
The truth is that I am dealing with pain that is bothersome. Of course, one can always keep going, but the issue is not only the pain itself; it is also the cloud that is constantly hanging over your head, keeping you from enjoying life the way you should.
I am aware of the possible complications that surgery may involve. Even so, I want to trust that the doctor or surgeon knows what he is doing, and once I understand the risks, I am willing to take that chance. The problem is that, many times, whether or not to have surgery is no longer only the patient’s decision. It also depends on whether the doctor considers it appropriate. And sometimes, even if the patient wants surgery, the doctor may refuse for different reasons.
Do you know what other scans or medical tests do doctor request?
As rightly said, a dental problem can potentially lead to consequences that originate elsewhere, and because this is such a complex area, one can never know with absolute certainty.
Because I have tried to learn more and have not simply accepted the opinion of the first or second doctor I saw, I have been able to understand that, at this point, the possibility that my condition is Eagle Syndrome is being taken very seriously.
So I do not think one should give up. For now, I will wait until the 1st and I will keep you informed.
Hyoid Bone Syndrome: A Comprehensive Medical Review
Have a read of this and see if any of your symptoms match.
I have pain in my throat on phonation and exertion, so my symptoms are completely different to yours, but perhaps worth a read.
Thank you @virenlondon I will definitely will!
I will look forward to what you share about your appt. on June 1st, @Algobe. 
Your Ct shows the styloids, hyoid & thyroid cartilage well, and if you’ve previously had an MRI that should show any spinal issues. If members have vascular symptoms (fainting, dizziness, head pressure for example) we suggest that they try to get a CT with contrast, but it doesn’t sound like you need that? A FIESTA MRI can show the cranial nerves around the skull base in more detail, it’s usually done if there’s suspicion of blood vessels compressing the trigeminal nerve & causing trigeminal neuralgia, but this is often hard to get done. So I think the scans you’ve had should be enough.
Thanks @Jules and all of you.
I have had many scans over the past few years: MRI with and without contrast of nect and throat in 25, MRI with contrast of my skull/brain in 25, a CT scan in 2024, a voice study in 2026… None of them showed anything significant until this most recent CT scan in 2026. To be honest, that makes very little sense to me.
A neurologist from Mexico recently suggested a FIESTA MRI. If I can have it done in Spain, I certainly will, but it will depend on what the doctor recommends and whether the clinics there offer that type of imaging.
I also want to mention something that feels very strange to me, to the point that I almost feel embarrassed bringing it up with a doctor. When I let my beard grow to a certain length, I feel sometimes numbness in my left cheek. This never happens when I shave. I know it sounds absurd, but I have tested it several times, and the pattern is quite consistent. You can probably imagine whether I choose to wear a beard now or not :). Still, saying this to a doctor feels very difficult for obvious reasons, even though I can guarantee that it happens.
Thank you all again.
So frustrating that you’ve had so many scans yet nothing was seen until now- sadly we see that quite often here, & if members get hold of older scans & look back you can often see calcifications there which were missed…Often unless specifically asked to look for styloid length etc radiologists don’t think to comment!
Nerves are strange things! I get weird sensations since my surgery up the outside of my ear, it’s like a whoosh & only happens if I get a shock, or a bit panicky about something! It could be the trigeminal or facial nerve, maybe the beard hair is pulling slightly on the skin, but you’d think you would have it when you shave!
Hello everyone,
As I mentioned a few days ago, on June 1st (yesterday) I traveled to Spain to meet with two laryngologists at different medical centers. Since both consultations were with new specialists, I had to start from the beginning and explain my entire medical history, symptoms, and the findings from my recent CT scan.
After reviewing the scans and listening to my history, both specialists agreed that the diagnosis of Eagle Syndrome appears highly likely. They reviewed the CT findings showing elongation and calcification of the stylohyoid complex, measuring approximately 41 mm on the left side and 50 mm on the right side.
The first laryngologist explained that my cricothyroid-region pain could potentially be related to Eagle Syndrome. Her reasoning was that the styloid process and calcified stylohyoid ligament are anatomically connected to the hyoid apparatus, which in turn has functional and anatomical relationships with the laryngeal framework. In her opinion, there is a plausible connection between Eagle Syndrome and the type of pain I experience.
However, after carefully reading the radiology report, she became concerned about another finding that she felt should be investigated before considering Eagle surgery.
The CT report also describes several cervical spine abnormalities, including:
Multilevel cervical degenerative changes, predominantly at C5-C6 and C6-C7.
A diffuse disc bulge at C5-C6 with moderate foraminal stenosis.
A left foraminal disc protrusion with a disc-osteophyte component at C6-C7, contacting the exiting C7 nerve root.
Mild facet arthropathy with hypertrophic changes.
Because of these findings, she told me that she would want me to be evaluated by a neurosurgeon and possibly an orthopedic spine specialist before proceeding with Eagle surgery, an electromyography is was she suggested.. Her concern was that some of my symptoms might be related to the cervical pathology, and she wants to determine whether those findings are contributing to my pain before operating. She performs Eagle surgery through an intraoral approach, but she felt strongly that the cervical findings should be properly investigated first.
To be honest, this caught me off guard. Over the last two years I have seen multiple physicians, ENT specialists, and radiologists, and no one had ever suggested that these cervical findings might be clinically significant.
Interestingly, about four hours later, I attended my second consultation with another laryngologist. He also agreed that Eagle Syndrome is clearly present and stated that we had finally identified a structural explanation for at least some of my symptoms. However, after reading the same radiology report, he independently expressed concern about the cervical spine findings.
Like the first specialist, he recommended evaluation by a neurosurgeon and a spine specialist before making a final decision regarding Eagle surgery. His view was that it would be important to determine whether my symptoms are being caused by Eagle Syndrome, by the cervical abnormalities, or by a combination of both.
When two independent specialists reach the same conclusion on the same day, it certainly gets your attention.
As a result, my next step will be to seek consultation with a neurosurgeon and possibly a spine specialist to better understand the significance of these cervical findings.
The two doctors also suggested different additional investigations. The first physician mentioned that an electromyography (EMG) might be useful, while the second felt that obtaining additional MRI imaging could also provide valuable information before moving forward with surgery. However, Dr. Llópez, the second one, never heard of a FIESTA cut.
Regarding surgery itself, the two specialists use different techniques:
Dr. Irene López (Quirón) performs the procedure through an intraoral approach.
Dr. Nacho Llópez (Vithas) performs the procedure through an external cervical (neck) approach.
Both discussed the risks involved. They explained that reaching the styloid process is not a trivial procedure and that surgery can sometimes create new problems through scar tissue formation, fibrosis, or unintended irritation of nearby structures. In other words, while one pain may improve, another issue can occasionally appear.
The second surgeon was particularly cautious in describing the expected outcomes. He emphasized that Eagle surgery cannot guarantee success and suggested that results can sometimes be unpredictable. He also stated that, in his opinion, there is no truly effective conservative treatment that reliably resolves Eagle Syndrome symptoms. Ultimately, he felt the decision would be mine.
Although I respected both opinions, I must admit that I left with somewhat more confidence in the first specialist’s overall assessment.
At the same time, I came away with mixed feelings.
On one hand, I feel that real progress has finally been made. Both specialists acknowledged the presence of Eagle Syndrome and both would be willing to operate if I decide to proceed.
On the other hand, neither could guarantee that surgery would resolve my symptoms 100%, and both raised concerns about the cervical spine findings that may also be contributing to my condition.
The reality is that I seem to have two distinct pain patterns:
Pain around the left tonsillar/oropharyngeal region, which appears highly consistent with Eagle Syndrome.
Pain in the cricothyroid/laryngeal region, which could potentially be related to Eagle Syndrome, as the first doctor suggested, or could be influenced by the cervical abnormalities described in the CT report.
Unfortunately, neither I nor the physicians can determine with absolute certainty which structure is responsible for which symptom. Medicine rarely provides mathematical certainty, and this appears to be one of those situations.
In any case, I wanted to share my experience from yesterday in case it helps someone else facing a similar situation. I will continue updating the group as I learn more and move forward with additional evaluations.
I would also be interested in hearing from anyone who has experience with:
Intraoral vs. external cervical Eagle surgery.
Success rates and long-term outcomes.
Cases involving both Eagle Syndrome and cervical spine pathology.
Any thoughts on how to differentiate symptoms arising from Eagle Syndrome versus cervical nerve involvement.
Thank you all for taking the time to read this, and I appreciate any suggestions or experiences you may be willing to share.
Best wishes to everyone.
That’s interesting both doctors were concerned about your C-spine too, it’s a tricky one… Personally I would do some research into this, as from my understanding of anatomy the nerves to the throat are the vagus and glossopharyngeal nerves, which exit from the skull base beside the styloid processes, which is why these throat pain/ swallowing difficulties/ globus sensation symptoms are very common with ES? Whereas the nerves which exit the spine at C5-C6 which would be affected by a prolapsed disc are to the arms and hands, so I would question if the throat symptoms you have could be caused by this disc bulge? I mean, it’s good to get all things investigated before making a decision about surgery, it shouldn’t be a decision undertaken lightly, so if you can live with symptoms a bit longer to have some more testing then fair enough. (I speak from personal experience, as I had a prolapsed disc C5-C6, which has been managed with physiotherapy, but if you were to consider seeing a physio, they would need to understand ES as well, as some exercises could worsen your ES symptoms, or even be dangerous). Many of our members do have similar degenerative changes in their cervical spine, but still have successful ES surgeries. I think if members have CCI / AAI then there can be more complications/ uncertainty with surgical outcomes, but not so much with the usual changes further down the C spine.
Members are often concerned that doctors don’t guarantee their symptoms will go with surgery, but this is quite normal- unfortunately because of the world we live in, doctors have to be cautious about promising too much with surgery.
There’s info in here about the pros and cons of external or intra-oral surgery:
ES Information- Treatment: Surgery - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
But briefly, while many members have had successful intra-oral surgery, external surgery is regarded as safer because of better visibility to see nerves and blood vessels, and also often better results because more of the styloid process can be removed.
I don’t think we have any up to date research showing success rates, but there are some figures quoted from research papers in the ES Info Surgery section I’ve linked above.
At the end of the day, the only ‘cure’ for ES in surgery…
Hello everyone,
I wanted to take this opportunity to share the latest findings and update you on the progress I’ve made with my doctors regarding my condition.
As I mentioned in previous posts, I was diagnosed with bilateral elongation of the styloid processes, and symptomatic left-sided Eagle syndrome was confirmed. In addition, cervical spinal stenosis and multiple cervical disc bulges were also identified, findings that I discussed in earlier posts.
During my most recent consultations, my doctors felt that, before focusing treatment exclusively on Eagle syndrome, it was important to determine to what extent the cervical spine abnormalities might be contributing to my pain and other symptoms.
For that reason, they recommended that I undergo a new MRI of my cervical spine. Below, I’m sharing the results, as they have provided additional information that may help better explain my case.
MRI OF THE CERVICAL SPINE WITHOUT CONTRAST
Examination: MRI of the cervical spine without intravenous contrast.
Clinical indication: Cervicalgia (neck pain).
Multiplanar T1- and T2-weighted MRI sequences were obtained.
Findings:
Normal sagittal alignment of the cervical vertebral bodies.
Diffuse intervertebral osteochondrosis with posterior osteophytic ridging, uncovertebral arthrosis (uncovertebral joint hypertrophy), facet joint hypertrophy, and multilevel degenerative disc disease, resulting in the following findings:
The cervicomedullary junction, cervical spinal cord, and spinal canal are otherwise unremarkable, with no additional abnormalities identified.
When I received the MRI results, I have to admit I was quite worried. I then consulted an orthopedic spine specialist, who explained that these types of cervical findings are actually quite common and, by themselves, are often not severe enough to warrant cervical spine surgery.
However, he also wanted to be cautious. He acknowledged that the cervical abnormalities could still be contributing to my symptoms and suggested a diagnostic cervical injection. This procedure is performed in the operating room, and his reasoning was straightforward: if my pain disappeared after the injection, it would strongly suggest that at least part of my symptoms originate from the cervical spine. Specifically, it could indicate that the neck pathology is referring pain to the cricothyroid region. Anatomically, he explained, this is plausible, even if the mechanism is not always easy to understand.
Later, I consulted a neurologist. She recommended trying antidepressant medication commonly used for neuropathic pain. She explained that these medications can reduce pain signaling and, in some cases, may even help restore nerve function, although that possibility is considered relatively uncommon.
My concern is that if I start the medication and undergo the cervical injection at the same time, I won’t know which treatment is actually responsible if my cricothyroid pain improves. For that reason, I am trying to have the cervical injection performed before I return to the United States on August 3.
During this time, I also had a follow-up appointment with my laryngologist at Quirón Hospital in Valencia. Interestingly, her opinion had changed somewhat since our first visit. Initially, she believed that the pain in my cricothyroid region could be closely related to the pain I experience around my tonsillar area because of the confirmed symptomatic Eagle syndrome on the left side. At this second visit, however, she was less convinced that both pains necessarily had the same origin. I still don’t fully understand what led to this change in her opinion.
I also asked her a question that has been on my mind throughout this process: what structure is actually causing my pain? Although the neurologist believes the pain is neuropathic, my laryngologist explained that physicians often cannot determine with certainty exactly which tissue or nerve is generating pain in complex cases like this. Instead, these conditions are frequently approached through a process of elimination.
For that reason, she agreed with the plan of first performing the cervical injection. If it does not relieve my symptoms, the next step would be to begin the neuropathic pain medication. Only after evaluating the response to those treatments would she consider proceeding with a styloidectomy, likely seven or eight months from now. Her goal is to identify which treatment, if any, is responsible for improving my symptoms before recommending surgery.
At this point, I can clearly distinguish between two different types of pain. One is located in the oropharyngeal or tonsillar region. The other is located around what I describe as the cricothyroid region. I call it the cricothyroid region because that is where I perceive it, although I cannot be certain whether the pain is truly arising there, whether it is deeper, or whether it is referred from another structure.
The one feature that has remained remarkably consistent throughout all of this is that the cricothyroid pain is strongly influenced by posture, especially the way I sit and position my neck. For that reason, several of the physicians I have seen continue to believe that my cervical spine may be contributing, at least in part, to my symptoms.
Thank you for a very thorough follow-up report, @Algobe. It sounds like you’ve found some very knowledgeable doctors in Spain.
I completely agree with this approach. It’s very logical. I have to say that some doctors will do an ultrasound guided injection of lidocaine + steroid into the tonsillar fossa to determine if certain nerve pain is being caused by an elongated styloid. These injections are not a reliable source of information because they help reduce pain in some cases, do nothing in other cases & make pain worse in still others. Just so you know there is a possibility that the cervical injection you get may not be a totally reliable source of information. It is good that you know there could be more than one source of your pain & that the doctors you’ve seen are trying to help figure the puzzle out.
Would the doctor who’s doing the injection do the styloidectomy in seven or eight months or would she refer you to someone else to do it?
Thank you very much for taking the time to respond to me in such detail. I truly appreciate your comments and your experience.
Regarding my cervical spine, I completely agree that it’s a complex issue. My understanding is also that the cranial nerves, especially the glossopharyngeal and vagus nerves, are primarily responsible for many of the classic symptoms of Eagle syndrome, such as throat pain, dysphagia, and the sensation of a lump in the throat (globus). That’s why I find it difficult to believe that a C5–C6 or C6–C7 disc protrusion alone could explain everything I’m experiencing.
That said, the doctors who have evaluated me also explained that not every structure in the anterior neck depends exclusively on the cranial nerves. There are muscles, fasciae, and other components of the hyoid-laryngeal complex that receive innervation from cervical fibers (such as the ansa cervicalis and other branches of the cervical plexus), in addition to branches of the vagus nerve. This was something I didn’t know, and as a patient I can’t question what they have explained to me. For that reason, they want to rule out whether there is a cervical component contributing to my symptoms, even if it is not necessarily the primary cause.
The cervical injection will be performed by Dr. Gerd Bordon, an orthopedic surgeon at IMSKE Hospital in Valencia. I have not talked to him yet.
I completely understand your point that a diagnostic injection is not a definitive test. If it improves my pain, it will not prove 100% that my cervical spine is the cause; and if it doesn’t help, it won’t completely rule it out either. Even so, I believe it may provide another piece of the puzzle.
If I have the opportunity, I would also like to ask whether, in my case, it would make sense to perform some type of diagnostic injection directed toward the styloid region, like the one you mentioned, since it might provide additional information.
My reasoning as a patient is only a personal hypothesis. I wonder whether there could be a mechanical relationship between the elongated styloid process and the larynx. Specifically, I wonder whether the elongated styloid could alter the tension of the hyoid bone and the thyrohyoid structures, somehow irritating the tissues around the thyrohyoid membrane, where the internal branch of the superior laryngeal nerve enters the larynx.
As for surgery, if we ultimately conclude that Eagle syndrome is the primary cause of my symptoms, the styloidectomy would be performed by Dr. Manuel Bernal Spreckelsen. The ENT specialist who confirmed that my left side is consistent with symptomatic Eagle syndrome, Dr. Irene López, spoke very highly of his experience with this condition. She told me that she would prefer my case to be managed by the surgeon who taught her how to perform Eagle syndrome surgery. As she explained it to me, she would also be present during the operation.
I also appreciate your comments regarding physiotherapy. If I eventually go down that route, I’ll make sure the physiotherapist is familiar with Eagle syndrome and carefully reviews all of my imaging studies before considering any cervical treatment.
Unfortunately, we have to accept why surgeons are cautious when discussing surgical outcomes, and that is precisely why they must investigate every reasonable possibility before taking such a significant step.
Once again, thank you all very much. I truly appreciate your willingness to share your experience and knowledge. It is genuinely helping me make more informed decisions.
I’ll be sure to keep you updated on my progress. 
@Algobe The styloids may also contribute to soft-tissue issues, such as fascial bands or other reactive tissue changes, so that might be something to add to your list of questions for your doctors. In my case, it was suggested that my styloids may have caused the soft-tissue lesion near C1, possibly a fascial band. Even if other possible causes are being investigated, the styloids could still be the main underlying contributor.