It’s a complicated situation for sure! And nerves can refer pain to other areas so it’s understandable the doctors are cautious - for example an injury to the spleen is known to cause pain in the shoulder!
It does sound a logical process to try the cervical injections first and then nerve pain meds, I hope the injections do help!
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Hello everyone,
I wanted to write a new update to let you know how my situation is progressing.
On July 29, I visited Dr. Gerd Bordon, a spine specialist at IMSKE Hospital in Valencia (Spain). The purpose of the appointment was to evaluate the possibility of having a cervical injection, as I only have a limited amount of time in Spain before returning to the United States.
As I mentioned in previous posts, in addition to being diagnosed with symptomatic Eagle Syndrome on the left side (and an elongated styloid process on the right side, although asymptomatic), my MRI also showed several degenerative cervical changes. Because of those findings, some of my doctors thought it was reasonable to first rule out a cervical cause for my throat pain.
After reviewing my CT scan, MRI, and all of my medical reports, Dr. Bordon was very clear. Based on his experience, he explained that cervical conditions requiring injections typically cause pain in the back of the neck or pain radiating into the arms, not pain located in the front of the throat, where my symptoms are. For that reason, he felt that a cervical injection would have no diagnostic or therapeutic value in my case and advised against it completely. Instead, he recommended that my ENT specialists focus on the Eagle Syndrome as the most likely cause of my symptoms.
Following that appointment, I contacted my ENT specialist again, Dr. Irene López, and I now have an online consultation scheduled with Dr. Manuel Bernal-Sprekelsen (I’ve been told that he is a very good surgeon) on August 14 to discuss possible surgery and the next steps.
Even so, there is one point I would like to discuss with him. Although Eagle Syndrome currently seems to be the most likely explanation for my symptoms, I would like the cricothyroid region to be carefully evaluated as well, since that is where I most frequently experience the pain. It is a pain that appears or worsens with certain neck positions, prolonged neck flexion, or sudden movements. I also have episodes of pain in my left tonsil and oropharynx, which seem to fit Eagle Syndrome more clearly.
However, from my own experience, the lower throat pain often feels as though it has a mechanical or biomechanical component, particularly because it is frequently triggered by neck positions or prolonged posture. None of my doctors has been able to identify yet which anatomical structure is responsible, and they have all acknowledged that this can be difficult to determine. The neurologist simply commented that my pain had “neuropathic characteristics.”
For that reason, I recently started taking duloxetine. So far, it seems to have reduced the intensity of the pain, although it has not disappeared completely.
I still have one question that many of you may have asked at some point: Can a 4.1 cm elongated styloid process really cause such persistent pain that far from it? I understand that it is not only the length that matters, but also the angle, direction, thickness of the calcification, and its relationship with the surrounding structures. Even so, it is a question that still stays in the back of my mind.
At this point, Eagle Syndrome remains the only objective anatomical finding that reasonably explains my symptoms, although I am fully aware that no surgeon can guarantee a perfect outcome.
As always, thank you very much for taking the time to read my update. I will keep you updated after my consultation on August 14.
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I’m glad that the spinal consultant you saw clarified that the pain is unlikely to be from the degenerative neck issues, that’s one thing crossed off(ish) . Nerves are strange things as we’ve said before, the pain seems to be very varied for different members, which is understandable given the variation in length, width and angle the styloids grow, so I don’t think we can say for sure if ES is causing the pain or whether there is another issue. It’s not that far though in the scheme of things, and the vagus nerve travels down from the skull base alongside the carotid artery, so this could potentially cause pain aroid the crichoid area, I guess?
We do have a list of questions we suggest that members ask a doctor if they’re not well known for ES surgery:
- How many ES surgeries have they done and what was the success rate?
- Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
- You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
- If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
- There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
- Will it be a day case surgery or will you need to stay in?
- Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
- Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
- What painkillers will be prescribed afterwards.
- Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
- We have heard that occasionally doctors use surgical clips which are left in, it’s been suggested that these could interfere with chiropractic adjustments if needed post-surgery, so something to consider, and also we have now seen members who’ve been left in pain from the clips and needed further surgery to remove them, so do ask if they might be used
I hope that your appointment with DR Bernal-Sprekelsen goes well, look forward to hearing if he’ll help!
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@Algobe - Here are images of the vagus & glossopharyngeal nerves, the two most likely to be causing the cricopharyngeal pain, so you can see that they extend significantly beyond the tips of the styloids. Thus, when the are irritated up by the styloids, the pain created can run the length of the nerve fibers causing symptoms elsewhere.
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@Algobe I like Dr. Bordon a lot already, common sense! 
It sounds like you are in very good hands and I pray relief is on the horizon for you very soon!.
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@Algobe - I agree w/ @MGORNEAU, Dr. Bordon sounds like a very thorough & sensible doctor. I’m glad you found him. It’s also great to know you’ve got the name of an experienced surgeon & have a consult date set up that’s coming up soon. It sounds like you’re making good headway.
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Hello everyone,
First of all, I want to thank everyone who commented on my previous posts and shared their experiences and perspectives with me. Feeling understood and being able to compare experiences with others is incredibly helpful.
I wanted to share the latest update. On August 11, I had a telephone consultation with Dr. Manuel Bernal-Sprekelsen. After reviewing my case, he agreed with Dr. Gerd Bordón that there is no real reason to proceed with a cervical injection and that the focus should remain on Eagle Syndrome. The imaging clearly shows elongated styloid processes, and several specialists who evaluated me this summer agree that the Eagle Syndrome on the left side is symptomatic. Dr. Bernal also believes that Eagle Syndrome is the main explanation for what I am experiencing.
However, he explained something that I found particularly interesting: pain caused by Eagle Syndrome can lead the neck to unconsciously adopt compensatory postures, creating muscle tension and imbalances that may also affect the muscles in the front of the neck and around the laryngeal region.
For that reason, before considering surgery, he recommended six weeks of cervical isometric exercises. In his experience, some Eagle Syndrome patients improve considerably with this type of rehabilitation.
We also discussed my treatment with duloxetine. Although it seems to have reduced the intensity of the pain somewhat, the pain continues to appear and still has a very clear relationship with certain neck positions and movements. For that reason, from my own experience, I continue to feel that there is an important biomechanical component, it is not just neuropathic. This doctor also acknowledged that it can sometimes be very difficult to determine whether the precise source is a muscle, tendon, nerve, or a combination of different structures.
I have already started the exercises, although I am finding that I need to do them very gently, because if I push too hard, they seem to trigger the same anterior throat pain that I have described in previous posts.
So, for now, the plan is to complete these six weeks of rehabilitation and then speak with Dr. Bernal again to decide whether to proceed with surgery. Which I am sure I will end up doing.
I would be very interested to hear from anyone who underwent cervical exercises before a styloidectomy, and whether it helped reduce your symptoms.
Thank you again for all your help, and I wish everyone the very best with their own journey!
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@Algobe I tried cervical exercises, PRP, upper cervical chiropractic… I did improve my neck curve and posture but nothing moved the needle on my VES symptoms except the surgery.
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I hope that they help make you more comfortable… some members have found chin tucks especially (if they’re one of the exercises you have to do) can make symptoms quite a bit worse, so be careful with your exercises, it sounds like you are though. I’m sure the exercises could well help after a styloidectomy too, other members have found that because of the inflammation and pain with ES, muscles have got used to guarding, and posture has changed, so sometimes it can take a while after surgery to correct this.
It’s worth trying before surgery , at least you’ll be confident that surgery is definitely needed , you’ve exhausted all options to ease your pain
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Hi everyone,
I hope all of you fighting Eagle Syndrome every single day are holding up with the greatest strength and highest spirits possible. I am writing today to share an update on my journey and, above all, to express my heartfelt gratitude for this community. This group has been an invaluable source of information, support, and understanding for me throughout this process.
Following an initial consultation with Dr. Bernal Sprekelsen, I started practicing isometric cervical exercises alongside a 30 mg dose of Duloxetine. While the medication has not completely eliminated the pain and my long-term goal remains to avoid dependency on daily drugs, I must say that the intensity and aggressiveness of the flare-ups have significantly decreased compared to what I was experiencing prior to this treatment.
On October 23rd, I had a follow-up consultation with Dr. Bernal Sprekelsen. His conclusion was straightforward: after three years of persistent pain that has not resolved through conservative management, the physical trigger is clearly identified. Regardless of the exact size or shape of the elongation, there is a sharp bone spur or “spine” rubbing against and irritating adjacent nerves and tissues. At this stage, after realizing that living with this pain is no longer acceptable for me, I decided to take the necessary step and proceed with surgery to seek a definitive solution.
Dr. Bernal assured me that the procedure generally carries a very high success rate. My surgery is now scheduled for April 30th. He walked me through the recovery process with complete transparency: swallowing will be painful for the first few days due to inflammation around the sutures, but this will be managed with pain medication.
Furthermore, we discussed a neurophysiological concept that made immense sense to me: the brain’s “alert circuit” or pain memory. After years of receiving chronic pain signals, the central nervous system can keep this circuit active, continuing to send pain signals even after the physical bone spur has been removed. To break this closed loop post-surgery if needed, local infiltrations (such as lidocaine injections) will be used to effectively “reset” the nerve response.
Right now, I feel a mix of emotions: naturally nervous about entering the operating room, but simultaneously deeply relieved, happy, and hopeful to finally see a clear light at the end of the tunnel.
Any thoughts, shared experiences, or advice you might have would be deeply appreciated, welcomed, and respected. Thank you from the bottom of my heart for reading my story and for being such a supportive community.
Warm regards to all,
Alfonso
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@Algobe - Thank you for the really great update! I’m glad you found Dr. Sprekelsen & that he will do your ES surgery. I’m sorry the non-invasive therapies you tried didn’t make enough of a difference to prevent surgery, but having a spur on your styloid definitely makes it more aggressive in irritating soft tissues in your neck.
I’m glad to have the name of another surgeon in Spain who does ES surgeries. It’s been a long time since we’ve added anyone.
We’ve had some discussions here about neuroplasticity which can help stop long term pain by changing neural pathways once the cause of the pain is eradicated. It’s very interesting that Dr. Sprekelsen brought up the topic of pain memory as most doctors never mention it. Here’s a link @Chrickychricky posted on the subject of neuroplasticity:
https://www.symptomatic.me/qa-registration?utm_source=ATNS+Symptomatic&utm_campaign=8f5f6b7b0b-EMAIL_CAMPAIGN_2025_05_04_06_26_COPY_06&utm_medium=email&utm_term=0_-1d1f473692-509526692
I’ve put your surgery date on my calendar. Please update us again before you head back to Spain for surgery. I will pray for you on your surgery day. 
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It’s good that you’ve exhausted all the less invasive options, so hopefully feel confident with your decision to have surgery. I think we all get to the point where our quality of life is affected so much it’s worth taking the risks of surgery- and those risks are lessened when having an experienced surgeon too. Has Dr Bernal told you how many surgeries he’s performed?
I hope that the Duloxetine continues to help with your nerve pain until next April 
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@Algobe You can check out neuroplastic.org for more information about neural circuit pain/symptoms.
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Thank you all from the bottom of my heart for your supportive comments. To be completely honest, Duloxetine is only working partially: the flare-ups are less aggressive and the overall volume of pain has gone down, but the discomfort is still there. However, duloxetine causes side effects I assume some of you is familiar with.
During my consultations, I tried to ask the doctor as many questions as possible without sounding overly obsessive, mainly because the pattern and location of my pain still puzzle me. In my case, the primary discomfort starts lower down, in the cricothyroid area. Although I also feel pain in the tonsillar region, Dr. Bernal explained that pain in the lower larynx is often a direct consequence of what is happening higher up at the styloid process—namely referred pain, compensatory muscle spasms, or secondary inflammation. As he pointed out, pain doesn’t always show up where the primary conflict is located.
On another note, I have persistent tension and a “pinched” feeling in the nape of my neck. While an MRI previously showed some cervical stenosis that doctors blamed for that pain, I am increasingly wondering if it might also be linked to Eagle Syndrome due to the chronic muscular strain it causes. On top of that, I experience significant vocal fatigue after talking for a while, which I strongly attribute to the impact of Eagle on the pharyngeal muscles.
I have complete confidence in Dr. Bernal. He is an outstanding surgeon, highly recognized and with an impeccable track record. The procedure will almost certainly be transoral (intraoral), and if there is an option to perform it using robotic surgery (TORS)—as is currently done at centers like Quirón in Barcelona—the precision will be even greater. I am currently waiting to receive the detailed surgical budget and logistical information.
I suppose it is entirely human and normal to have a sea of questions and to feel like you can’t ask every single one without overwhelming the doctor. In the end, the reality is straightforward: surgery is the only definitive path forward, and all that’s left is to cross my fingers that everything goes smoothly and that it truly cures the root cause of this pain.
The isometric exercises are helping, and the doctor considers them essential for managing muscle tone, but during this waiting period, it’s hard to stop the mind from cycling through the “what ifs.”
We keep moving forward. Warm regards to everyone.
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@Algobe - Vocal fatigue/vocal loss are usually related to the vagus nerve being irritated or compressed by the styloids, though your pharyngeal muscles could be affected by the irritated vagus.
It sounds like Dr. Bernal’s understanding of the cause & locations of your pain are very logical. I’m glad you’ve found a doctor who truly understands ES & the ways it causes the symptoms we experience. I will say that if you have intraoral surgery, swallowing may be painful for more than the first few days post op. Our members who’ve had intraoral surgeries have had significant throat pain for up to a month post op. I’m not saying Dr. Bernal is wrong, I just wanted to let you know the experience of some of our members. It may be that Dr. Bernal has a unique approach for doing intraoral surgery that causes less pain. If he does it robotically, perhaps that helps, too.
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