An update on prevalence of styloid elongation

The most quoted stats for elongated styloid process (> 3 cm) prevalence seem to be ~4% of people have elongation and 4% of those have symptoms. I took a shallow dive into the literature last week and found that this information seems to be incorrect/outdated. I’m sure that prevalence depends a bit on demographics, but it seems to be significantly higher than 4%.

What does this mean? I think it really highlights the need for better diagnostic options for ES, since both the the imaging and symptoms are typically very nonspecific. For me, this also gives a bit more context why radiologists and doctors do not all ‘believe’ in ES - it’s quite possible the 4 out of 10 patients they saw before us might have also had the same imaging with no problems.

43% in this cohort of 198 older patients

43% in this cohort, 736 patients

41.5% right, 36.2% left - 539 patients…/pii/S1991790221002439

27.3% in 300 randomized patients

54% in 208 patients…/1746-160X-10-5


Thanks, that’s really interesting! We’ve long suspected that ES is far more common than the figures suggested & just under diagnosed!

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I’ve noticed this discrepancy in the data too. What do you think is the reason so many have elongated styloids without symptoms? Why do the styloids cause problems in only some?

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I think that it depends on the angle of the styloids too, & the person’s anatomy- I guess some are lucky & their styloids don’t compress any blood vessels or irritate any nerves…I do wonder though if some don’t think they have symptoms, but could have some of the lesser known ones that we see on here. For example, a feeling of something being stuck in the throat & difficulty swallowing are the 2 most known about symptoms, I didn’t have either of them, so could’ve been dismissed as not having ES!

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Wayyyy to many factors to speculate or make generalizations, I think. The growth probably happens very gradually in most people so the surrounding tissues have a chance to adapt. Some people develop symptoms after a traumatic event like whiplash or a chiropractic adjustment that suddenly disrupts this equilibrium. Others might slowly develop symptoms as cervical discs dehydrate and tissue becomes stiffer with aging. And as @Jules says, probably many do have minor symptoms that are misattributed or minor enough to ignore. My personal theory around jugular ES is that the compression exists for many years, and over the course of thousands of neck flexions per day, along with natural aging and loss of vascular elasticity, the vessel becomes scarred and fibrotic enough to start causing a restriction of flow.


Even though these people are being reported as asymptomatic, it might not be the case. First off, most people don’t get scans unless there’s a reason for it. So the mere fact they got scans suggests something is off.

Second, many Drs won’t classify anything as eagles unless it’s the classic symptoms.

If someone has TN or upper neck and back pain, even if they have elongated styloids it could very well be the connection is never made and their elongated styloids are still considered “asymptomatic”.

One of my ENTs said my styloids are fine and not calcified. Look at my posts and you’ll see how wrong he is!

It could very well be that both the prevalence of elongated styloids and symptoms of it are higher than we give credit for, but our reporting and recognition of it are very poor.


Of course these retrospective studies have limitations, but one would have to convince an ethics committee of the value of irradiating healthy people to organize a better-controlled prospective trial. With the exception of the final article, the patients were mostly imaged at dental clinics and were not previously suspected for ES (the final one includes patients with orofacial pain). Panoramic imaging is standard in many dental clinics. I feel safe in assuming that these statistics are essentially representative of the healthy population.

My post did not touch on the topic of symptoms, as that is a whole different can of worms. But I agree with you that ES is almost certainly underdiagnosed.


This is a good survey of literature @coldbear. There was a good study posted by our friend @TheDude sometime ago that talks about how this condition is sometimes misdiagnosed. What I liked about this study, it has video animations that depicts the compression depending on the neck positions with diagnostic chart that helps diagnose ES since it is heavily underdiagnosed or misdiagnosed.