I saw Dr. Gillespie today (after sending him my disks of CT scans). He stated that the scans need to have styloid measurements on them. Again, it seemed to be all about elongation. He said insurance won’t pay for surgery if the styloid is shorter than 26 (and closer to 30 is better for insurance approval). Another frustrating experience. Had I of known that I would have gotten that information upfront.
Have any of you had surgery for styloids that were shorter than 26?
Hi @1speechpick - I’m sorry you’re getting a bit of a goose chase presented to you. This is such a testing process.
I’ve learned SO much valuable information from this forum and the first and foremost (even my diagnosing ENT says the same) is that it’s not necessarily just the length of the styloid process, it’s the thickness, curvature, the calcification of the ligament, even body size can make a difference on what is being irritated in this very compact area.
You have I believe 6 of the 12 cranial nerves that pass through this area amongst major arteries. There’s a lot that can be irritated that would cause symptoms.
I’ve scoured this site over the last 6 mos so to answer your question, I’ve seen only a couple posts that styloids were mostly “normal” in size where “average” length seems to be up for interpretation and can range from 2.5-3cm. But I’d not get hung up on size and I’d ask radiology also look at the ligament for calcification.
Seems your doctor is doing a bit of a disservice if only length is a consideration. Is there another experienced doctor near you that may be worth visiting for another opinion?
My very best to you! 
I’m seeing a local ent tomorrow morning who is actually on this list. Thanks for your insight. I’m praying for the best for tomorrow. I also have one side of the hyoid bone that’s traversing through the carotid artery bifurcation. So that needs investigated as well. What a journey this is!
So sorry that you’ve had another frustrating doctors visit! I wouldn’t want to guess the measurement, but from the scan pics you’ve posted on here they do look a little longer than average, but as @Tjmhawk01 says, the average doctors use can vary alot! I can appreciate though if they want the measurements for insurance reasons then I guess it’s understandable they have to be over a certain length 
It’s so difficult that different doctors request different scans/ reports…maybe ring ahead if you have any more appts lined up to see?
What are your next steps, is there anyone else ‘local’ to see, otherwise some doctors (like Dr Samji & Dr Cognetti) do phone consults?
Another hug for you after another difficult day
Just seen your post that you’re seeing Dr DeSilva (?sp) soon, so hope that goes better, let us know how you get on!
Please take a look through @naturelover ’s posts. She shared a post op photo of her styloid which looked about 2.5cm. 
@1speechpick @Tjmhawk01 - My styloids were diagnosed as 4.5 and 4.4. I don’t exactly know how they measure that, but I am sure it includes the calcified portion. It makes sense that it is to the skull base, but I don’t know. The radiologist measured them & included it on my scans. When I got my little spike back from my surgery, just the skinny part was an inch. Also, like others have said, the angle plays a big part in your symptoms. Mine were pointed to my jugular veins. Others might have theirs pointed to the throat & mouth causing the classic ES symptoms.
Good luck with the ENT appt. Hopefully, you will get good answers!
when Dr Hackman reviewed my CT scan, he let me know that my left styloid wasn’t necessarily elongated, but was thick. he said he would not operate unless it was symptomatic and he believed my problems were all due to my right and whiplash, but we could re-examine later if I remained symptomatic after right side surgery. so, I think it may depend on what the drs and billing department has figured out how to get approved?