Can styloids with no changes in length cause more symptoms?

I’ve been reading on this site for many months and gained a lot of knowledge.

I am no stranger to pain. I have gastritis since high school. I’m 32 btw.
Since 2012/2013, I’ve been battling neck and shoulder pain (muscle spasm according to dr) and constipation and pelvic pain due to IBS. (Tests done: endoscopy, colonoscopy, abdomen n pelvic ultrasounds)

Around 2015/2016, pressure like pain in both ears and headaches around temple area. My eyes were also off with constant floating image. Developed pain in jaw, teeth, gum and tongue area. Also clicking sound when opening mouth. Suspected for sinusitis and ES. Ended up with glasses for astigmatism . Eye problem solved with less headache both in frequency n intensity. Ear pain eventually went away. Diagnosed with TMJ. Not diagnosed with ES due to lenght. (Test done: ct scan sinus - left styloid 3.2cm, right is 3.0cm, eye examination, left mandible ultrasounds)

since 2017 : constant tension like headaches from the back of head to the temple (more severe on left side) that i thought due to my neck n shoulder spasm.
Late 2017, started having on and off sore throat. I also felt sudden throbbing around my head when projecting my voice loudly. Thought it’s normal since I’m a teacher. Around this time, my jaw, teeth, gum and tongue pain intensity increase again.

September 2018 to March 2019- feeling sharp pain around the left end of hard palate and upper gum when talking. By October, the pain became constant. Feel like i have a cut that keep been sliced open by a razor. The pain centering from left hard palate and back of tongue (wisdom teeth, floor of mouth n tongue area - i dont the correct term) towards soft palate and down my throat. The multiple pain are on top of each other. Cut like pain, throbbing and needle like pain all over my throat. My throat is sore and inflamed. I notice that there are small bumps around soft palate and and back of my throat(don’t know since when they’ve been there). Talking and teaching are torture. I cannot sleep properly due to the pain. This 10 scale pain last for 6 months.(test done: throat MRI, ear,nose and throat scopes by multiple ents) took antibiotics n medication for silent reflux with no progress. I lost weight and became anemic because the pain made it hard for me to eat and also because I’m stressing out that i might have cancer.

Since April 2019- the throat pain go down to 7/8 in scale when I’m talking/teaching. When I’m resting and don’t talk much, the pain will be 4/5. Although the throat pain go down, my teeth, gum and tongue pain are not. There is a hard knot on my left cheek - parallel with the wisdom tooth area. There is also lump (unnoticeable but can be felt) under the jaw around a jagular (next to the pulse area).

Starting this year, I’ve met dentist, general doctors, ents, speech therapists. Now, I’m under the care of OMF dr who also suspects ES. However, ES is in KIV because in my newest cone beam ct, my styloids are more or less the same. Dr compare the cbct with my 2016 ct scan.
For now, I’m treated for TMJ. I’m wearing soft upper n lower splints and taking amitriptyline 20mg a day.

After all the lengthy history, what i want to know is whether the unchange styloids length can cause more severe symptoms?

Thanks in advance to those who read this till the end. Pardon my language as English is not my first language.

Hi Dia87 -

First off, your English is excellent for it not being your first language so no need to apologize.

As far as ES goes, a styloid measurement of 3 cm & 3.2 cm, even though on the shorter end of the scale, can absolutely be classified as ES. It is not only the length of the styloid processes that plays a role in how severe ES symptoms are but also the thickness, angle (how curved & in what direction), pointedness or how twisted they are that can influence how much pain & which other symptoms a person has. That is a complicated way to say that even though your styloids aren’t super long, they could be angled sharply or very pointed, thick or twisted & so they are really irritating some of the cranial nerves that run through that area of your neck. Additionally, if there is any calcification on your stylohyoid ligaments that can also add to symptoms.

Muscle tension/swelling is not uncommon with ES. Where that happens is up to which nerves are being irritated. Your gastrointestinal, vocal & throat problems could be a symptom of an irritated vagus nerve (one of the nerves most commonly affected by ES). The neck & shoulder pain will come from your accessory nerve being irritated. The ear aches, tooth pain, & headaches can come from irritation to the facial, vagus &/or trigeminal nerves &/or from vascular compression of the internal carotid artery &/or jugular vein by the styloids. I don’t know about the bumps in your soft palate. Your doctor would need to look at that situation.

As far as the lump under your jaw, there’s a good chance that’s the styloid process you feel. I could feel my left one in that area & at the base of my tongue back by my throat. The right one I could feel more under my ear.

So, in answer to your final question is YES, your symptoms can become more severe over time because your nerves are getting more irritated w/ the styloids remaining in place. The only solution & chance for recovery will be to have your styloids removed. Unfortunately, there are no doctors on our list from your country. We had another member from Malaysia in 2014/2015 who went to Singapore (I think) to have her surgery but she wasn’t thrilled with the end results. It would be wonderful if you can find a skull based ENT surgeon (often a cancer specialist) or a skull based maxillofacial surgeon in your area. These are the types of doctors who often do surgery in the area of the neck where the styloid processes are & with whom you potentially would have the best surgical results.

I hope I haven’t overwhelmed you w/ information & that what I’ve written is helpful.


I second all that; think of the styloids as potentially rubbing on a nerve, over time that can wear away the protective sheath round the nerve, & so cause more pain. You’re only young, but as we age connective tissue loses it’s elasticity, which very slightly alters the position of structures in the neck which can shift the styloids slighty & make them irritate different nerves. Plus we’ve had quite a few members who are teachers & singers, & using their voice so much seems to make symptoms worse- you can search for discussions about that.
I hope that you can get some treatment!

Thanks Isaiah & Jules. The information is quite overwhelming with all the terms but they give great insight for me to understand more about ES.
All this time I thought all the muscle pain, headaches and TMJ sypmtoms are the results of my poor posture and my habit of leaning my chin on my hand (i’m right-handed so all the leanings are done on my left side hence all the problems on that side, i also only chew on the left).
Most of the Ent and OMF drs that I’ve met so far know about ES. My primary OMF dr want to eliminate other causes with non-invasive treatment first since there are risks with the surgery. If it comes to it, the surgery will be done externally by another dr (a prof that have done a couple ES surgery).

About the lump, if it is the styloid process, should it feel bony or not? It feel lumpy not bony (is this makes sense?). I can only feel it from outside. Btw, i can’t help and keep thinking that i have oral cancer (especially when pain goes rampant) and all the drs miss it.
The area on my soft palate, left n right besides the uvula is darker in colour. Like permanent inflammation (i asked dr google and he said rare skin cancer can develop in throat). Very nice of him telling this to me who has health anxiety.
I will try to search the discussion that you mention, Jules.

I would think that the styloid would feel fairly hard when you feel it, mine did. Lots of members have felt enlarged lymph nodes, perhaps that’s what you can feel? Doctors don’t seem to associate it with ES, but I wouldn’t be surprised if the inflammation the these styloids can cause affects the lymph nodes. Sore throats are common too, without infections.
It is scary & I know many of us have had worries about something like cancer, all you can do is be reassured that you’ve had scans & specialists looking at them, so anything should’ve been picked up. Plus read up on ES symptoms, & you’ll see that the things you’ve experienced are ‘normal’ for ES!

My left nodes are very noticeable when touched. The lump feel like a mass of fat, not so much like a node. I don’t know for sure. My Dr said that constant irritation around the muscle can cause knot to happen.
For now all the pain (in the throat mostly) are manageable bcause the school is in holiday so i don’t talk so much. The school will start 1 Jan 2020. I’m dreading what lies ahead next year and preparing to once again persevere through all my teaching and my daily life living in pain.
I wonder if stress plays a factor in exacerbating my symptoms. The throat started in Sept. last year when i was busy preparing my students with their very final exam in secondary school (my first experience). I’m less stress for this year. Last year was also when the higher up in my district education system kept coming to my school and observed our teaching. I was one of the chosen. Luckily, this year they stopped.
In Malaysia, being a teacher is one of the stressful professions especially teaching in secondary school ( i don’t know about other country). Every dr that I’ve met till now asked whether I’m stress once i said I’m a teacher. If only changing career is so easy.

Dia87 -

YES! Stress can ramp up the symptoms. This happens because stress causes our muscles to tense up. Tense muscles then squeeze the already irritated cranial nerves causing more irritation. Stress also causes the release of cortisol into your blood stream which stimulates your flight, fight or freeze responses. Having cortisol in a higher than needed level in your blood also triggers the nerves to fire more as they’re preparing for an “emergency” to which you might need to react quickly.

As far as your lump goes, it is definitely possible to be caused by ES due to irritation of one of the structures in that area. There are nerves, muscles, connective tissue & vascular tissues there. If your doctor isn’t concerned, then take a deep breath & try to not worry about it if it isn’t painful or growing.

It’s nice that your doctor is trying to be conservative with your treatment, but you most likely won’t have any real relief from the symptoms until your styloid(s) &/or calcified ligaments are removed. In the US, most experienced ES doctors require two surgeries for bilateral ES as there is quite a bit of throat swelling post op. It’s for the patient’s safety & comfort. That said, we do have forum members who’ve had very successful bilateral surgeries done all at once.

I hope you’re able to enjoy your time off from work now. Rest & restore as much as you can.


I think teaching is definitely stressful in whatever country you’re in! Well done to you- I couldn’t do it! Hope you get a good rest over the holidays…:christmas_tree::+1: