@Acliff - Here’s a post @Jules wrote that will help you differentiate between non-vascular & vascular ES symptoms: ES Information: Common Symptoms And Possible Explanations For Them
Dr. Cognetti does surgeries which include IJV compression if it’s necessary so one of the two doctors you’re planning to see for certain could help your husband if he does have IJV compression. When the IJV is compressed it is often between the C1 vertebra & the styloid - up very close to the skull base, but sometimes the styloid alone is the culprit. If C1 is a contributor it may need to have a bit taken off of it to help the IJV open.
If your husband has internal carotid artery (ICA) compression, which usually occurs farther from the skull base, then it is usually naturally decompressed by the styloid being removed. The fact he’s experiencing dizziness could possibly point to carotid compression.
Most people who are diagnosed with ES have bilaterally elongated styloids. It’s not uncommon for one side to have worse symptoms than the other. It’s also normal for symptoms to come & go over days or weeks. As you suggested your husband’s GERD symptom could be caused by his vagus nerve being irritated by his styloid(s). Vagus nerve decompression also happens naturally once the styloids are shortened, unless C1 is the cause of the vagus compression. Did your husband have a CT with contrast? If so, whether he has vascular compression of any sort or not should be visible in his imaging.
Neck & shoulder pain are typically caused by the spinal accessory nerve which runs through the sternocleidomastoid muscle (SCM), the largest of our neck muscles, & down into the shoulders. Pain behind the ear is often caused by the occipital nerve & is also a common ES symptom.
Dr. Chan has done quite a number of successful ES surgeries for our TX members. Most surgeons don’t cut the styloid completely back to the skull base but leave 1-2 mm to protect the facial nerve which exits the skull right where the styloids attach. That small amount of styloid remaining typically isn’t problematic. We know that Dr. Cognetti leaves .5-1 mm of styloid post op so he gets very close to the skull base. He’s extremely experienced w/ ES surgeries & has done them for 11+ years.