I have persistent pain my upper throat that feels like something sharp poking in my throat.In the last 3 months I have seen quite a few doctors and finally 2 days back my ENT suggested a 3D CT scan.
It shows thinning in the mid part of right styloid and very slightly elongated left styloid.
My ENT says that most of my symptoms are due to left one and the fracture visible in CT 3D on right side might be an artifact and there is no trauma but he cannot say for sure.
Can you tell by this image of my CT whether it looks like an artifact or a fracture/thinning.
Hi @Shruti - I am sorry to read about the hardships youâve had over the last couple of years including ES & how itâs affecting your life.
I annotated your image by putting a cover over what looked to be your name - just so you know why thereâs a brown rectangle on the right side now.
The area you circled looks like a broken styloid where the piece that broke off has migrated down toward your hyoid bone. The reason I think itâs broken as opposed to being the normal styloid & a separate section of calcified stylohyoid ligament is because of how flat the end of your styloid is & the top end of piece below it.
I am not a doctor, but I believe your doctor is wrong in suggesting that the left side is most likely to be causing your symptoms. I think there is equal chance that the right side is involved, too, because of that detached section of your styloid that may have more freedom of movement & can be causing itâs own problems because of that. Your left one does look plenty long to be a troublemaker so Iâm glad youâve gotten diagnosed.
Are your symptoms worse on one side than the other?
Itâs worse on the right side which is why I was not convinced when he said right side was normal and just an artifact.He has not dealt with many cases of ES.Most doctors here in my country do not have a very good understanding of it.I do not know what to do now.I feel dizzy all the time alongwith this sharp throat pain.I have never felt so helpless.No doctor here seems to take this seriously.
Iâm sorry your doctor isnât being as helpful as he could be. With dizziness as a symptom, there is some concern that vascular compression by the styloid could be present. Here are the doctors we have on our Doctors List for your country in case you havenât seen the list. If there is anyone close enough for you to get a second opinion, that would be a good idea:
â˘Dr Anuradha Navneetham, No 7, Cornwell Road, Langford Garden, Richmond Circle
Bangalore, phone # 080 42114432 or +91 93412 18602 (This doctor was reported to us as having done ES surgery though none of our members have seen her as far as we know).
â˘Dr Parth Amin, 205-207, Anushri Accolade, Besides Connplex Opps, 2, Science City Rd, above Flavour Restaurant, near Shell Petrol Pump, Ahmedabad, Gujarat 380060, India, +91 97258 54865]
We have several members from India who have been able to travel to TurkĂŻye to see Dr. Kamran Aghayev for ES surgery. For the most part their surgeries have turned out well. He will operate on both sides in one surgery which many doctors wonât do. Perhaps you can start with a consult with him. He will do them via telehealth so you donât need to travel to see him initially.
â˘Dr. Kamran Aghayev - https://kamranaghayev.com
Thank you for letting me know about these doctors.I will also try for a virtual consultation with Dr.Kamran.My ENT has never performed this surgery so he is reluctant to remove it.
Does a 3D CT show vascular,carotid or jugular involvement or is an MRI needed for that.CT report does not mention anything about this and I cannot tell from these scan films.
If your CT scan was done w/ contrast, your carotids & jugulars will be visible in 3D images. Sometimes compression doesnât show up w/ the head in a neutral position which is how a CT scan is usually done. If your CT was w/o contrast, only the bony tissues will be visible. In the image you sent, it appears you had a CT w/o contrast.
An MRI will show the soft tissues, but the bones are can be hidden behind the soft tissues so itâs harder to make the connection regarding what might be causing the compression.
You can make your CT slices into 3D images using radiantviewer.com (for PCs) or Bee Dicom Viewer app (for Mac computers). Another option is to upload your images to dicomlibrary.com. It anonymizes the images plus providing 3D images. The site will give you a link to share with others. Youâll have to do a bit of image âmaneuveringâ using the menu at the top of the images once you get them in order to find the best 3D pics of the things you want to see.
It was done without contrast.I am going to try to upload it to diacom.If I manage it to do it right Iâll share it here.Maybe that can help get an idea about the constant dizziness.
Thank you for taking out time for helping me understand all of this.
If itâs done without contrast, then you wonât be able to see any blood vessels unfortunately. Itâs not possible to tell for sure from your images , but it looks like the styloids could be close to your C1 processes, which can often compress the Internal Jugular veinsâŚthat can cause dizziness & an off-balance feeling.
I hope that youâre able to get a consultation with Dr Aghayev!
I saw another ENT todayâŚhe confirmed trauma to right styloid because of which itâs lower part might be causing nerve irritation.
Referred me to Neuromedicine.Got Neuroâs appointment 3 weeks from today.
He did say it would be good to remove it but he said that should be the last option due to its risks like nerve damage and suggested to manage symptoms using medicines.I got a prescription for Dosulepin(50 mg) and Carbamazepine(100 mg).He said if the pain becomes unbearable he will give some steroid injections to numb it.
Given that the lower detached part of right styloid is free floating I am really scared of carotid irritation.Although I do not have a very good understanding of its anatomy but seems really risky.
None of the ENT here is ready for surgery but atleast the one I saw today allowed me to discuss my symptoms in detail.So I am hoping he will be able to help me.
@Shruti - Itâs really good news that the ENT you saw today seemed more knowledgeable about ES & listened to your concerns + offered you nerve pain meds to help relieve your symptoms to some degree. Nerve pain meds can take several weeks to start helping so youâll need to be patient if the two medications donât help right away. Both of those can cause drowsiness so itâs best to take them at night if possible. Your body may adjust to that side effect over time so it isnât as much of a problem.
I probably shouldnât have called the broken off piece of styloid âfree floatingâ as it isnât really. You have small muscles in the area that will help contain it, itâs just that it isnât attached to the main styloid body anymore so can move a small amount w/in the muscles that support it.
In general we agree w/ this approach initially as avoiding surgery for ES is good but only if symptoms can be significantly controlled by nerve pain meds & quality of life maintained. Once pain & other symptoms are affecting your quality of life (as they are now), itâs time to consider surgery as the next step.
Elongated styloids do tend to grow over time & will continue to irritate the nerves in the area. The longer the nerves are irritated, the greater the risk of permanent nerve damage. Many surgeons in the US use nerve monitoring during surgery so there is less risk of causing permanent nerve damage.
This is somewhat rare, but if your internal carotid(s) (ICAs) become irritated you will most likely have stroke-like symptoms or a TIA (transient ischemic attack). You may also have carotid pain.
I am starting medicines today.Hope theyâll give relief from this horrible pain in some time.
I am waiting for Neuroâs appointment.I hope heâll do a contrast CT or MRI to be able to see blood vessels and nerve involvement.That can give clarity regarding surgery.
But I am keeping my hopes low because doctors here do not really give you attention or time unless you are someone important.There are very few people fortunate enough to meet doctors who care to listen to them.
A CT with contrast would be better to try and get if you can, as an MRI doesnât show the styloids as wellâŚI hope that the new meds help with the nerve pain
Itâs possible that in the images you posted here, the calcification is thin enough that it doesnât appear in the image thus making the styloid look fractured. Since radiologists look at the imaging slice by slice, they sometimes see things we donât see. That is likely what he is commenting on - a âthreadâ of calcification that is connecting the two pieces of your right styloid.
Regardless of what the report says, your styloids are a bit longer than normal, (radiologists often measure them as shorter than an ENT whoâs experienced w/ ES) plus, during surgery, theyâre often found to be longer than the imaging shows. Since your styloids appear to be slightly elongated & you have such intense throat pain, I think the two situations could be related. Iâd highly recommend you send your imaging to one of the doctors on our list along with a message regarding your sore throat & ask for a second opinion. Some of our members have seen a number of doctors before finally finding one who diagnoses ES & offers surgery to help resolve the symptoms. I realize you may not have the $$ or time to do that because youâre in school, but it may be the only way to get the help you need.
If the nerve pain meds youâve gotten help reduce your pain enough, you can put off trying to get a diagnosis & trying to find someone to do your surgery for a while.
A bit strange though that the report says âThere is marked thinned out part of right styloid process ⌠possibility of sequence of old insultâ ? That to me implies potentially a previous fracture⌠I agree with @Isaiah_40_31 that the lengths of your styloids seem to have been measured as shorter than they appear- normally with âaverageâ length styloids, you wouldnât expect them to be visible down to or past the C1 process, as yours are.
I called the ENT to ask about this he told me to not analyse CT report.Told me to just take medication as surgery is not an option in my case.
I am losing hope.Medicines give me no relief.Report contradicts itself and doctors get upset when I try to understand whatâs going on with me.I have barely eaten in days.I cannot survive with this pain everyday.It does not seem things will get better.
Iâm sorry that the ENT wasnât helpful, what about any of the other doctors on our list, is it possible for you to contact any of them & ask them to review your CT? âŚThe medicines youâve started taking can take up to a couple of weeks to build up enough to start to help, so hang in there & hopefully things will improveâŚand if these donât work then there are other medications to try. Sending you a hug
I am trying to get a CT contrast before I take a virtual consultation with Dr.Aghayev because I wonât be able to afford it more than once.I do not know how helpful plain CT would be.
I also tried creating 3D images but I do not have CT films in DICOM format so could not do it.
Probably the most difficult part of ES is people around you be it at work,school or home do not understand how painful it is to live with everyday and tell you itâs all in your head.Life is really unfair.
@Shruti - Did you try using radiantviewer.com (for PCs) or Bee Dicom Viewer App (for Macs)? Uploading images to dicomlibrary.com is another option. Your CT images will be converted to 3D on there & youâll be given a link to view them.
We also have a tutorial on our forum that might help you, but itâs pretty old at this point:
You could try contacting @LimeZest to see if he would have time to help you convert your CT into 3D images. Heâs pretty busy these days, but has helped several of our members including me in the past.
