When I measure in Radient, I’m getting about 4 cm where the radiologist got 3.4. Is the 3d view more or less accurate than the 2d version the radiologist probably used? Or am I not measuring correctly?
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It’s not a huge difference, but it looks like you probably started your measurement a bit higher than where the styloid fully separates from the temporal bone (where it becomes an isolated white dot on the 2D axial view).
The measurements are often wrong; when members have had surgery invariably the styloids are longer than estimated by CT. It is documented in one of the research papers which states they’re not always accurate.
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I concur with Jules. Please don’t put too much faith into CT lengths. I was adamant about length too…two CTs, multiple measurements & 3D conversions all pointed to 3.1-3.5cm. Mine measured 4cm after removal. I’d also point out that based on your image, it aligns in very close proximity to where mine did via image. Yours also appear to be rather thick, which can also wreak havoc in that tight little space of our neck.
My very best to you in this journey 
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I have an appointment with my ent to discuss my ct, so I think I’m trying to gain confidence that Eagle’s is a possibility. I know he’s skeptical. Half a centimeter makes me feel more confident even if measurements aren’t terribly accurate or the end-all indicator of Eagle’s!
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I found an artical that looked at thickness of styloids. In asymptomatic ES, styloids averaged 3-3.5 mm thick, and in symptomatic ES, styloids averaged 4-4.5 mm thick. Mine get to 6 mm, so that is pretty chunky.
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Ooh yikes…I never really considered the width and just measured mine at a max of 7.9mm 
Could you post a link to the article you mentioned?
I know nothing about evaluating the strength of studies. Still it’s interesting. https://www.researchgate.net/publication/309861747_Assessment_of_stylohyoid_ligament_in_patients_with_Eagle’s_syndrome_and_patients_with_asymptomatic_elongated_styloid_process_A_Cone-Beam_CT_study
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Yes! I can validate those feelings and it’s exactly why I was so hung up in length. But look in the newbie guide here where it talks about thickness, angle as well as calcified ligaments. Any single one of these or all of them will contribute to symptoms. If you’re dismissed, ask why and ask for a credible reason and be persistent. Many of the experienced folks here really encourage self-advocacy so please print off anything you can that would further support your case to bring to your appt.
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My experience has been that the radiologists are almost always wrong on length - from multiple CTs over 2 bilateral surgeries in 3 years and multiple radiology reviews. Doctors also under-estimate the length of styloids. Your styloid does appear long and thick, and with the angulation, it is difficult to to measure how long it really is. Your 4 cm looks closer to reality.
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@Ladybug - That’s one really scary looking styloid. So thick at the top & needle-like at the bottom plus the sharp bend at the top. It’s got much more character than some I’ve seen! If your ENT doesn’t diagnose ES, he is definitely not in the know about this syndrome!!!