Bio- In Aug 2024 I had bottom left wisdom tooth extracted by dental surgeon( cavities). Then 1 week later had top left molar extracted failed root canal from 3 years ago was slightly infected. Surgery went well but had panic attack that night because on top freaked me out. I do have major health anxiety for many years. So the next month Sept 2024 had some more crowns dental work done on left side. By the end of sept the pain subsided in mouth but Oct 1 I started to get this throat sensation on left side mostly when swallowing but not ever painful. Put on many anxiety meds saying I was creating symptoms which has not stopped the sensation. I did have this same issue after a case of strep throat which caused panic attack bc my uvula was really inflamed in 1995 after many doc visits it did go away after couple years The doc in Philadelphia said it wasn’t Eagle syndrome its anxiety. In 2025 spring sensation still there sometimes even when I don’t swallow and also my face left side tingles but not painful. I went to local ENT and got ct scan no contrast April 2025. Results : Pharynx: Elongated calcified stylohyoid ligaments extend to the submucosal tissues in the lateral right and left oropharynx near the base of tongue. **
no measurements.** ENT said its eagle syndrome and referred me to Dr Cognetti in Phila for Dec this year. DR Cognetti reviewed CT before they schedule appointment so he must agree. So now I’m in this debate whether its psychological or really Eagle. I have severe anxiety because I cant handle throat sensation and im claustrophobic.
Symptoms : only left side not painful
-throat sensation when swallowing sometimes even not swallowing will ache at times but mostly sensation causing severe panic. All day maybe cant let it go.
face cheek will tingle comes and goes especially if I’m pre occupied
sometimes both extractions will get achy
does not get worse turning head left or right. Eating no pain mask symptoms so better.
voice gets hoarseness
I have a lot of ct pics not sure which ones u need?. maybe someone could please share diagnosis of ct!
Thank you
just a few more symptoms:
if i cough or sneeze does not make it worse or hurt
I still have both tonsils and rarely get sick.
It feels like when you run and your throat gets dry in back of throat a little deeper then tonsil that would be the location on left of sensation not a dry feeling though.
When i feel throat i try and turn head to make it worse it doesn’t really change sensation.
nothing on right side at all. Could this all be anxiety created and not eagle. Its been a year and have not had 1 hr where i didn’t feel it .It seems to get less active later at night. Just don’t want an operation and it be from anxiety. Anxiety meds don’t make throat go away.
How do you know? Thank you for reading any help please!
@musclecarguy are you able to download radiantviewer on your computer (if it’s a windows computer) and open your imaging in it and create a 3D model? The images you provided don’t quite show your styloids, so I think a 3D model would be a good starting point and then we can dive into the axial view of your CT imaging
When you’re on the portal, is there a button somewhere by your CT imaging that says “download” or “download DICOMs” or something like that? Usually the portals have a button where you can actually download the CT files to your computer, rather than strictly viewing the CT on the portal
Hmm, odd. We won’t be able to make a 3D construction unless we can get the imaging downloaded to your computer off the portal. Unless there is a 3D option in the portal itself.
Dr. Cognetti is one of the top recommended ES surgeons on the forum. He is an expert and has been so for many years. If he has you booked in for a consult (which he doesn’t do unless he think surgery will help) then I don’t think it’s anxiety. Your symptoms seem to align with classic ES, in that it’s mostly nerve irritation. Other members (such as myself) have vascular ES where the styloids compress vascular structures (carotids and/or internal jugular veins) where other members have a combination of classic and vascular ES.
Your CT is without contrast it seems (I think it says that in the portal) so I won’t be able to provide my two cents on vascular compression. But the symptoms you described don’t really suggest vascular compression anyway. It’s really hard to assess the lengths/angles of your styloids/stylohyoid ligaments without a 3D reconstruction since there are often calcified pockets that are hard to track on the original CT imaging.
Great! Now click the “2x2 SAG” file on the left side. Then once that is selected, there should be a “3D” button along the top row (I think it’s like a green red and blue cube looking icon). Click that
There are three important buttons along the top. Theres the rotate button, pan button, and zoom button. Click the rotate button and then go to the center of your 3D model and rotate the model until we get a side view of your neck. Then using the pan and zoom buttons see if you can get a good angle on the styloid. Something like this:
Your styloids/stylhyoid ligament calcifications are quite long. The left side is very curved & it looks more like your stylohyoid ligament has calcified in segments than your styloid elongating. What I can see of your right side looks pretty solid.
As I mentioned in my welcome letter to you, with your very high level of anxiety it sounds like your vagus nerve may be compressed or otherwise compromised by your styloid(s). The curve of your left calcifications is surely putting them in contact with the nerves that are causing your symptoms.
I’m really glad you have an appointment with Dr. Cognetti in Dec. I expect he’ll be able to put you at ease about surgery helping reduce or eliminate the symptoms on your left side, however, with your right styloid being very long as well, there may be symptoms that don’t go away which are those being caused by the right styloid. It’s more common in cases like yours that once one styloid is shortened, the symptoms being caused by the remaining styloid can flare up which makes it seem like the initial surgery didn’t help when in actuality it did. I found that to be true for myself i.e. symptoms from my remaining elongated styloid flared up significantly after the first one was shortened & even caused some symptoms on the already operated on side.
The thing to note is that you’ve lost the lordotic curve in your neck & even have the beginning of a reverse curve. The loss of the proper curve brings your styloids & hyoid bone into closer contact with nerves & vascular tissues in your neck. There are simple exercises that can be done to help restore the lordotic curve but it takes a fair bit of time.
Here’s a link to a discussion thread with information about the proper exercises to help restore your neck curve:
I’ve highlighted your left stylohyoid ligament w/ a pink line so you can see the curve better.
@Isaiah_40_31 I was actually emailing with @musclecarguy and I was able to access their imaging and discuss with them.
Here is the annotated imaging and update.
Tons of room between styloids and C1 and no compression of IJVs (and most likely no vagus compression I would think). Long thick calcifications of both stylohyoid ligaments, while styloids themselves are normal.
Symptoms seem to be purely classic ES-related (facial and glossopharyngeal nerve most likely), particularly on the left side. But possible that nerve irritation near the carotids could cause anxious bodily state. CT didn’t have contrast so I can’t say much about carotids.
Hi, I just wanted to say that I am also being treated by Dr. Cognetti, and he is the best! I have a lot of medical anxiety from some experiences when I was younger, so I really appreciate how straightforward Dr. Cognetti is while still being very compassionate. I think you will have a good experience with him.
Thank you for writing. I have this debate going on whether it’s eagle or panic /anxiety. Cant handle the throat which is only the left side sensation sometimes throbs. im claustrophobic so the psych docs say im creating it bc i had panic attacks from all my left dental work. I take a big breath and throat stops and tingling face. Comes back in 15 sec does this everyday all day. Makes no sense? Been a year with throat & face about 6 months. I don’t know who is correct. I have it 24/7 but no pain turning head or swallowing.
I also spent time unsure of whether or not it was my anxiety causing symptoms because I had symptoms. I started symptoms in 2021 and did not get my ES diagnosis until 2024, so I had doctors trying lots of other things to “fix” me or diagnose me with something (improving vitamin deficiencies, autoimmune panels, etc). None of that worked, so I was starting to think it was all in my head. It was my dentist who mentioned ES. Then, my ENT ordered scans which confirmed the calcified ligaments and elongated styloids, so he sent me to Dr. Cognetti. Dr. Cognetti was able to press on my styloid through the mouth and it triggered an attack of my symptoms. It was super uncomfortable obviously, but it was so validating to finally have an answer. Hopefully, you will also find an answer either way so that you can get proper treatment. Best of luck!
So what symptoms did you have if you dont mind saying and did DR cognetti perform any surgery on you or any medicine treatments? Advil for me has done nothing and the psych meds help maybe 10%. My only relief is sleeping or eating.did you find any medicine to help?
My worst symptoms were neck pain and stiffness, face tingling (eventually turned into pain and/or burning sensation at its worse), and trouble swallowing (especially in certain positions, such a laying down). I had intermittent symptoms, occurring periodically, that continued to worsen over time in both frequency and pain level. When I first started experiencing symptoms back in 2021, a lot of times Naproxen would help with the pain related symptoms but not the other symptoms. Naproxen continued to work on lower pain days, but as my symptoms worsened and became more frequent, it only dulled the pain less and less. I found that my symptoms would worsen in the cold, so wearing a scarf in cold weather was a simple thing I could do to help prepare for symptoms. In general, I found using heat was often more effective for my pain than medication was. As far as treatments, Dr. Cognetti gave me the option of having surgery scheduled after my diagnostic appointment, as he was fairly certain based on my symptom onset due to him pushing on my styloid, that at least some of my symptoms were caused by my ES. I liked that he presented the option of surgery to me but did not push surgery on me. I personally decided to wait and continue to try pain management. However, over the year following my diagnosis, my symptoms continued to worsen and became more debilitating, so I opted to get the procedure. I got my right styloid removed at the beginning of August and have not experienced any of my ES symptoms since. I am hopeful that that will continue. My symptoms were primarily on the right side. I have not experienced any increase in left side symptoms (which are very infrequent) though I do know that my left side styloid is also elongated though to a lesser extent than the right was. I hope this is all helpful information to you.
Thanks it was very helpful. Did he do external surgery and bc I’m so claustrophobic what symptoms did you have after surgery and for how long? Were you released the same day and how was the discomfort after. I’m assuming your neck pain was in front on right side
