ES Information: What Causes ES?

Professional publications (some of the articles can’t be read fully unless subscribed to). Many thanks to heidemt for her research and contribution, and for her example of being your own advocate and not giving up. Members are encouraged to seek medical opinion and these pages are not intended to replace that. Members are also encouraged to research more for themselves- there is more research available but with the limitation of time and neck pain, this was the best that I could do! Past discussions are useful sources of info as well; search whatever the subject is, and you’ll often find someone who’s been through it too!

There has been some research and some possible theories put forward.

Eagle believed that of the two types, ‘classic’ ES was the result of tonsillectomy or pharyngeal trauma.

Tonsillectomy/ Pharyngeal Trauma:
In this case it is thought that scarring can put the stylohyoid ligament complex under tension, with stretching or compression causing pain and inflammation. For example, ossification of the stylohyoid ligament complex can contract the stylopharyngeal muscle, and therefore stretch the XII Cranial Nerve (Monsour and Young, 1986).

Trauma in the soft tissue during tonsillectomy may result in elongation of the SP and calcification of the stylohyoid ligament. (Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G, 2009.

Eagle’s syndrome: a review of the literature.) Ceylan et al in 2008 suggested there could be stretching and fibrosis involving Cranial Nerves V, VII, IX and X post-tonsillectomy. Ceylan et al also theorised that rheumatic styloiditis caused by pharyngeal infections, trauma, and tonsillectomy could be a cause.

Fractured Styloid Process:
A fracture of the styloid process (this could be from a car accident, trauma, epileptic fit or even laughing or yawning) could then result in proliferation of granulation tissue, causing stimulation of surrounding nerves, such as the terminal branches of the glossopharyngeal nerve and trigeminal nerve or the chorda tympani nerve (Murtagh RD, Caracciolo JT, Fernandez G. CT findings associated with Eagle syndrome, 2001). Steinman called this ‘Reactive Hyperplasia’- that stimulation from trauma on the end of the styloid process could result in ossification of any part of the stylohyoid apparatus, and ‘Reactive Metaplasia’-metaplastic changes in the stylohyoid ligament leading to ossification.

Anatomical Variations/ Abnormal Angulation:

As seen in the section about styloid length, abnormal angulation can cause symptoms by compressing blood vessels and nerves, or compressing these between the Styloid Process and the transverse processes of cervical vertebrae.

An elongated styloid process itself can cause inflammatory changes in the surrounding tissues, or irritate the pharyngeal mucosa.

Carmada et al also suggested that symptoms appearing earlier in life may be due to developmental anomaly of ossified ligaments or elongated processes with no history of trauma. This might explain a hereditary element to ES which a few members have noticed.


Insertion tendonitis -which is a degenerative and inflammatory change occurring in the tendinous portion of the attached area of the stylohyoid ligament- was suggested by Murtagh RD, Caracciolo JT, Fernandez G.: ‘CT findings associated with Eagle syndrome’. Carmada et al called this ‘Pseudostyloid Syndrome’- tendinosis in older individuals with no history of trauma, elongated styloids or ossification.

Steinman also believed that aging could be a cause; aging decreases elasticity of soft tissues, which could result in tendinosis between the stylohyoid ligament and the Lesser Cornu of Hyoid.

Ceylan et all (2008) again thought that ES could be age-related and suggested that degenerative cervical discopathy may shorten the cervical spine and alter the direction of the styloid process.

Early-onset menopause has also been suggested (Ceylan A, Köybaşioglu A, Celenk F, Yilmaz O, Uslu S, 2008). Epifanio (1962) considered that the ossification of the styloid process was related to endocrine disorders in women at menopause, accompanied by the ossification of ligaments elsewhere (e.g. iliolumbar, thyrohyoid).

On this site we’ve found this (endocrine disorders) to be something a lot of members have in common.

However, a mixture of these theories is also suggested: ‘The evidence presented seems to indicate that anatomically abnormal and ossified stylohyoid chains develop in a significant number of young, healthy individuals during their early formative years, and that many years may pass before symptoms occur. These symptoms of dysphagia and/or cervicopharyngeal pain occur because of the loss of elasticity of surrounding soft tissue structures, rendering these same tissues less adaptable to pressures caused by the slowly-worsening abnormally-ossified stylohyoid chain.

According to our proposed Theory of Anatomic Anomaly, it is believed that a number of these young asymptomatic patients go on to acquire such symptoms with age.’ (Stylohyoid chain ossification: A discussion of etiology by A. J. Camarda, C. Deschamps, and D. Forest, 1989)

There have been several discussions about this on the forum, and what we’ve seen seems to fit with some of the theories:

+there seem to be quite a high proportion of members who’ve had previous trauma to the neck,

+quite a few members with calcium regulation problems, thyroid and parathyroid problems, (parathyroid gland is responsible for calcium regulation)

+and also quite a few members whose symptoms have been noticed after the menopause.

Here’s a couple of links:

There was an interesting discussion about our stories and possible causes for our ES: New member with lots of questions - #19 by JJ1

MusicGeek posted an article about a professor who lost her voice due to ES, but her symptoms began straight after a surfing injury to her neck:

Hypercalcaemia has also been mentioned as a possible cause of ES by Red_Pill: Would like help on this - #9 by heidemt

This paper researched the link between elongated SP and the role of ectopic calcification, by studying patients with renal failure, as abnormal calcium (Ca), phosphorus (P) and vitamin D metabolism is very common in patients with end-stage renal disease (ESRD). The authors say that elongated SP and calcification in the area are common with these patients, so mentions that they make a good study group, but doesn’t give any figures, justs suggests that more research is needed

This research paper also mentions inflammation of the parotid gland and linked it to an elongated SP: Unveiling The Hidden Eagle: Acute Parotitis-Induced Eagle Syndrome - PMC

TMD/ TMJD- this article from the Brazilian Dental Journal concluded that there is prevalence of elongated styloid process in patients with TMD -

Also TJ (Mod Support) found research showing this link :

While not necessarily being a cause of ES, we are regularly seeing members with the same conditions alongside ES; Military neck/ Lordosis, CCI, Ehlers Danlos Syndrome, Chairi Malformation, and Vascular conditions like Thoracic Outlet Syndrome & Nutcracker Syndrome.

1 Like

Thank You Jules! This is very well written and helpful! I hope you are healing well :slight_smile:

Bumping this up

Thank you Jules…very helpful indeed :full_moon_with_face:

I believe that My Styloids grow after an car accident. I sat on back seat another crashed in to the car from the back…but I’m not 100pro sure.

Jules, I just want to thank you for the awesome research you’ve done on all types of Eagle’s Syndrome. It helped me so much.

You’re very welcome Michael- Heidemt did lots of research & brought alot of work to the info as well. I think you’ve probably done nearly as much yourself! I will have a read through those papers & add in links when I get a chance!

Bumping this up