Finding a specialist in Ontario

General Eagle Canada
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I’m in Ontario and was diagnosed with Eagle Syndrome by a chiropractor and am researching the next steps. I have a lot of ES symptoms, especially vascular related symptoms.

I plan on first asking my family doctor for a CT with 3D reconstruction and doppler ultrasound. I understand Dynamic CT angiogram/venogram is usually required for vascular symptoms, but since I am extremely sensitive with MCAS like symptoms, I would like to hold off on any tests with contrast dye until I know exactly what tests are required by the ES specialists I can consult. I don’t want to be told I have to re-do any tests with contrast dye because it wasn’t exactly what the specialist needed.

My questions are:

-are there any ENTs knowledgeable about ES/VES in Ontario, preferably in the GTA?

-does Dr.Allan Vescan at Mount Sinai in Toronto still take patients for ES/VES?

-am I correct in understanding that there are no surgeons in Canada that will also shave C1 if there is involvement?

-Dr Viallet in Manitoba and Dr Trites in Halifax, NS have been mentioned in this forum. Has anyone from Ontario traveled to them for surgery?

Thanks in advance

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@Sunrise!

Welcome to our forum! I think your first step is a good one though the vascular tissues in your neck won’t show up w/o the iodine contrast used in CT imaging so if you want an answer about whether or not you have IJV (internal jugular vein) or ICA (internal carotid artery) compression early on, you’ll have to considering having your CT w/ contrast. Most doctors who work w/ ES want a CT w/ contrast so they can see the soft tissues as well as the bony tissues. Can you take cromolyn/extra cromolyn, or something else to help reduce your MCAS symptoms if you do opt for contrast?

There are several doctors in Ontario who are familiar with ES but none do the surgery you’d need if you do have vascular compression being caused by your styloids. As far as I know, Dr. Hodaie is the only one of those listed below that is doing ES surgeries in Ontario, but again, probably not vascular decompression. Our CA members who’ve needed styloidectomies with IJV decompression have either come to the US, England or Turkey for their surgeries.

•Dr Eric Monteiro, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto 416-586- 4800 (possibly treat ES, he has done a surgery with Dr Ian Witterick, who no longer does ES surgery.) Otolaryngology Care Team | Sinai Health

•Dr. Hodaie, via St. Michael’s or Toronto Western ENT departments/clinics , Mojgan Hodaie | Department of Surgery

•Dr Kulbaba, Radiologist, [ARC - MSK Ultrasound - Atlas Radiology Consultants]
(ARC - MSK Ultrasound - Atlas Radiology Consultants) will give opinions on CT scans and performs neck ultrasound

•Dr. Vitor Pereira, Unity Health Toronto, https://unityhealth.to/physician-directory/dr-vitor-mendes-pereira/

•Dr. Joseph McKenna, Owen Sound, Ontario - https://register.cpso.on.ca/physician-info/?cpsonum=89419

I don’t believe Dr. Vescan’s name has been mentioned on our forum so I’m sorry I can’t answer your question about whether or not he still takes ES patients. Perhaps one of our other CA members might have some input about him.

I don’t recall that anyone from our forum has traveled outside of their province to see either of these doctors. Dr. Trites did a difficult surgery for one of our members who had both ES & Hyoid Bone Syndrome but then refused surgery to another member in a similar situation. We haven’t heard back from the member who had the surgeries so don’t know how he is doing post op.

If you have migraines, head pressure, brain fog, visual changes & tinnitus/pulsatile tinnitus symptoms, you can try sleeping w/ head/shoulders elevation at night. You may need to experiment w/ how much elevation helps reduce symptoms. You can also try icing your neck for 20 min. several times a day. Use a thin towel between ice pack & skin to prevent ice burns. Gel packs that can be heated or frozen are a good option for this as some people have found heat is more helpful than ice.

Getting an Rx for a blood thinner such as Brilinta, Plavix or Xarelto has helped reduce head pressure symptoms & headaches for a number of our members as they await surgery. A blood thinner can take up to a month to begin noticeably helping.

We’re very sorry that our CA members don’t have better support from the medical community in CA. I hope you’re able to find a doctor locally to at least help provide guidance that helps with symptoms reduction.

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Dr. Perreira is in Toronto and is a specialist who refers out for surgery.

Dr.Allan Vescan I’m not sure.

There is no doctor in Canada doing C1 shave.

I have not seen either Dr. Trites or Viallet.

My own 2 cents, CT Venogram with contrast is the way to go if you want to see something clear.

Kind Regards,

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@Isaiah_40_31 Thank you for all this information including the updated list of specialists in Ontario. This is super helpful!

I’ll probably have to get the CT done with contrast so will look into the different contrast dyes available and have my family doctor specify my preference on the requisition. Based on some online research, it seems that certain contrast dyes have a lower rate of certain reactions. I have to still look into this.

I will give an update when I have done the CT.

Thank you again

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@Dave Thanks for your input. I’ll ask my chiropractor whether he thinks C1 is involved. Yeah, I think I’ll have to get the CT w contrast. Thanks

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Hi Sunrise,

In my experience I wouldn’t bother with any Canadian Health care. You will be frustrated for years and there is very little experience with Eagles.

I had surgery with Dr. Cognetti in Philadelphia. Such a great experience. Taken care of very quickly and professionally. He does Eagles Surgeries the first Friday of Every Month so he and his team have a lot of experience.

By the time I saw him, I was non-functional. I couldn’t do anything for myself anymore. My surgery was in 2022 I believe and I’m 100% recovered from all of my horrible symptoms. It took a few years for my Vagus nerve to recover but I feel healthier now than I have in20 years. Really amazing to have it looked after. I still have one of the calcified styloids but it’s not interfering with anything so Cognetti didn’t want to take it out. (it’s a surgery in a delicate spot and there is always potential for something to go wrong)

If you are suffering and want the quickest resolution you have to go to the US.

If it’s not that bad and you don’t mind waiting and getting half assed treatment then stay in Canada.

Just my opinion. But I had the full experience from the darkest days to now full recovery. It was 100% worth it.

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@Tomas10 Thanks so much for your honest opinion. That’s great that the surgery was life-changing for you. I have other health conditions as well, so it’s hard to tell how much Eagle Syndrome is contributing to my symptoms.

I am planning on getting the CT done to assess VES and also ask for referrals to Canadian doctors so that it’s documented that at least I tried, but I will also reach out to a few US specialists including Dr.Cognetti. If my family doctor will just order the CT, then I can go ahead and reach out to specialists overseas while I wait in the Canadian system. I may also look into private clinics for the CT.

Where did you get your CT done? Did you have to ask your family doctor for the requisition?

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Got my CT done at St Michael’s through the ENT clinic, which made the diagnosis of vascular Eagle’s, and referred me to Dr. Ian Witterick, who referred me to Dr. Mojgan Hodaie at Toronto Western (neurosurgery). They did the partial styloidectomy surgery on one side only and it was life-changing for me. I got amazing care at both hospitals and am so grateful! I still have some problems on the other side, but not as serious (and sounds too risky to do surgery for now). Best of luck!!!

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I’m glad that you’re doing so well @Tomas10 , that’s great to hear!

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@AS2005 That’s awesome. Finally, some good news from Ontario lol

I have a few questions:

  1. Do you remember the name of the ENT that diagnosed VES?
  2. How long were the wait times for the ENT and Dr.Hodaie?
  3. For the partial styloidectomy, was the styloid just shortened? I’m assuming that’s what a partial styloidectomy is, but I’m still learning. Or was it completely removed from the base (or any discussion on whether Dr.Hodaie can/cannot do that)?
  4. Were other structures compressing the vein(s) removed?
  5. Did you have C1 involvement?
  6. Was the surgery done from inside the mouth (transoral) or from outside the neck (transcervical)?

Thanks in advance!

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  1. I don’t remember, sorry! It was back in late 2022… everyone at the clinic is great!
  2. Not much wait time for ENT, maybe a few weeks. I thought I had an ear infection, was sent for CT and diagnosed after that, so it was a couple of visits. From there, it was a few months to see Dr. Witterick, then a couple of months to see Dr. Hodaie and overall 8 months til I had surgery in fall 2023.
  3. Yes, right styloid shortened by 1cm (from about 5) - so it would not compress my carotid anymore.
  4. No
  5. No
  6. Inside the mouth - transoral, removed right side tonsils.

Good luck!!!

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@AS2005 Thanks for your answers. This is very helpful for me and other members here in Ontario.

I will ask my family doctor for a referral to ENT at St Michaels, and simultaneously a referral to Dr.Hodaie.

I think there’s C1 involvement in my case, so I may end up having to go overseas, but ENT at St Michaels and Dr.Hodaie will be a good starting point.

I’m also going to ask to be referred to Dr.Eric Monteiro at Mount Sinai and Dr. Ivan Radovanovic (who Dr.Pereira refers out to) in Toronto.

Thanks so much

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