I have bilateral Eagle syndrome with very long, completely calcified styloid processes (approximately 5.6 cm on the left and 4.6 cm on the right). Since 2017, I’ve been
suffering from dizziness. Since 2018, it has been almost constant, and over the years I’ve received many incorrect diagnoses. About two years ago, I was finally diagnosed with Eagle syndrome. Both styloid processes are completely calcified. My symptoms include: * Constant dizziness * Vertigo, especially when moving my head or nodding * Tinnitus/ear ringing * Occasional pain in the middle of my face * Constant jaw tension (I also have TMJ dysfunction) * Tightness along the sides of my neck * Frequent pressure at the base of my skull * My atlas (C1) never seems to stay in a stable position * Poor cervical spine posture with significant muscle tension. Instability of the cervical ligaments has already been investigated and ruled out. What I keep wondering is whether my movement-induced vertigo could be caused directly by Eagle syndrome. Or could the very long, calcified styloid processes be contributing indirectly by taking up space and placing constant tension on the surrounding muscles, fascia, and soft tissues, leading to muscle tightness, postural changes, jaw problems, atlas dysfunction, and ultimately dizziness? Has anyone here experienced similar symptoms, especially vertigo triggered by head movements? If you’ve had surgery, did your dizziness or vertigo improve afterward? I’d be very grateful to hear about your experiences. Thank you!
@Sunshine - Welcome to our forum. I’ve annotated the two pictures you posted.
I’m sorry you’ve had such bad symptoms for so long but I’m glad you were finally diagnosed. Your left styloid is normal length, but you have sections of calcified stylohyoid ligament down the length of the whole ligament to your hyoid bone. On the right, I’m not sure what I labeled is your styloid, but if it is, it looks very short & thick. You also have at least one section of calcified stylohyoid ligament on the right. I couldn’t see all the way to your hyoid on that side because your mandible is in the way.
The more interesting thing I noticed is the transverse processes of your C1 vertebra are quite large & the left side almost looks like it could be a form of ponticulus posticus/arcuate foramen, but I could also be wrong about that. Due to how big the TPs of C1 are, & how close they look to your internal carotid arteries (ICAs), I suspect you may have internal jugular vein (IJVs) compression. Unfortunately it looks like you had a CTA so the IJVs are not visible only the ICAs are. IJV &/or ICA compression can cause positional dizziness & tinnitus, however, your ICAs look fine in the pictures you posted so I’m suspicious your problem may lie with your IJVs.
The reason IJV compression can cause dizziness/vertigo is because deoxygenated blood & other toxins flow out of the brain through the IJVs & freshly oxygenated blood flows into the brain through the ICAs. When the IJVs are compressed, often at the level of C1, blood can’t flow out of the brain as fast as it’s flowing in so a situation of high pressure (intracranial hypertension) occurs in the brain which can cause dizziness, tinnitus/pulsatile tinnitus, brain fog, visual changes, a sense of derealization, & migraine headaches. Sleeping with head/shoulder elevation at night can help reduce the pressure temporarily. Icing your neck for 15 min several times/day, w/ a thin cloth between skin & ice pack to prevent ice burns, can help w/ the nerve pain symptoms.
If you can get a CTV (contrast is injected at the venous phase of the heartbeat) so the jugulars are visible, that would help to be able to rule IJV compression in or out as a possible cause of some of your symptoms.
The other symptoms you’ve mentioned are common w/ ES & are caused by irritated cranial nerves which can become irritated by elongated styloids &/or calcified stylohyoid ligaments.
I agree that your cervical spine is quite straight but that can be corrected gradually using gentle PT exercises. Here’s a link to a discussion thread where there is information about how to do that: List of my favourite resources on YouTube to learn anatomy
Many of our members who’ve had vascular decompression surgeries & styloidectomies have had good reduction or resolution of dizziness & the other symptoms you’ve listed.
Hi,
thank you so much for taking the time to look at my CT scans so carefully and for writing such a detailed and thoughtful response. I truly appreciate the effort you put into this. It means a lot, especially after such a long journey with symptoms and so many different opinions over the years.
Your observations were extremely interesting, especially regarding my C1 anatomy and the possible involvement of the internal jugular vein. No one has ever pointed this out to me before, so it really opened up a completely new perspective that I will definitely bring into my upcoming medical consultation.
After almost 9 years of symptoms and many misdiagnoses, it is honestly very valuable to have someone look at my case in such a detailed and thoughtful way.
I can also try to upload a few additional CT images or even the CT reconstruction video in the comments or in my post. I’m not entirely sure if they are necessary or how useful they might be, since I honestly struggle to properly interpret them myself.
At the end of July, I have an appointment with a head of department in Hilden, Germany (hopefully Dr. Martini). I really hope he has experience with cases like this and can help me finally make sense of all these findings.
Thank you again for your time, it truly means a lot.
I had bilateral IJV compression by the styloids, so had quite a few similar symptoms to you- head and ear pressure, a constant off-balance/ drunk feeling, brain fog, dizzy spells, feeling like I was falling sometimes, pulsatile tinnitus… These disappeared pretty quickly after my first surgery, so I’ve been very lucky.
Other members have mentioned feeling vertigo so badly that they’re very ill in a car, and some have even been bedridden. There are often overlaps with other conditions, like instability (AAI/CCI), so it;s not always possible to say whether ES is completely to blame, sometimes the only way is to have the surgery and see what resolves.
As @Isaiah_40_31 says, you would need a CT with contrast timed to show the veins to see for sure if you do have IJV compression, but your symptoms certainly indicate it… The images you’ve posted do have a phase number on them, so maybe other images have been done of the veins?
Hopefully Dr Martini will be able to help you!
I’ve had both styloids removed in the past six months. Main symptoms were loud, high-pitched tinnitus, positional dizziness, fatigue, and severe crashes after meals. Suspected cause was cranial pressure due to both IJVs being compressed between the styloids and the atlas (C-1).
Since decompression, there has been much improvement of these symptoms, but there is still some positional dizziness at times and the tinnitus has not completely been resolved. However, after having lived with the condition for many years, I’m aware that more improvement may be forthcoming and I have patience.
I also have advanced Psoriatic Arthritis, or PsA. That, combined with the Eagle Syndrome was a double whammy on my systems. So it is that two major issues are being monitored and treated but, again, it’s good to have major improvements in regard to those symptoms identified and associated with Eagle. Now I can concentrate my efforts on dealing with the PsA condition.
I hope some of the above info will help with your questions.
@Octoberkurt - Thank you for updating us! I’m so glad to learn how well you’re doing after your surgeries. You’re correct - with more time, the dizziness & tinnitus may further resolve. Tinnitus in particular is a tough bugger to get rid of so it may never go away fully, but any reduction in volume/intensity is a win.
Psoriatic Arthritis is another tough problem to deal with. Did you know that there is a PsA support group that exists under the Ben’s Friends “umbrella” under which this site exists? In case that’s news to you, here is the link - https://www.livingwithpsoriaticarthritis.org
Even though you’re a member on Living with Eagle, you would also have to apply to the PsA group if you want to join & participate in it. I hope your efforts in dealing w/ PsA go far toward helping reduce those symptoms, too.
You’re welcome to upload additional images. Sometimes the angles to view & assess the important bones & blood vessels in one image are better than in another. The CT reconstruction video might be very interesting & helpful though I don’t know if it might contain too much data which would keep it from uploading. It’s worth a try though.
Dr. Martini has helped several of our members on this forum. Unfortunately, if you do have IJV compression, that is not something he will specifically take care of. He does styloidectomies, & if shortening a styloid takes the pressure off someone’s IJV so it can re-open, there is victory. However, if the TP of C1 needs to also be shaved to make more room for the IJV, that’s not something he does, as far as we know. Before jumping too far ahead, though, let’s see if he can tell whether or not you have IJV compression as knowing that will help us to help you in choosing a doctor.
Hi!
I have ES without IJV compression and also suffer from constant dizziness as well as positional vertigo. Sorry to hear you are going through this too! I haven’t had surgery yet but hoping to soon.
Thank you so much for your detailed reply and for taking the time to look at my case and share your experience – I really appreciate it.
From my side, I can add a bit more context from the diagnostics I’ve already done:
After my first functional MRI of the cranio-cervical junction, there were so far no clear signs of instability (CCI/AAI). However, the assessment of the small ligamentous structures (“micro-ligaments”) was not specifically part of that examination, so I’m aware that this aspect may not be fully ruled out yet.
In the CT scan of my neck, the vascular structures were included, but unfortunately the veins were not properly visualised, and the scan was also performed in a neutral position only, without any dynamic component.
What I personally find very interesting – and also helpful in your feedback – is the observation that my atlas seems to have a slightly atypical position or morphology compared to what is usually expected. This has actually been mentioned in different contexts before, and it makes me reflect on how sensitive my whole cranio-cervical system seems to be.
Even if my long-standing dizziness (which I have been dealing with for more than 8 years) is not caused by a direct venous compression, I do wonder whether the Eagle syndrome and the surrounding anatomical structures could still be contributing indirectly – for example by influencing muscle tone, posture, or the functional position of my atlas.
What I clearly notice is that my symptoms are highly variable in their presentation and intensity: sometimes more rotational vertigo, sometimes swaying dizziness, sometimes a strong gait instability. There are also periods where I am relatively stable for weeks or even a few months, followed by clear flare-ups.
At this point, I am honestly still trying to understand the full picture. One thing I can say for sure is that my symptoms are very position- and tension-dependent. Even small changes in neck position or muscular load seem to significantly influence my condition.
What has become very limiting for me over the years is that activities like driving, sleeping well, or even being physically close in relationships have become very difficult or sometimes not possible at all during bad phases.
I am currently waiting for further evaluation with a specialist (Dr. Martini), and I really hope this will bring more clarity regarding the role of Eagle syndrome in my case.
Thank you again for sharing your experience – it really helps to compare patterns and understand that there may be overlapping mechanisms involved
@jesaja_40_31 PS: I will try to upload more pictures/videos. I’m not yet sure whether I should create a new post for that or send them privately—I’m still getting familiar with how this forum works. Thank you so much for your helpful support.
If you want to upload more images, you can put them in to this discussion…
Here are a few more screenshots. I’m not sure if they’ll be helpful, but I also sent you the login details for my CT scan via private message, just in case.
All the best! 
The additional screen shots are helpful, @Sunshine. The top image shows your very “interesting” C1 transverse processes in addition to showing how out of alignment w/ the rest of your spine, C1/C2 are, & C3 also but to a lesser degree.
Your styloids & calcified stylohyoid ligaments are also more fully visible in first & last images. The styloid & calcification on the left side are much thicker than on the right though there is a similar situation on each side w/ the styloids being normal length (right styloid is barely existent) then a gap then significant stylohyoid ligament calcification. Due to the tilt in your C1/C2 vertebra, your left s-h ligament calcification may go all the way to your hyoid bone, though I can’t see whether that’s the case from the back. The hyoid typically sits at about the level of C3, but it can be between C3/C4.
I agree that your C1 & C2 look pretty tilted, @Isaiah_40_31 has been very helpful labelling your images! I’m sorry I’m not able to help with this, but in this image:
your hyoid bone processes (the greater horns, the lower ones) look pretty long & pointed at the end- you can’t tell from that angle but they could potentially be close to your carotid arteries. There’s also some calcification I think on the lesser horns of the stylo-hyoid ligament. Your thyroid cartilage looks pretty chunky too- we have seen this occasionally with members, some have had symptoms from this, so this all might be worth looking into as well!
Hi Jules,
thank you so much for taking the time to look at my images and for sharing your observations with me. I really appreciate it 
Also thank you for your honesty in saying you’re not fully able to help with this – I still value your input a lot, especially your careful eye on the anatomy.
And thank you as well for pointing out the C1/C2 alignment, the hyoid bone processes, the possible calcification around the stylohyoid ligament, and the thyroid cartilage. It really helps me to have different perspectives on all of this, especially since I would never be able to identify these structures on my own.
I will take all of your thoughts, along with the beautifully labelled images from @Isaiah_40_31, with me to my appointment with Dr. Martini in July/August. I will also bring everything to my CMD therapist, whom I’m seeing today. I think it will be very helpful to discuss all of this with them directly.
Thank you again for your time, care, and for contributing to this space. It truly means a lot to me.
All my love,
Laura
You’re welcome, glad to help…hope it goes okay with the therapist today!