How to determine which styloid is causing symptoms?

My husband’s eagle’s diagnosis was uncomplicated as one styloid is poking through his esophagus. CT shows both styloids are elongated but Dr. only wants to remove the styloid poking through his throat. When my husband turns his head to the right, he feels like he is going to pass out. I suspect it is compression, but from which styloid?
Question: If you only have compression symptoms when turning your head to the right, which styloid is the likely culprit? Which test would confirm/rule out compression? Thank you

I think your assumption is right. There is probably a contact/compression on carotid artery. Feeling of passing out is called presyncope/syncope and it is one of the symptoms of carotid compression/irritation.

Hard to say which styloid is causing it since when you move your neck both styloids move (one interiorly and the other exteriorly) internal carotid or external carotid could be compressed but also the move will depend on where the styloids were pointing to begin with so the orientation angle, size of the styloid, ligament calcifications all come into play.

The best test to diagnose is Dynamic Catheter Angiogram since it shows both the blood flow and if there is an occlusion induced by Styloid compression by moving his head/neck to different positions. I would say it is even more critical to do the Dynamic testing because he might be having blood supply cut off from the brain when he turn. This can potentially cause stroke.


Hi @hardtoswallow ~

Welcome to our forum! I’m very sorry for your husband’s situation. @KoolDude has given you great advice.

Is the doctor your husband is seeing only willing to remove one styloid period or is (s)he only willing to remove one at a time? Many of the more experienced ES surgeons on our forum will only remove one styloid at a time so it’s worth it to confirm which scenario is accurate.

If your husband’s surgeon is only willing to remove the one poking through his throat (that sounds beyond ghastly!! :scream: but we know it can happen), then it would be worthwhile getting a second opinion (we can give you the names of some of the more experienced doctors on our list). We have one surgeon on our doctors list who will routinely remove both elongated styloids in one surgery - Dr. Hackman in North Carolina. Quite a number of our members have seen him for surgery & most have had very good outcomes. It can take some months for a full recovery & sometimes up to a year +, but even with that, most people feel much better by 2-6 mos post op.


I’m newly learning about this and I find it all so fascinating because I was recently diagnosed. I finally feel like I’m not alone. I have always had pain when looking to my left side for too long. My face will go numb and my vision blurs. All of my pain symptoms are primarily on my right side. I always just thought I had neck issues. Turns out it’s ES.


Thank you for the sage advice. Dr. Old will remove the styloid poking through his throat but was doubtful that the symptoms turning his head were from Eagles. A doppler US is scheduled this week. I wasn’t sure if the ultrasound could see the possible compression area. Certainly removing one styloid will relieve the throat pain. The vascular symptoms are also significant.

If you’re interested, you can search for posts abt Dr. Old on our forum by clicking on the magnifying glass icon & typing his name in. I know he’s on our list which means we have at least one member who hd a good outcome from ES surgery he did. :blush:

My left side was much more symptomatic than my right side, but my Doc saw more compression on my right side even though my biggest problems were coming from left. He removed the right one, and now my left side is much worse so I think it can be a bit of a gamble on which one to remove first. Luckily though, sometimes when you remove one, that is enough to alleviate the primary symptoms. But using my case as an example; just because one side has more compression doesn’t mean that it is causing the most painful/worse symptoms.

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I was totally in your situation, @hyperichard. My less painful side was removed first because of angle & thickness but my second side was the one that was most symptomatic. I was totally miserable until my second styloid was removed 9 mos later. Though I must say, some symptoms did resolve after the first one was removed.