Obviously only amateurs here, not doctors! I would think that it’s possible looking at your images that the styloids could be causing symptoms, they are quite thick & angled; I feel for you with all this backwards & forwards with the diagnosis…I do agree with TheDude that if you don’t get anywhere with Dr Osbourne- if you read this discussion there’s info about what Dr Samji needs:
CT neck non-contrast “styloid protocol”? - General - Living with Eagle
But you ask about ligament vs bone; ES is defined as either elongated styloid process or calcified stylo-hyoid ligament (or both) causing symptoms, so really I can’t see that it matters whether it’s an elongated styloid process, or calcified ligament joined on, if it’s causing symptoms it needs removing. Often they merge into one bony process, sometimes you can see joints & sometimes separate calcifications along the ligaments length. Yours to me look like it’s a long process, it’s impossible to tell if that includes any calcified ligament too, & doesn’t really matter anyway…
I hope that you can get some help soon…
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