@Pamela1 - I’m very sorry for how severe your symptoms have become. Your styloids are quite long, irregularly shaped, & very pointed at the tips. It looks like you had your CT w/o contrast so I can’t comment on possible vascular contact your styloids might be making with either your internal jugular veins or internal/external carotid arteries.
It sounds like you have significant vagus nerve irritation or compression being caused by your styloids as most of your symptoms can be attributed to the vagus nerve being unhappy. Your vasovagal syncope, though possibly vagus nerve related also sounds to me like it could be caused by compression of your carotid artery(ies) by your styloid(s) as that can cause the blacking out during the tilt table test, & your heart pain, though the heart pain can also be caused by your vagus nerve. I know because I had that, too, prior to my styloidectomies.
The symptoms you mentioned that we know can be related to vagus nerve irritation are vocal dysphonia, possibly the head/neck/sinus pressure when speaking (though the trigeminal nerve could be contributing there), insomnia, temperature intolerance, & chest tightness/heart pain. Increased anxiety can also be related to vagus irritation. Here’s an illustration of where the vagus nerve is located in the body which may help you see why it can cause so many symptoms:
Elongated styloids can cause a shift in the position of the jaw as the body compensates to accommodate the pressure the styloids are putting on smaller muscles & significant cranial nerves. We’ve had members mention that their TMJ issues stopped & jaw position changed once their styloids were cut back.
The trigeminal & facial nerves are other cranial nerves that are often irritated by elongated styloids. These can cause the feeling of pressure/pain in teeth, sinuses & face. Here are illustrations of the locations of those nerves:
Have you had a consult with any of the doctors on our Doctors List for your state? There are several & getting at least a couple of opinions is a good idea. You want to choose a doctor who will use the transcervical (through the neck) approach to cut your styloids as close to the skull base as possible. If you want them both removed in one surgery then Dr. Hackman in NC is the doctor to contact as he is one of the few on our Doctors List who routinely does that. Here’s the link to our Doctors List:
Here are also links to a post written by @Jules regarding ES symptoms & possible causes & one about ES surgery:
Finally here’s a post from one of our members who had terrible vagus nerve symptoms & for whom surgery provided excellent recovery:
Getting your styloid cut back close to your skull base should help immensely with getting your symptoms to resolve.