I received my new CTA images. Can anyone pinpoint anything different on these scans from before? The majority of my symptoms are in the front of my neck, hyoid area. I plan on sending my disk out to a specialist mentioned on this site. The radiologist found nothing wrong with my images and said everything was normal. Thanks in advance.
In this image I’ve marked the curve of your hyoid bone. The right greater horn is more curved than the left & sits higher. The height discrepancy & position of each greater horn between left & right sides could cause some problems.
Your left greater horn looks to be sitting very close to your cervical spine, however, I can’t tell from the angle of this image if that’s just an illusion. Can you also post an image of the right greater horn?
I think you may be onto something w/ your suggestion of hyoid bone syndrome + ES, as styloids that are as long as yours would surely be contributing to your symptoms. I don’t know that the thyroid cartilage calcification is a problem. I just noted it because it’s visible. I recall reading that some calcification of the thyroid cartilage is normal.
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Thank you @Isaiah_40_31 for your detailed response! I will upload another image of my hyoid bone tomorrow. I’m definitely going to send my disks out to a specialist who deals both with my hyoid and styloids and finally get to the bottom of this. 
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I agree that the hyoid bone processes look a bit long, & the right seems to have a bit of a ‘hook’ on the end…it looks a bit wonky as @Isaiah_40_31 says…Glad that you were able to get the right scan done 
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Your right greater horn also looks like the tip is close to your spine. A doctor who does both hyoid bone surgeries & styloidectomies is Dr. Cognetti, but someone just posted that he’s booking initial consults in July of next year now. His office does keep a cancellation list which has been helpful for some members to get earlier appointment.
Unfortunately, Dr. Dewan, who’s been our “go to” for hyoid bone syndrome, doesn’t do styloidectomies, but only works on the hyoid. Dr. Chhetri at UCLA Med Ctr in Los Angeles also does HBS surgeries & used to do styloidectomies, so he would also be a good resource for you as he’s experienced w/ both & could potentially add a styloidectomy into an HBS surgery. I know you’ve mentioned traveling out of state would be a hardship for you so I’ll pray there is a doctor in your state who can help you with both situations if you’re also diagnosed w/ HBS.
•Dr Dinesh Chhetri, UCLA, Los Angeles (ENT/ Otolaryngologist, Head and Neck Surgeon) Dinesh K. Chhetri, MD - Otolaryngology - Head & Neck Surgery | UCLA Health Does phone/telehealth consults.
•Dr David Cognetti, Thomas Jefferson University Hospital, Philadelphia 215- 955- 6760 (Has done many successful surgeries on members). Only removes ligaments if calcified. Works with Dr Heller now to do C1 shaves
David M Cognetti MD | Jefferson Health Does do online or phone consults.
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Thank you again for this useful information @Isaiah_40_31 I know you and Jules both have given me some great recommendations on specialists who perform these types of procedures. I do have a referral put in now to a neurosurgeon but whether he deals with the styloids is yet to be determined. It seems like everything I have researched, most styloidectomies are performed by otolaryngologists, especially if the hyoid bone is involved as well.
There was mention of Dr. Brad DeSilva on here dealing with the hyoid bone, and he is in Ohio also, which is much closer to Michigan. Have any of you heard of him performing styloidectomies, as well as hyoid bone surgeries?
Thank you again
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I can’t find anything in the past discussions, I’ve just done a quick search; some of the doctors’ names were given to us a while ago, so it might be it wasn’t recently…might be worth ringing up where he practises to ask?
Looking at the new images you posted, sometimes it’s not so easy to tell from that view how close the bones are to blood vessels, but your hyoid looks pretty wonky, the hyoid processes especially the right look very close to the internal carotid artery, and the styloid that side too…but sometimes it looks like that whereas in the axial view there can be a bigger gap.
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I hope everyone is doing well on here. I had my appointment today with the neurosurgeon. He went over my CTA scan and agreed that I do have an elongated right styloid that appears to be 1 cm longer than the left. I told him my whole list of symptoms including sleep issues, dizziness at times, whooshing in the right ear occasionally, feeling disconnected, double vision occasionally, etc. and he said none of my symptoms are coming from my neck. In fact, he stated that my right styloid is compressing my jugular vein but people can have completely occluded jugular veins and be just fine. 
I’m just feeling disheartened this evening. I’m going to look through your prior recommendations for people who specialize in this condition, but I really need to stay close to Michigan as can be. So, if anyone hears of anyone who specializes in Michigan,
please let me know. I have seen about 20 different specialists now who A. never heard of Eagles syndrome B. Doesn’t believe I have it or C. Refers me off to some other various specialty.
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@Lynny43 - I’m really sorry the neurosurgeon was so ignorant of the symptoms IJV compression causes. We should have suggested you take copies of a couple of the research papers we have listed in our Research Paper section that verify your symptoms are among those seen w/ IJV compression & that decompression helps provide recovery from them. Every doctor ignorant of this information needs to be educated!!
The doctors we know of who do IJV decompression surgeries w/ styloidectomies are Dr. Cognetti in Philadelphia, PA; Dr. Costantino in White Plains, NY; Dr. Hepworth in Denver, CO; Dr. Nakaji in Scottsdale, AZ; & Dr. Damrose in Palo Alto, CA. None are very close to you, unfortunately.
Your situation is a bit complex because of how long your styloids are & the way your carotid arteries (left especially) wrap around your IJVs, thus it is important for you to see someone who’s very experienced.
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Thank you @Isaiah_40_31 I’m going to be making some calls in the coming weeks to set up some consultations with these specialists. I can’t believe how these specialists here in Michigan don’t understand anything about Eagles or IJV compression.
This image shows the compression pretty good.
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I’m sorry he didn’t take you seriously, it’s so frustrating! We have had a few members who’ve been told that compressed IJVs don’t cause symptoms, when we know full well they do!
It is hard when you can’t travel far, but it does sound as if you’re not going to be able to find anyone nearby unfortunately…hugs to you
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Yes, that’s a good compression picture, @Lynny43. 
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Good evening.
I haven’t been on here in a bit and wanted to give an update. I have been to countless doctors here in Michigan with several of them confirming my elongated styloids, but none willing to perform surgery. UofM has offered to give me a stylohyoid ligament injection but nothing else. I have finally broken down and called Cognetti, Constantino, and Hackman’s numbers for consultations. The only office who actually provided me with any answers was Dr. Cognetti, as the other 2 never got back in touch with me after I left messages.
I was instructed to send Cognetti’s office my scans and medical records and then he would set up a consultation.
Unfortunately, I believe about 2 months ago I had a CSF leak where an enormous amount of clear fluid came out of my ears, and I had the worst headache. My symptoms are still present including visual disturbances, feeling disconnected, anxious, and now a new symptom of tachycardia when I wake up in the morning.
Does Cognetti deal with CSF leaks and hyoid bone issues also?
Thanks
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I believe that Dr Cognetti does look at hyoid issues too, but not CSF leaks- however, if you had the leak 2 months ago & no more fluid since then, I would suggest that the leak has probably healed itself. We see this sometimes with IJV compression; the head pressure (intracranial hypertension) build up because of the compression in the veins, then if there’s a weak spot this can leak CSF, so the pressure is lessened. You then get symptoms of hypotension like you mention with the headache, until pressure builds up again. So sometimes people cycle between high pressure, CSF leaks, & low pressure. So if the compression is fixed, hopefully the pressure will stabilise & you won’t have any more leaks- does that make sense?
You mention tachycardia & anxiety; these could be caused by an irritated vagus nerve, which lies next to the styloid & the IJV, so is often compressed if the IJVs are.
Dr Hepworth does treat CSF leaks, but doesn’t do hyoid surgery. It’s a shame that you haven’t heard back from the other doctors, but if you have hyoid issues too then probably Dr Cognetti would be the best one to see anyway
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Thanks Jules for the lengthy response. I’m planning on getting my scans and medical records ready this weekend and then sending them out. Hopefully I can get some concrete answers soon 
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@Lynny43 - Dr. Cognetti books very far ahead because he gives priority to his cancer patients. I just don’t want you to be surprised when your appointment is sometime in the summer. You can make a case to get in sooner by mentioning your CSF leak though I can’t promise that will help, but it’s sure worth a try. Make sure you ask to be put on a cancellation list, too, as that sometimes can help your appointment move up considerably.
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That’s good to know. I figured it would probably take a while. I misspoke above when I said Hackman; I meant Hepworth. Hepworth’s office called today and they told me they were on a scheduling freeze until May! I’m still waiting to hear back from Constantino’s office, so hopefully that happens soon, and I can have both consultations lined up.
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I’m glad you got a call back from Hepworth’s office. Waiting for that can take some patience!
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