Thanks so so very much for the add to the group! This is my left side. And I get a lot of stabbing pain under this earlobe, as well as ear pressure and pain and tinnitus, and also lightheadedness. The concern isn’t really the styloid length, but how the vasculature is wrapped around it. I think it’s the internal carotid. And then the jugular in sandwiched between styloid and fin of c1. Does this look like anything to you? If not the compression may be coming from a different location. I have some aTOS positive testing to also discuss with vascular surgeon. But if this looks like something I wanted to call his attention to it. Thanks!!
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I think you’re right about the ICA, that’s quite unusual to see it twisted around the styloid like this… It does look from this image that there’s a reasonable gap between the styloid & C1 , although it can sometimes look very different from other angles.
Your neck does look quite straight, you might have lost your lordotic/ natural curve, which can make vascular symptom worse, there are some exercises which might help in this discussion:
List of my favourite resources on YouTube to learn anatomy - General - Living with Eagle
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@Amy77morris - Welcome to our forum. Do you have any other 3D images you can post i.e. from the back side & front side?
I see what I think is your IJV behind your styloid, but it doesn’t look like it’s compressed between styloid & C1 in this image. If it is, there’s a good chance your vagus nerve is too. Assuming the most obvious vessel in the picture you posted is the carotid artery (which usually sits on top of the IJV, so this makes sense), the internal carotid (ICA) branch looks a bit “bulgy” starting at the carotid bifurcation. It also looks like your hyoid bone may be poking into your common carotid artery, but that could just be the angle of the imaging.
Your styloid is longer than normal, & by virtue of the fact your ICA looks to be draped over it, you’ll likely need the styloid resected as close to skull base as possible to relieve any symptoms being caused by that situation.
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Thanks! Do you think a vascular surgeon, one who specializes in TOS and venous compression syndromes will be able to assess this situation pretty well? I’m seeing one in 5 days… here is my non symptomatic side for comparison .. we are trying to get some better angles. The one from underneath is hard to figure out how to get, but working on it.
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From the rear, your left IJV looks fine, but your right side looks like it’s suffering compression between your styloid & C1 - even though that’s your asymptomatic side. The vascular symptoms you have on the left are more likely coming from your internal carotid artery’s interaction w/ your styloid & possibly the left greater horn of your hyoid bone.
If the vascular surgeon you’re seeing is acquainted w/ ES & has an understanding of the problems it can cause, (s)he should be able to diagnose what’s going on in your neck as well as your possible TOS. We have a list of several US doctors who specialize in IJV compression caused by the styloids & often C1 as well. Especially in cases where vascular compression(s) is/are involved, we suggest getting a second opinion from one of these doctors:
Dr. Costantino in White Plains, NY, Dr. Cognetti in Philadelphia, PA, Dr. Lui in Livingston, NJ, Dr. Hepworth in Denver, CO, Dr. Nakaji in Scottsdale, AZ, or Dr. Welch in Dallas, TX.
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I also noticed that your right ICA looks “bulgy” right above the bifurcation. Perhaps this is just an anamlous finding that’s normal for your ICAs. If the right greater hyoid horn is poking anything, it looks like it would be the ECA but that little artery looks pretty normal to me. I’m not a doctor so these are just observations you can discuss with your doctor to get a professional opinion.
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Thanks @Isaiah_40_31 for labelling the images! 
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They blood vessels look unusual to me- we’ve had some members who’ve had IJV compression from other blood vessels as well as from the styloids, so that could be possible? It will be interesting to see what your doctor says, if you get a chance to look over your images…
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@Amy77morris - I agree w/ @Jules. What it looks like to me is you may have some soft tissue (SCM?) compression of both your IJV & ICA in the area just above the bulge in the ICA. It doesn’t look to me like the TP of C1 is playing a significant role on the left, but the fact that your IJV disappears right where your ICA appears to be compressed is an indication that the contrast couldn’t through it beyond that point which is one way we identify points of compression. You’re welcome to take the images I’ve annotated along w/ Jules & my comments to the doctor you’re consulting so you can ask about what we’ve seen & mentioned.
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Thanks so much for your input! It’s so so appreciated! I sent my ct and cta images to dr David cagnetti. Do you think of there is vascular compression at this site he will find it? I talked to a vascular surgeon about some TOS issues, and he wasn’t really knowing anything about these types of compression. It’s hard to find someone who does actually not look at you like you’re nuts when you mention IJV compression…
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De. Cognetti does look for IJV compression & operates together w/ Dr. Heller, a neurosurgeon, when C1 needs to be shaved. There are cases where just a styloidectomy is enough to allow the IJVs to open. He will also identify if he thinks that’s your situation.
Just so you know, Dr. Cognetti is booking RS appts in October or November now. Please ask to be put on his cancellation list when you get your appt.
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Thanks so much! I was a bit worried that they don’t want to know any symptoms or clinical history… but is it a case where either the cta shows the problem or it doesn’t??
Typically a CTA/CTV will show the problem or even just a plain CT with contrast. The bigger issue is that the radiologist reading the imaging may not be aware of, or considers what we know is significant, to be insignificant so neglects to note it in the radiology report. Some doctors give more weight to the written report than what the imaging shows, thus it’s important to inform yourself & be your own best advocate in the face of medical denial. That can mean having to see multiple doctors until you find one who better knows the significance of what the imaging shows & doesn’t rely on the radiology report to tell the whole story.
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The radiologist locally noted absolutely nothing about this area of my body on the report. But the cta wasn’t ordered to eval ES. I uploaded the images to Dr Cognetti, hoping he will look at the actual images themselves, and not the report. Thanks so much for spending time to chat about this with me. I’m having a terrible time. Trying to get eval for vascular compression, ES, CCI, CsF leak. Any of which may cause my sx list amd are very hard to get evaluated correctly. But, my quality of life is very poor. I can’t work of function barely at all.
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I’m sorry you’re feeling so rough, I felt pretty grim before my surgery but wasn’t as symptomatic as you are
I hope Dr Cognetti can help you, some doctors do evaluate the scans themselves & not just look at the reports, so hopefully he will 
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@Amy77morris - I believe Dr. Cognetti looks at the imaging to decide whether or not he can help a patient. The radiology report is a secondary thing. I assume you sent a message w/ your imaging letting him know that the imaging wasn’t done to diagnose ES so he should also take that into consideration when reading the radiology report.
Please let us know when you hear back from him/his office.
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I wondered if you can look at this real quick. It appears to indicate eagles syndrome pathology?? The ossified ligament and the space between styloid and c1 is 8.5mm where as cutoff of normal is I think 10mm.
It notes a lot of people are asymptomatic with this, so I don’t have confidence now, if this is the cause of all my symptoms. I have a lot of discomfort under my left earlobe that’s radiates into my ear and jaw and side of my throat, as well as pulsitile tinnitus, lightheadedness at times with certain positions, like turning my head, a lump in throat feeling.
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@Amy77morris - I wish radiologists would add, “In my experience” …prior to putting things like, “this finding is typically asymptomatic”… in their reports. Your report did include, “but may present with clinical symptoms of Eagle syndrome.” With the radiologic evidence you have, plus your symptoms, it seems pretty clear cut that you’re on the right diagnostic path. Though every single symptom may not be caused by your ligament calcification/vascular compressions, the worst ones most likely are.
With ES, often even normal is abnormal. There are other variables besides the space between the styloid & C1 that can cause vascular compression.
These are all symptoms known to occur with ES. The radiating pain from your left earlobe into your ear, jaw & throat is likely being caused by your trigeminal nerve. Lump in throat feeling is caused by the glossopharyngeal nerve & lightheadedness in certain head positions is a symptom of vascular compression. If you haven’t read this post that @Jules wrote, it will be very helpful:
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Thank you! I have many many many of these symptoms!
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