I’m from French so i’m so sorry if my english is a little bad.
I’m currently having throat pain since 3 or 4 years. My last injected CT from March 2023 show that my left styloid is irritating my jugular vein with compression (but I have no compression symptom). My ENT wanted first to cut my left hyoid greater horn because he thinks she is irritating he area, so I did it in September 2024. Today, I’m very discomfortable in this area even though my surgery was 4 months ago. Do you think it’s normal? I have a little pain when I swallow and when talking a lot (my job makes me talking a lot…). I’m also very stressful in this period maybe it’s related?
Otherwise, my symptoms since 4 years are principally pain in throat and the neck like something is stucked in. I made many exams and that made my sometimes in depression. I’m also a little hypochondriac and subject to health anxiety. I take Lexapro 15 mg on morning and Mirtazapine 3.25 mg on evening for sleeping (I think they make me a dry throat witch can be irritated too?). I smoke a little (2 or 3 cig per day max).
Here are photos made in radiant of my last CT.
I’m very thankful to find this community and thank you in advance for reading me.
Hi, & welcome, your English is very good, way better than my terrible French!
The styloids in your images certainly look pretty thick, which can cause symptoms, and longer than average. The feeling of something stuck in your throat is a common ES symptom, and certainly given that your styloids look so thick & a bit long it’s worth looking into ES as a diagnosis. Also pain swallowing and pain after talking can be caused by ES, so might be from that & not from your surgery? On your left side it does look as if there is compression of the Internal Jugular Vein, as you said, but good you don’t have any symptoms of that. Often people have one dominant vein, so maybe it’s not your dominant one so the compression isn’t affecting you too much, although we have seen members who seem to compensate quite well for a while, until suddenly they get symptoms, so it’s worth keeping an eye on.
The hyoid bones do both look quite long, and the left one a bit of a funny angle, so I can understand why the doctor wanted to shorten it- if you’re still uncomfortable there it could be that the nerves are still healing- they can take up to a year to heal, so patience is needed. It’s too early really to say how well they’ll heal, but it could be that not enough was trimmed, or it could be that the end wasn’t smoothed very well where it was removed if you still get symptoms later on.
So I do think that the styloids could be causing symptoms, but it’s a personal decision as to whether the risks of surgery to have them removed would outweigh the symptoms; how badly do they affect your quality of life? And how confident you feel in a doctor if your doctor would agree to operate?
We do have a list of questions we suggest members ask a doctor if they’re thinking of having surgery, this might help:
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
Thank you for your very complete answer! That reassure me a little.
I see my ENT in February to make a check after the surgery. I will talk to him about my symptoms but the fact that i’m not completely healed is good to know. I’m not very patience in general lol.
I also have chronic pharyngitis, do you think it can be an ES symptom?
The pharyngitis could definitely be an ES symptom. Both the vagus nerve & glossopharyngeal nerve are frequent victims of elongated styloids & a chronic sore throat, weak voice, pharyngitis can be the result.
Your styloids are not only thick but are also “wavy” so their shape can also be contributing to the symptoms you have. I’m glad you have a surgery follow-up in Feb. That would be a good time to discuss your styloids as well as any really bothersome symptoms you still have from the hyoid surgery.
Re: smoking - smoke is irritating to the throat & lungs which means that it could be enhancing the symptoms of your pharyngitis when you smoke. If it’s possible for you to stop, it would be helpful in reducing the symptoms of pharyngitis & perhaps the dry throat, too.
Anxiety is a common side effect of ES & Hyoid Bone Syndrome both from the pain they cause & from irritation to the vagus nerve which helps control anxiety levels.
If you’re able to translate them, there are lots of research papers in the Research papers category which explain symptoms of ES so you could print off a couple of papers and take them with you or send them to your ENT. Unfortunately because doctors are taught in medical school that ES is very rare (and sometimes that it doesn’t exist!), so many doctors are ignorant about it.
Here’s a link to the Research papers category: Latest General/Research Papers topics - Living with Eagle
This study sums up symptoms quite well for example: New review article I read today - General / Research Papers - Living with Eagle IJO 7(21)2013
Hopefully he’ll listen if he reads something peer reviewed!
Since you’ve tried not smoking & it didn’t make a difference, it makes sense that now is not the time to try quitting again.
I’m very sorry your ENT is in denial about ES not causing pain. I just don’t understand how any doctor who knows neck anatomy could make that claim because there are so many major nerves right in the area where the styloids “live” thus if the styloids elongate or are thick, steeply angled, curved, twisted, etc., or the stylohyoid ligaments calcify, they are much more prone to wreak havoc with the nerves in the area & create pain. It seems like common sense to me!!
Thank you all for your helpful answers ! @Isaiah_40_31 I don’t have any calcification on my CT
I’m very happy to have found this community!
All theses symptoms make me a bad anxiety every day… I’m sometimes feeling like if i have a cancer or something else wich makes me more nervous. My last CT is from March 2024 I think it’s to short to have a cancer since lol but my anxiety make my think about it.
In fact, i’m also griting my teeth (i don’t know how to say it in english) all day and night. I think that it makes tenses in my jaw and then in my throat too. Do you think this contribute to my pain or in pharyngitis eventually? (I already an orthodontic prosthesis for night)
I never had the throat pain symptom or trouble swallowing, I had nerve pain in my teeth & jaw, over my eye & scalp, so I presume Trigeminal Neuralgia, medication controls that.
Gritting (that it right!) or grinding your teeth probably isn’t helping, it’ll cause tension in your jaw & all the muscles around the area, so could be causing pressure on nerves. I think one theory of a cause of ES is jaw problems , I’m sure a doctor mentioned that to one ember, that it causes inflammation which leads to calcification.
Unfortunately anxiety is a chicken & egg thing- anxiety can be caused by vagus nerve compression, or by worrying about symptoms, but then that causes more tension and inflammation, which makes symptoms worse, & then causes more anxiety!
Many of our members have been told they don’t have any calcification or styloid elongation when in fact they did. The radiologists often don’t know about ES & don’t know what to look for. Additionally, not everyone w/ ES has long styloids or calcified stylohyoid ligaments. The styloids can be normal length but be extra thick or curved or pointed, or twisted or growing at a very steep angle. Even normal length styloids displaying one or more of those features can cause ES symptoms & IJV compression.
Ernest Syndrome is another syndrome like ES but the stylomandibular ligament is what calcifies. It can also cause throat pain. It is more rare than ES as far as we know, but calcification of the s-m ligament can also be missed in CT scans. It can cause the symptoms you have including the TMJ problems as a calcified stylomandibular ligament can cause the lower jaw to be pulled a bit backwards which puts a lot of pressure on the jaw joint.
