New ES surgeon (San Antonio, TX), experience with recent styloidectomy

I’m posting this on behalf of my wife…
First I want to report that we found a superb surgeon that knows ES and has performed many styloidectomies: Dr. Nathan Hales, in San Antonio, TX. He’s a very, very skilled, experienced surgeon - over 20 years of experience, and sometimes is in the operating room until 2 a.m. He’s an ENT, but focuses on head and neck surgery, and is extremely experienced with thyroid cancer. He’s a very simple, modest person, with NO ego. Just meeting him on the street, you’d never believe he was a world-class surgeon. As with many such doctors, he’s hard to get an appointment with. Larisa’s appointment was 2 months out, then another 3 months before he could do her surgery.
She had symptoms for over 2 years. Moderate hearing loss, continuous tinnitus (“whooshing”), and a feeling like “a nail was stuck inside my head.” Some symptoms, including heart fluttering, dizziness, queasy stomach, etc. depended on what position she was in. She was quite miserable.
We went to doctor after doctor over those 2 years, an NOBODY could figure it out; they’d just shrug their shoulders, with “gee, I don’t know, I hope you get better…” Over, and over and over. Larisa started having spells of major depression, overcome with fear that this is what her life would be like from now on.
Then, just on a leap of faith, I took her to one of the top neurosurgeons in Texas, Dr. Christopher Bogaev. He’s one of these “elite” surgeons, who removes 5 to 8 brain tumors per week. He has to review your records before he’ll even accept you as a patient, and even then it can take several months to get into his office. I figured if anybody could help her, he could. I sent him her records, history and images, and he said he’d see her in a week! But… she had had so many negative experiences she didn’t want to go; it’d just be another bitter disappointment, but I managed to drag her into his office.
We looked at her CT in the exam room and he didn’t see anything at first. Then she said, “it feels like there’s a nail in my head.” He said “let me look again.” He turned back around to the CT image and immediately said, “your styloid is huge, you have Eagle Syndrome.” We’d never heard of it. Unfortunately, Dr. Bogaev is a soft tissue surgeon (tumors, vascular, nerve), not a bone guy, so he couldn’t work on it.
Just calling around town at random, I eventually called Hales’s office and asked if he had any experience with Eagle Syndrome. Nobody else had ever heard of it, including some ENTs with 30-40 years of experience. The lady on the phone said, “oh, yes, he’s very experienced with Eagle Syndrome.” I was so excited I almost fell out of my chair. Well… the rest is history.
Dr. Hales prefers transcervical styloidectomies, because it’s less traumatic, has faster recovery and presents total access to the styloid, compared to the tonsilar approach.
They kept Larisa in the hospital overnight for observation, and after sleeping off the anasthesia for a couple of days, she was more up and about. Her symptoms were GONE!!! I saw her sitting on the back porch in the morning sun, with her eyes closed. She said, “I’m just enjoying sitting here; for the first time in 2 years, without feeling like there’s a big nail stuck in my head.” She was almost in tears.
It’s been a couple of weeks now; her hearing is almost completely returned. The tinnitus, heart fluttering, uneasy stomach, etc. are all gone. The “nail” feeling is completely gone, and both sides of her head now feel the same. Her face is smoother and not distorted from continuously tolerating her symptoms.
I hate to think where we’d be if I hadn’t decided to gamble with going to Dr. Bogaev. Going to him was really just a hunch, out of desperation. Then, out of sheer luck, we found Dr. Nathan Hales to do the surgery. Maybe there IS such a thing as a Guardian Angel!

Footnote: after Bogaev said it looked like ES, we went to another “highly recommended” ENT who turned out to be a jerk. He actually said “you don’t have Eagle Syndrome, I don’t know what it is.” That was when I kept searching, and ran across Dr. Hales. After the surgery, Dr. Hales said her styloid was about 1.5 inches long, with lots of calcification.


Just wanted to say what a caring and capable partner you have been to your wife. She is lucky to have someone help figure things out and find the help she needed. Glad to hear of her recovery. D


@Larisam This is a good story with a happy ending. We really need encouraging stories like this. ES is a great mimicker of many diseases so you were lucky to have found a doctor who cared enough to look a bit deeper. Most of us here were sent to psychiatric ward (go to diagnoses when Doctors have no clue). Thanks again for sharing this moving story


Thank you for sharing your story with us; I second what @PatientD says in that although your wife isn’t lucky to have ES, she’s lucky that you believed her & were able to help her when she was understandably discouraged! So pleased for her that you persevered :grinning: & that her surgery has been successful! Did she just have the one side elongated styloid?
I’ve added Dr Hales’ name to our list, great to be able to share this info as you’ve had such a positive experience!

Thank you so much for the extremely encouraging update @Larisam! We love great success stories. Please be aware though that complete healing can be a three steps forward, two steps back process. As much as I hope that is not the case for your wife, it is possible that some of her symptoms may come & go repeatedly over the months as her nerves & vascular tissues heal. This process can take a year or more but as time passes, most symptoms become significantly less intense & bothersome until they gradually disappear.

I opened our Doctors List to add Dr. Hales & saw that he was the top doctor on our TX list. I added his address, phone & website info to make him easier for our TX members to find. We really appreciate the information you’ve given.

Here’s to a long, healthy, pain-free life for your wife once she’s fully healed from her surgery. :blush:


I can’t express my gratitude for your post enough! I’ve been at my wits end trying to find the right ENT around here that will see me. I prayed yesterday before seeing your post for a door to open and I pray this is the RIGHT door! When I called Dr Hales’ office yesterday after receiving news from a different doctor that they wouldn’t be able to help me, Dr. Hales was booked out until February, but thankfully the nurse booked me with his PA at the beginning of December. Has your wife met with his PA at any time? Mine is a bad vascular ES with 60% stenosis of my internal jugular vein. I’m so glad to hear your wife is doing so much better post-surgery!! :slight_smile:

1 Like

I’m sorry for your situation @LoriBD. So glad God answered your prayer quickly. We have another member whom this post helped as well.

Did you ask if Dr. Hales’ ofc keeps a cancellation list? Most offices do & getting on that list can help to expedite your appt. Good job getting your foot in the door w/ his PA who can also put in a good word for you if (s)he feels your situation is urgent.

I had every intention of being placed on the cancelation list when I called, but now I cant remember if I actually asked or not. I will definitely call and ask tomorrow. So happy to hear another member was helped as well by the OP. I’ve learned quickly that with rare diagnoses, its so important to share information and doctor information!


We haven’t met his PA, but he/she should be able to go ahead and schedule the surgery and get the ball rolling. The main thing is to get your foot in the door. He is so booked up, it may be several months before the surgery, so be ready to settle in for the long haul. It will really be important to bring or transfer all of your imaging to his office, so you won’t have to schedule yet another appointment while waiting for imaging to be done.
Try to focus on the actual, physical aspects of your ES, such as the 60% stenosis. When you go in and complain about headaches, stomach butterflies, etc. that’s when doctors start thinking you’re just another hypochondriac housewife.

Please note that his clinic is a typical multi-doctor madhouse at times. There are 4 providers plus a hearing aid dealer in one clinic, with a fairly small waiting room which is often packed, complete with noisy kids. So you have to get past that. I pretty much expect that these days… (-;

NOTE: the address on the doctor list is NOT correct. He is NOT on Wiseman Blvd., he is on Rogers Road, which is very near his old office. His actual current address is:

5715 Rogers Rd Suite 128
San Antonio, TX 78251

Please be very careful using online directories in finding out about local doctors; they move constantly, especially in big cities, and these directories are often out of date. It’s always best to use the doctor’s actual web site for contact information.In this case,

Good luck, and God bless! Please post here and keep us up to date on your experience. I’m glad we were able to help!


Dr. Hales’ info has been corrected on our Doctors List.

Thank you for the tips! I printed out all my past medical and imaging reports from a neurosurgeon when we thought I had a vascular malformation, highlighted the critical points where it says my styloid process is pressing against my IJV and Transverse Process, and have all my imaging Ive had this year and in the past that I’ll be bringing with me for my first appointment.

Thank you for confirming address; when I made the appointment, I asked for address cause their website wasnt working for me for awhile, and they said it would be at the office you specified.

Interesting enough I was supposed to see another doctor in Dr Hales’ office and he confirmed over the phone that I had ES, but referred me to UT Health’s ENT instead of Dr Hales. But upon review of my referral, UT Health ENT (Dr Williams) said they couldnt help me, I need to go to a cerebrovascular neurosurgeon. I said I just came from one and he’s telling me I need to go to an ENT! Needless to say I’ve been going in circles between Methodist and UT Health. It seriously is maddening, as you already know, and I just hope Dr Hales and his PA is my final stop for this health issue.

I will let you know what comes of the PA appointment next month. Im excited but apprehensive that I’ll get dismissed and sent to another wrong doctor. But as you said, I just need to stick to the facts.

Did Dr Hales’ go all the way up the base of her skull or just partial removal of the styloid process?

I’ve had similar experiences at UT Health. It’s also a teaching hospital, so there are lots of residents and med students in the mix. There is one doctor there, a Dr. Frank Miller, who has been around a long time and reportedly does ES cases - in fact, he’s written a couple of journal articles about ES - but both I and my wife have had rather unpleasant experiences with his chairside manner. So many doctors are such egotistical prima donnas. That’s what I like about Dr. Hales; he’s a superb, superb, world-class surgeon, but meeting him face to face he’s like the guy working behind the counter at the post office.

When my wife went to one highly recommended ENT about her ES and particularly her sudden profound hearing loss, he just laughed and said it wasn’t ES, but he didn’t know what it was. He said her hearing loss was probably just “wax or water in her ears.” Imagine. She was so pissed she got out of the exam chair and walked straight out of the office. The professional ignorance out there about ES is just staggering.

Regarding my wife’s surgery, Dr. Hales prefers to use the cervical approach, for several reasons. For one, recovery is much faster, because with the tonsilar approach, you’re also recovering from a tonsilectomy, which can be an ordeal in itself, with a throat so sore it can up 2 weeks before you can swallow anything. You’re actually making a big cut in the back of your throat with a knife. Also, the tonsilar approach doesn’t give access to the entire styloid, so removing the entire styloid process can be problematic.

The cervical approach, on the other hand, avoids all the tonsilar cutting and presents a completely exposed and accessible styloid, ready to remove in its entirety, which is what he did. Recovery wasn’t a big deal, just taking it easy for a few days getting over the anesthesia and letting the scar tighten up, etc. like any other incision.

The negatives of the cervical approach: for some people, it’s the 3 inch scar on the side of the neck, which he carefully puts in your neck crease so it really doesn’t show - it’s not really visible, anyway, if you’re wearing any kind of collar. Up to you. Also, when working in that area, there’s always the risk of facial nerve damage, but good surgeons like Hales use specific techniques and methods to prevent this from happening. Last, it usually requires an overnight hospital stay, just for observation.

Please keep us posted on how you are doing and how everything goes!


@Larisam has given you thorough info. If you’re interested, there are Youtube videos of both forms of ES surgery. There isn’t a lot of blood involved but they are very graphic. When I had my surgeries only intraoral videos were available, but since then external (cervical approach) videos have been added.


Im not sure Im quite ready for that just yet, but will when Im ready. Thank you for the suggestion!


You can also choose not to watch them @LoriBD. There is no shame in that. :blush:

1 Like

Thank you for this information and I’m glad your wife has someone to count on. I live in in a rural city in Deep South Texas so I made my Appointment with this exact Dr so thank you so very much. I have been having issues for about 5 years and they finally diagnosed me after seeing it on imaging. I have it on both sides and the pain has been unbearable and also having 24 other health issues doesn’t help at all so I’m trying to hold it together until my appointment in February 15th. I have been sick since I was about 20 when I was diagnosed with bone cancer in my lower spine and right hip but I have been in remission after chemo and radiation. I do have a question though? I have been having issues with my teeth and I have had to remove half of my teeth and I’m having the same issues again so does anyone know if it affects teeth?

Emily, I don’t know if ES can affect teeth, although there are some relatively rare cases where the facial and mandibular pain have been interpreted as being dental in origin, sometimes culminating in the removal of healthy molars. Here’s one article from 25 years ago that describes this situation. I think it’s quite rare, though.
I’m curious what the issue is with your teeth - why they were removed, what’s happening now, etc. if it’s not too personal, I don’t want to intrude.
As far as your appointment in February, you probably need to settle in for the long haul. If you see him in February, your actual surgery date will probably be in April or May. He’s just that booked, even though he goes full blast in the surgery room, sometimes operating until 1:00 or 2:00 a.m.

1 Like

@Larisam, actually not that rare! I got diagnosed initially after toothache, which never went away, & then a salivary gland stone, the imaging showed the elongated SPs…we have had quite a few members who’ve had unnecessary dental treatment for toothache, when it turns out either the Trigeminal nerve or the Facial nerve has likely been causing the pain…so worth considering before you have any more teeth removed @Emily ! So pleased that you’ve got an appt with Dr Hales & hope that the time goes quickly for you…if you can travel at short notice you could ask to be put on the cancellation list?

1 Like

@Larisam & @Emily,

The image below shows the course of the trigeminal nerve & thus the reason so many people w/ ES experience pain in their teeth. The trigeminal nerve is one of the cranial nerves most often affected by ES.

1 Like

That explains a lot thank you

1 Like