Possible Diagnosis/Lidocaine Injections

Hey guys!
So after explaining that I thought I might have ES to an area ENT, I got a call from him the next day saying the radiologist had reexamined my CT. Apparently my styloid on the right side is 3.5cm. Didn’t say anything about ligament calcification, but I was so happy he listened to me that I didn’t ask.

So he’s referring me to the only surgeon in my area who does ES surgeries to take another look and see if surgery is an option for me. One thing he suggested is doing a lidocaine injection- he says if this eliminates the pain that is suggestive that surgery would be successful. Anyone have experience with these? Is it important that i get them done with someone who’s super familiar with ES, or can I have this ENT do the first one? Have they been successful for you? I know they’re not a cure or even really a long term solution, just curious about what to expect.

Thanks in advance!

I benenfited some from the lidocaine injections and got injections in the back of my head to block migraines. It did work ,but had to keep going back. I had surgery on the right side for ES , but was told it did not work. It did work somewhat because I could not turn my head to the right without everything going black. Everybody is different I had a Dr. Who did many of these surgeries. I would get a second opinion as well . Hope that helps.

Interesting. I’m curious to see if they’ll help with my voice changes- I’m guessing no they’ll just help with pain. Sounds like they’re going to try to get me in tomorrow morning though, so I guess we’ll see! Maybe if the injections help with the pain my muscles will be able to go back to normal and my voice will resolve too.

Hi kittchenita,

The general opinion regarding lidocaine/cortisone shots is that, yes, they can help diagnose & temporarily stop some local ES symptoms, but there are others they won’t touch. The lidocaine masks/numbs the pain temporarily (from a few minutes to several weeks &, in rare cases, longer) while cortisone injections help by reducing inflammation in the area (also for the same time range). It’s unlikely you’ll get a vocal improvement from a lidocaine shot (sorry to be a naysayer), but if you do, that’s an added bonus!! The nerves that affect the vocal cords are among those irritated by elongated styloids & calcified s-h ligaments, & until the source of irritation is removed, you’re likely to find your voice is problematic.

When you see the ES surgeon, please be proactive & point out your potentially calcified s-h ligament in addition to the elongated styloid, & let him know you’d like both the ligament & the styloid process removed from the hyoid bone to the skull base. That is the most sure-fire way to insure that they won’t be able to create issues for you in the future.

Not many current members responding with info for you- you could search the past discussions using the magnifying glass icon as the injections have been mentioned quite a bit.
I’ve not had them done personally so can only comment from what I’ve read of others’ experiences…some members have found them very successful & have managed for quite a while, others less so. I think one member was alot worse off afterwards, maybe that was done by someone with no experience, I don’t know. Some members have had the injections with an ultrasound, so the needle is guided to the right place. You could ask your doctor about this. Hope it helps!

I was curious as to what kind of voice issues you’ve been experiencing.


So I got the lidocaine shot yesterday. Good news- it worked! I felt so much better last night and much of today. Doctor says it shouldn’t last very long though.

As far as voice changes go- I’ve felt like my voice is more muffled and gravely. I’m a singer, and I struggle with dynamic changes and switching between upper and lower register way more than I used to. There’s also pain associated with it, which I’m sure causes muscle tension and a nasty feedback cycle.

Enjoy the next few pain-free days, (or however long it lasts!) glad that it went well, & confirms the ES diagnosis!

I’m curious how soon the injections helped. Was it immediate or did it take a few hours to kick in? I’ve scheduled to have left side done next week and the right side the week after.

Hi LoriNola,

So glad you found a surgeon you feel is competent to do your surgeries. Just a thought - the more experienced ES surgeons prefer to put at least a 3 month space between surgeries so the first surgery can be mostly healed before a person has to deal w/ the second surgery. ES surgery is a major surgery & recovery is generally a bit uncomfy for at least the first 2 weeks because there is a lot of throat, & w/ external surgery, neck inflammation. You might consider waiting a bit for your second surgery. Nerve recovery from ES surgery can take up to a year.

Is your surgeon doing intraoral or external surgery? If your styloids are each 6 cm, they’re very long. External surgery would allow the surgeon to remove the full length of the elongated styloids & the stylohyoid ligaments while monitoring nerves & vascular tissues to help prevent damage to those. Full removal of styloid & ligament helps prevent any recurrence of symptoms later. The intraoral approach doesn’t provide the visual advantage for nerves/vascular tissues & will only allow for the styloid to be shortened not removed & doesn’t offer the best access for ligament removal.

Hopefully you know all this & are satisfied w/ the approach & surgical strategy your surgeon is planning to use.

Thanks for the info about surgeries. Right now I’m just getting lidocaine-type injections done to see if/how much it helps. I’m wondering if when I get the injection it will be immediate relief or if it takes hours or days to kick in. I’m meeting the doctor on Wednesday and injection for right side is scheduled for Friday.

Usually the lidocaine injection works quickly, as some doctors use it to diagnose ES- if it works they think ES is confirmed. If steroids are used I would think that might take a little longer.
Let us know how you get on!

So I’ve had the steroid/lidocaine injection about a week ago. The lidocaine only lasted about 2hours at the most, but it did help. It wasn’t any miracle shot, but I did feel like the pain that I feel in my face, top of head, and even the back of my neck on that side was better. Once the lidocaine wore off it was worse pain than usual in that spot because the steroid was in such a small area and it takes a few days to dissipate. It was level 8-9 eating or yawning for the rest of the day, but the next morning it was just super tender to the touch. Today (6 days after) is the first day it isn’t more tender than usual in that spot and I think the steroid may be helping a little because it’s not as tender as usual. All the other pain to face and neck are back to usual.

Oh, I should say that they did the glossopharyngeal (by ear/jaw) and not the stellate ganglion (by voice box) block. I am going back to have the right side done in 2 weeks. I wish they would block both the glossopharyngeal and stellate together, but for diagnostic purposes they only want to do one at a time and feel like the glosso will radiate down to stellate area and give the answer I’m looking for.

I’ll keep y’all posted and I hope my description helps anyone else who is thinking about getting the injections.

Hi LoriNola,

Thank you for this great information. Glad this seems to be working as a diagnostic tool for you. I’ve forgotten, are you having vocal loss as an ES symptom? Please do let us know what kind of results you get with the second injection. Some pain relief is certainly better than none!

I only have vocal symptoms occasionally. And its mostly like a hoarse throat when I get it. Mine is more pain in the ears, face and top of head. I also have issues with the cervical spine and pinched nerves/scar tissue, etc. I’m trying to figure out how much of the symptoms are from the ES and if it’s worth the risk of surgery.
I did have about a 3 week period last fall that was pretty excruciating where I thought I may have even broken the ES on the left side, but x-rays didn’t show anything broken. I swear I heard it crack though lol!

Just a couple days ago I rolled over from right to left and a felt a very big “pop” on my left side - that is my one remaining calcified ligament. My immediate thought was it got hung up on something and kid of snagged - it didn’t feel pleasant at all whatsoever. I hope it doesn’t happen again. But hopefully in a few months it will be gone if that is in fact what it was.

Hi LoriNola,

People have actually broken elongated styloids by laughing too hard or coughing (besides head/neck injuries). Glad your scan showed it’s still intact. Unfortunately, until you have the styloid(s) &/or ligament(s) removed, there’s no way to fully tell which symptoms they’re causing. The steroid/lidocaine injections won’t take care of all the symptoms but enough of the localized ones to give you a clue of at least part of what’s being affected.

Thanks for the info y’all!

So I’ve had injections on both sides now and it helped on the left and not on the right. I’d like to just get the surgery, but the doctor is recommending burning the nerve first and see how that goes.

I’m also going to ask about getting another injection lower down the neck where I can feel the end of it poking into my throat and see if that helps at all.

Anyone else experience similar? I do find lidocaine gel works pretty good on the back of my neck, but not on the front.

Before you burn the nerve, do some checking on how long it will last and how many times it can be done. If I remember correctly, it is a bandaid that procrastinates surgery.