Today I went for a surgical evaluation with Dr. Teresa Chan (ENT) at UT Southwestern in Dallas. I had waited almost five months for the appointment. I had shared my CTs ahead of time with her. She asked me why I was there. I told her I’d been diagnosed with Eagle Syndrome and elongated styloids by Mayo Clinic in 2013. But at the time they discovered it I had already been there 10 days for several issues and was discharged from OP evaluation when the results came in, so they just told me to follow up with doctors closer to home to decide about surgery if it correlated with the symptoms. I checked with two doctors in Austin and they both felt it was risky to do and not a good percentage of success rate (they said about 50%). So I lived with the symptoms from then until now.
I had a recent CT/CTA for other issues and you all helped me create 3D rendering and suggested it looked like not only elongated styloids but also angled at such a position to risk compression with the carotids. Right styloid: ~2.77 cm, angled medially; contacts the internal carotid artery (ICA). Left styloid: ~3.50 cm, elongated; contacts the external carotid artery (ECA). Both styloids show angulation bringing them into contact with carotid vessels.Also a C1-might have had issues with jugular veins. I showed it to my PCP and he agreed with your assessment and said he’d had another Eagle patient who he sent for surgery.
Dr. Chan asked me my symptoms, and I told her some of them (I had sent ahead a more thorough assessment, but unsure if she read it). She explained that some of my other conditions could also explain those symptoms. She palpated my tonsil bed and around my neck and asked if I had pain. I didn’t at the time. I told her it’s more when I turn my neck a certain ways.
She asked what my tests showed. I explained that the reports didn’t not mention the styloids this time like they did at Mayo, but that wasn’t the reason the scans had been ordered.
She pulled up the CT and showed me how she followed the styloid through the various planes or cuts of the scan, and did not see any compression issues. I asked her to look at the 3D views that were created for me because those seemed to show elongation and compression. She couldn’t find them at first, but then she did and she said you all did a great job recreating the 3D renderings! But she said “proximity doesn’t equal compression and elongation doesn’t equal symptoms.” She said she hoped I found the cause of my symptoms but she did not blame them on Eagle Syndrome.
She thought my diagnosis of Sjogren’s caused a lot of my symptoms. She said, she didn’t recommend borrowing trouble to chase a diagnosis of Eagles and have unnecessary surgery. She didn’t order any of the tests I had asked about such as high resolution CT/CTA (0.5 mm slices, skull base to hyoid) or dynamic Doppler or transcranial Doppler with head rotation.
They said to allow an hour for the appointment, but she was with me 10 minutes. On one hand, I’m relieved that I’m not a candidate for surgery, because I’d been really concerned about some of my surgical risk factors that we would have had to sort through and get clearance. But on the other hand, I wonder if I’m as safe as she says I am at not having vascular risk, since she’s an ENT and not a vascular surgeon. She said she only performs styloidectomies on those who clearly need it and she just doesn’t see it in my case.
She was very personable. And despite the short visit, seemed like she had thought through it before I got there. I’m just trying to decide if this gave me the peace of mind I was looking for or if it left me with more questions. I had spent so much time preparing information and questions if we moved from asking if surgery was recommended, to planning what I thought was inevitable, to being wished well and scooted out the door.
She hasn’t loaded her office visit report, so I don’t have that to read yet.
