Pseudo-Stylohyoid Syndrome?

Hi ES Warriors! Has anyone been dx’ed with pseudo-stylohyoid syndrome? I came across this dx in my endless internet search for answers. Apparently it exhibits the same symptoms as ES, but without the elongated styloid process or ossified stylohyoid ligament. It’s attributed to tendinitis.


Haven’t heard of this, but it makes sense that it exists. Seems like an odd place for tendinitis but inflammation can occur anywhere in the body in response to stress/injury & will create symptoms of some sort!

Here’s an excerpt from the article I found:

“Pseudostylohyoid syndrome is reserved for patients older than 40 who have no history of trauma and no radiographic or clinical evidence of stylohyoid chain ossi­fication. These patients have symptoms identical to those of stylohyoid syndrome patients but do not have radiographic or clinical findings of ossification within the ligament. It is proposed that these people have tendonitis at the junction of the sty­lohyoid ligament and the lesser horn of the hyoid bone resulting from the degen­erative and inflammatory changes in the tendinous portions of the stylohyoid in­sertion.”

It’s a 2008 publication, so relatively current-if a ten year old reference can be considered current.

I found it here:■■■■;year=2008;volume=20;issue=1;spage=1;epage=5;aulast=Arora

Interesting! Do they mention treatment? Presumably steroids might help?

Hi Chrissy,
Before ES is ruled out for certain, I’m wondering if you’ve seen any pictures of your styloid processes? You’ve been on this forum long enough to be well informed, but I’m curious as to whether anyone has checked to see if your styloid(s) are extra thick, very angled, pointy, twisted or broken? All of these can factor in to ES symptoms even when the styloids are normal length. I’d hate for you to be treated for something else if your styloids are still the culprit. Just a thought.

Isaiah, that’s been the challenge. I’ve seen four ENTs (and had many tests) and none of them think I have ES. They’ve looked at my CTs, too. When I look at them, there appears to be “nodules” - the only way I can describe it - along the right stylohyoid ligament (symptomatic side), but the doctors seem unimpressed by that.

Jules, as for the pseudo-stylohyoid syndrome, I’ve only recently come across it in the literature. It’s only mentioned in passing in these articles because the authors spend more time talking about ES, which makes sense. I’ve never come across a discussion of treatment in any of these articles. I assume that some sort of injection might be the appropriate treatment for it, but who knows?

The most recent development in my treatment of whatever this is is to take nortryptaline for the nerve pain. I’ve been on it for about 4 months at the lowest dose (10mg) and it seems to be working adequately. There are symptoms that aren’t touched though – globus, some facial and ear pain. It’s been sufficient in attenuating the glossopharyngeal nerve pain (note: I haven’t been dx’ed with glossopharyngeal neuralgia, it’s just the thing that best fits the nerve pain I experience).

As always, I’m so grateful for such a supportive community. You’re the only people who understand what I’m going through. Thanks for all your support!

Glad that you’re having some help for the nerve pain. So frustrating for you to not be able to get diagnosed. Would you be able to get a steroid/ lidocaine injection into the area, which might show if it is ES, or tendinitis, or have you already had that done?

Hi Chrissy,

The “nodules” you’re seeing on your ligament could possibly be calcifications. My styloids were long but my ligaments were also partially calcified. They looked like dashed lines on my CT scan. Since our bodies are differently “creative” it could be possible that your calcifications look like nodules instead of dashed lines like mine. Any calcification on your ligament could cause it to be less flexible & thus symptomatic. If your CT scan is pretty current, you could always send it to Dr. Samji for a 5th opinion since he’s an ES aficionado at this point. He would charge you a fee for his opinion, but it’s possible your insurance might pay for a phone consult w/ him.

His contact info is via his medical assistant Kim - kimberly @ caminoent . com (exclude spaces if you email her. It’s how we have to put in emails & phone numbers to get them past the software blocking on this site).


Yes! Dashed lines! They look like little rice kernels. Unfortunately, my CT scans are about 4 years old by now. I’m reluctant to ask for another. My GP has been so patient with me, but has come to the conclusion that there’s nothing structurally wrong and no pathology. I think she’d say no to another CT. I had an MRI about a year ago, but as we all know, those aren’t the best scans for ES.

My questions about the pseudo-stylohyoid syndrome come out of desperation for a dx. I’m stumped at this point and really don’t know what the next step should be. My pain is fairly well managed on the Nortriptyline so I’m not trying especially hard to confirm a dx, just making plans for what to do once the effectiveness of the meds wears off.

Thanks again for your support!