Did you ever find out more about Dr. Eric Monteiro | Sinai Health Toronto - especially as to his Eagle Syndrome experience. I am still searching for a competent elongated styloid specialist in the Toronto, Canada area. We have over 10 million people living in these parts an apparently not a single ES specialist! Pretty disheartening when you are desperate for treatment!
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The doctors on our Doctors List who are in ON are
â˘Dr Eric Monteiro, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto 416-586- 4800 (possibly treat ES, he has done a surgery with Dr Ian Witterick, who no longer does ES surgery.) Otolaryngology Care Team | Sinai Health
â˘Dr Michael Gupta, Hamilton, ON. https://surgery.mcmaster.ca/bio/michael-gupta
â˘Dr. Hodaie, via St. Michaelâs or Toronto Western ENT departments/clinics, Mojgan Hodaie | Department of Surgery
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Itâs unbelievable I know, it seems to be similar in Australia & New Zealand too, a few specialists in the UK, but extremely hard to actually get any treatment here too, so sadly youâre not alone @ESnerves2025 
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Hi there. Did you have surgery with Samji?
Seems he does deal as much with the vascular issuesâŚi.e. carotid artery.
Was it successful?
@Bmmac Unless he changed his position since I consulted with him a couple of years ago, Dr. Samji does not believe that venous compression is the cause of the symptoms people come to him with. He does styloidectomies (and has done many of them) but does not do C1 resections.
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I am assuming he does believe styloids can impact the IJV especially if C1 is impacting IJV.
Personally shaving C1 does not sound like a good idea. Dr. Centeno Denver would say need to tighen the alar and transvers ligaments to get C1 back in placeâŚ
Unfortunately the carotid can get trapped in there as well. What am I missing?
From what others have said, Dr Samji removes the styloids to skull base, but doesnât look into any vascular ES issues. Some of our members have had what appears to be extra long C1 processes, which are compressing the IJV, so thatâs why theyâve opted for shaves, itâs not always because the C1 is out of alignment. The IJV and ICA are next to each other so potentially could both be compressed, but we do seem to see more members with symptomatic IJV compression.
If youâre looking for a surgeon experienced with VES on the west coast, then Dr Nakaji in AZ might be a better bet than Dr Samji?
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Thank you this is what I thought
Thanks
Jules really interesting piece about the length of C1 rather than misalignment
That being said why does the length become a problem say after an injury?
@Bmmac - I did have successful surgeries w/ Dr. Samji, however, I had a cycling accident between my surgeries. I landed on the right side of my face & my C1 vertebra shifted to the left causing IJV compression. Though I became symptomatic for ES w/ IJV compression, Dr. Samji didnât recognize the symptoms
(nor did I), so he diagnosed me w/ Meniereâs Disease & sent me to one of his associates since his focus is throat & vocal problems. I had my second styloidectomy in 8/15, & Dr. Samji appears to have cut my styloid just short of where it was squashing my left IJV against C1, rather than cutting it above that point so the IJV could have a chance to decompress. It took me 7 years to discover this situation, & 9 years before I was able to have my IJV decompressed by a revision styloidectomy which removed the pressure of my L styloid from my IJV on that side. I saw Dr. Hepworth for the revision surgery in 10/24.
Please donât get me wrong. I appreciate what Dr. Samji did for me but was disappointed to have mostly lost the hearing in my left ear because of a problem (IJV compression) that could have been fixed in 2015, but I did get good recovery from the surgeries he did for me from the nerve pain I suffered as a result of ES.
After an injury like whiplash or the cycling injury I suffered, it is most likely misalignment of C1 that causes it to become a problem, however, that problem isnât necessarily as simple to fix as Dr. Centeno says unless he is proposing to tighten the alar & transverse ligaments via surgery. If by PT, there are Atlas Orthogonal Chiropractors who specifically deal w/ misalignment of the atlas (C1) & who have not been able to cure those who have that problem as C1 tends to move back to its misaligned position even after significant âencouragementâ to reside in proper alignment.
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I donât know that an injury would cause the length to be a problem, itâs just a guess but Iâve always thought that just as styloids can suddenly cause symptoms as people age (maybe because of slight changes in the neck associated with aging alters the angle slightly perhaps, bringing them into contact with nerves), perhaps the same can be said for the C1 processes, if theyâve always been on the larger side ? I had pain from my styloids, but it was only when I developed a prolapsed disc C5-C6 that I started getting vascular symptoms, so I guessed that maybe there was just a very small shift in the neck to cause IJV compression, unless it wasa complete coincidence!
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It would more likely be C1-2 instability
Damage to alar and transverse ligament
I was high speed rear end MVA whiplash
What were you symptoms with Styloids? Did you have it bilateral or just 1 side
I know you addressed your question to @Jules, @Bmmac, but I wanted to say I also had a whiplash injury when I was in college. Same sort of scenario as yours. I think it contributed to me ending up with ES but in my case, IJV compression came later, as previously
mentioned.
Fascinating story. Once your styloid was finally removed your IJV was fine? Samji graduated from UWO here in London Ont 
. I went there too. Not dealing with the vascular issues is such a big part of this. Hepworth has such a good reputationâŚsorry that got side tracked. Got Covid early March. It went straight to my injured neckâŚDr. Steele and other neurologist are seeing nerves being trapped post covid. Often by the lymph nodes. I see Steele in July and he is going to release those. He is a real nerve guyâŚhiding out in the fascia.
Agree Centeno treatment is. innovative but we need glue!!
I have had 1 PICL with him and posteriors. Will likely do another for sure. 3 weeks after I was there he started his new EPICL protocol. Need lots more work on rest of my body. Airbag hit me on left side of body/ headâŚthey yravel at 100 miles/ hr!!
I had lots more injury at C3-7 T4 and lower SI.
I just started seeing Dr. P. Steele in Montana who is treating my other injuries with prolotherapy and PRP
My superspinous ligament at T4 shows tear at that level. My Nuchal raphe higher up has completely moved rightâŚ
I am 73 so question the quality of the stem cells with Centeno I see Dr. Stan Pierce Epic chiropractic in Clearwater re C1-2 alignment. He is good. A form of AO.
Seems my SCM muscle is also trapping my IJV and Carotid further down the neck.
Did styloid removal create more instability for you
Thanks so much . Where do you live?
@Bmmac - It sounds like youâve seen some really great & knowledgeable doctors over the last few years. Youâre getting therapies that there hasnât been much discussion about here in part because it seems not many doctors do the treatments youâve had or are planning to have. Iâm glad youâre getting some symptoms relief from them.
I actually got COVID for the first time 3 weeks before my IJV decompression surgery. I mostly just had a bad cough, some back pain, was tired & lost taste & smell. It didnât really affect my neck. Curious how differently that virus affects each of us.
I was fortunate in that Dr. Hepworth didnât need to shave C1 for me. He did a revision surgery on my left styloid, cutting it shorter than it was which eased up facial pain that had come back & made more room for my IJV, but he still had to move it a bit away from C1 so it could open all the way. I felt a difference in the first week after surgery w/ the IJV being more open, but overall, my symptoms werenât nearly as bad as those of others so I didnât expect a dramatic outcome. My greatest hope was that some of my left earâs lost hearing would be restored, but sadly it has not been. Iâm blessed to still have a working ear so all is not lost. I have no instability of my cervical spine so IJV decompression surgery really didnât affect me in that way. 
Another âItâs a small worldâ story. 
Camino ENT where Dr. Samji works employs a number of brilliant ENT doctors & surgeons, however, I never saw either Dr. Samji or his associate who treated me for Meniereâs Disease have an interest in expanding their medical knowledge by learning about IJV compression as it relates to ES & potentially Meniereâs. It was disappointing.
Your injuries from your car accident sound much more significant than mine were. I was 21 when I was rear ended on the freeway in So. Cal. There were no airbags in 1979 when that happened to me. I was diagnosed w/ ES at age 57 & had my initial surgeries at age 58. I was 68 when I had my revision surgery & IJV decompression. We arenât too far apart in age.
Weâve had a few members whoâve had some aspect of their IJV compression caused by the SCM so the muscle has had to be de-bulked during the styloidectomy/decompression surgery. Since the IJV & ICA are close together in the neck, Iâm not surprised youâve got some compression of each one by your SCM. With the IJV, usually itâs not the SCM alone causing the compression but a combination of styloid, C1, SCM & possibly other soft tissues such as nerves, vascular, scar, & lymph nodes.
I lived in California from 1963 to earlier this year. Iâm now in South Dakota & LOVING IT!!
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Goodness, you have had rough time with so many injuries! I had a whiplash injury 30 years ago, & have had problems with my neck ever since, I do believe that it caused ES (I have an identical twin who doesnât have ES), that & traction & manipulation treatment I had as the insurance company requested I saw their doctor, which was incredibly painful!
I had nerve pain from ES in my jaw, cheek, teeth, eyebrow & top of the head, which Amitriptyline helped, mainly just my left side. That was bearable so I wasnât worried about surgery, but the vascular symptoms were quite bad (constant off-balance feeling, dizziness, head and ear pressure, sucking/ rolling feelings in my head, brain fog) , the CT showed bilateral IJV compression. I had the left side done first & the vascular symptoms massively improved after surgery, the other side did ramp up more so I had that done a year later.
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Debunking scmâŚwhat next..ugh