Question on CBCT conclusion

My CBCT scan conclusion reads the below:

“ The styloid processes are elongated and extend caudally beyond the transverse processes of the
atlasbilaterally. The right styloid/CI transverse interspace is 'tight. If there is suspicion of venous
outflow insufficiency of the IJV consider rotational CTV”

Question 1: What does being tight mean? With regards to the right styloid/C1 transverse interspace.

Question 2: Tilting my head to the left (e.g when laying down) seems to relieve my symptoms. Is this a normal occurrence for ES where the right side is tight? I mean do people get relief when tilting head to the other side which is less affected?

Questions 3: If both styloid processes are elongated. Why would only the right side be “tight”?


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The styloids can grow at different angles, and do vary in thickness, even between the left & right…obvs from your scan report there isn’t much of a gap between the C1 process and the styloid, so it sounds by your symptoms as if there is compression of the IJV between the 2 structures, that’s why the report says the space is tight…I would guess that your left styloid is growing at a slightly different angle so the gap is bigger between the C1 & styloid as it doesn’t mention any compression. It’s not just the length of the styloid which causes symptoms, but the angle too. If a styloid is very angled it can compress blood vessels and nerves right from where they exit the skull base, or otherwise if it has a kink, from further down. I hope this makes sense?
By tilting your head to the opposite side, it must shift the structures in your neck enough to give a bit more space on the right side, so things feel a bit more comfortable.

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This makes a lot of sense.

So perhaps the left is growing at a different angle that doesn’t really cause much tightness between c1 process and styloid.


Sorry to add a different question.

Does it make sense for ES to cause neck tension?

For example. When sitting upright or tensing the lower pelvis, it seems to cause tension in the neck and trigger symptoms. Feels like there is a connection between my pelvis and my neck.

It’s like a pulling sensation and it eventually causes a dull tension in skull base (subocciput area).

Is this something that can be caused by ES as well? I am struggling to think of how this is a possibility.

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The vagus nerve innervates many organs & functions in our bodies from skull base to pelvis. If your vagus nerve is being impacted by your right styloid, there is a chance that’s why you feel the connection from skull base to pelvis. Neck tension is common w/ ES but is most commonly caused by the spinal accessory nerve.

Here is an image of the vagus nerve that will give you an idea of how extensive it is.

Vagus Nerve Image.docx (81.7 KB)

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Personally, I think that the pain of ES causes all sorts of muscle tensions in the neck & shoulders, causing posture changes which can then affect other back muscles…@TheDude has posted about all the muscles affected and how he’s worked on them post surgery, I’ve had a look but couldn’t find it to share the link I’m afraid. @vdm has also posted similar…


I most often have tinnitus on one side as well, however in my case it is on the opposite side of my IJV compression,
it does change and a lot of times in the day and it is felt or heard on both my ears. I personally have not found that head turning relieved my tinnitus. And I can’t remember if I have ever heard it on the tight side only ,
A lot of times my tinnitus was made worse as well as increased head pain and pressure,with sitting at the computer longer than ten minutes,most likely brought on by poor posture and increased forward head position, For me this onset has not gone away very easy and I would have to lie down and try to sleep to feel relief from the flare up. This has led me to have very short sessions at the computer and pay more attention to posture as much as I can.
I also have quit a bit of neck tension and tight muscles on the left ( my tight side) and alot of pain on the right side, exatly at the base of skull on the right
Head bending to the right is limited and bending to the left feels hyper mobile , cracks and pops,and increases occipital pain on the right
I think your symptom relief is a good sign that your moving in the right direction
Did your AO doc provide a x ray work up of the vertebrae?

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Yes he also did a CBCT which surprisingly is what found my elongated styloid (other specialists didn’t find this).

You basically just described what i face and how i feel. I always have to lay down for a while to get relief from those symptoms (sitting is so hard for me and i do a desk job).

I still don’t understand why eagles should make muscles that tensed; I actually don’t have pain from eagles, just tinnitus and nerve disturbance (gastroparesis, anxiety, sleep issues etc).

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@Lababila - Neck tension may be the result of military neck/poor posture, & one cause of ES is suspected to be long term poor posture/forward head posture/military neck. Your head weighs about 10 lbs., & when it sits forward of your shoulders rather than more or less centered above them, it puts a lot of stress on the cervical spine & neck muscles which causes the muscles to tense & which sends a message to the brain that the neck needs “help”. The help that is sent is calcification of the stylohyoid ligaments/elongation of the styloid processes to try to strengthen/stabilize the neck. Of course, we know this isn’t helpful at all, but it’s what the brain sees as a fix for a neck that is overtaxed due to poor posture or other injury.

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