I’ve recently started the process of trying to determine whether I have Eagle Syndrome and was wondering if members of the community with more experience wouldn’t mind taking a look at some screenshots of my recent CBCT imaging.
I’ll provide my own newbie interpretation first so there’s a jumping off/discussion point.
1. It looks like my styloid processes are technically of normal length - the right one being the longest at 30mm (a fraction of a mm over depending on measurement error) and the left one is about 25mm:
2. I’m unsure whether there is calcification lower down near the hyoid bone. There are two little ridges that appear hyperintense, but I think these are just the lesser horns of the bone. I’m leaning towards this segment not being calcified stylohyoid ligament:
3. Lastly, and here’s what I think may explain my symptoms - my styloids look to be incredibly close to the transverse processes of my C1 vertebrae. It appears that the right styloid might actually be in direct contact with the transverse process and the left one is still very close:
Would you fine folks mind commenting on my image? Perhaps you have a different/better interpretation having spent time looking at your own images!
My symptoms are facial neuralgia that is consistent with the trigeminal and glossopharyngeal nerves, sensation of foreign body in my throat on the left side while swallowing, bilateral tinnitus with R>L, ear pain, dizziness, headache, nausea, air hunger, eye pressure/pain, visual disturbances (flashes and floaters). The autonomic symptoms get worse when I’ve been looking down for a period of time, when I rotate my head left or right and maintain the position, and when I retract my neck.
I’m sorry for the symptoms you have & how uncomfortable they’re making you. You’ve posted some good screen shots that definitely show cause for the symptoms you have.
I believe your styloids are longer than you’ve measured them to be. We find this is common because CT scans don’t provide perfectly accurate images so styloids often measure shorter than they truly are. They’re also a little on the thick side up close to the skull base. I agree that the lesser horns of your hyoid look pretty normal but need to add that the width of the greater horns appears wider than normal in the transverse plane image (top left in second set of pics).
Many of your symptoms do suggest IJV compression, & with your right styloid being right on top of your right C1 transverse process, you’re certain to have IJV & vagus nerve compression on the right. The space between your left styloid & TP of C1 is also very narrow so it’s likely you have compression of both the IJV & vagus on the left as well.
Nausea, & possibly air hunger, are likely coming from your vagus nerve being compromised. The nerve pain symptoms are more related to styloid elongation (nerve pain in your face & foreign body sensation in your throat). The remaining symptoms have a vascular basis.
The doctors closest to you who’ll be able to best help you are Dr. Costantino in White Plains, NY or Dr. Liu in Livingston, NJ.
Thank you so much for taking the time to review and comment! I appreciate you.
Out of curiosity, how did you learn that CT’s can lead to undermeasurement of styloid length? Have you heard from users who had a styloidectomy with the extracted styloid measuring more than the CT suggested?
It sounds like we’re in agreement on the styloids sitting close the C1. Thank you for sending back that labeled screenshot - it will be very helpful when I schedule with one of the specialists you linked.
Frequently our members have learned post op from their surgeons that their styloids were longer than measured via CT image. There are tiny spaces between each CT image & when a 3D model is made from them, those spaces are lost thus are not accounted for making the styloid measurements short of reality.
You’re most welcome! I’m glad you’re planning to expedite your care by seeing someone we feel confident can help you!
I’m not able to label the images for you, but I do think your styloids are longer than average, yours are down to the C1 process, so the styloids shouldn’t usually be that long imo… I agree that your styloids are really close to the C1 process, and given the tinnitus, dizziness and the visual disturbances you could possibly have IJV compression- have you had a look at the Newbies Guide Section about common symptoms, there might be others you’ve not realised were ES?
Your hyoid looks a little off centre:
Your hyoid bone does look quite chunky, the lesser horns are supposed to be small but yours do look like they have quite a sharp point to them, and from what I can see, the same on the greater horn which is visible too.
I do think that given your symptoms and the calcifications you have, that it does sound like ES and is worth pursuing a diagnosis, and the doctors that @Isaiah_40_31 has suggested would be a good idea .
Thanks so much for taking the time to comment on my images - I would’ve totally glossed over your observations about my hyoid bone if I were just doing this alone, so I appreciate your attention to detail. It’ll be another thing I can ask the specialists when I make my appointments.
I’ll have a look at the page you’ve referenced in your message. I’m sure there are symptoms that I haven’t even realized are eagle-related.
