Segmented styloids? How to find that? Anyone tried Amitriptyline for pain?

[Newuserhere]

Hi,
I don’t want to create 2 posts for my questions and added both the question in this post.

I have been dealing with constant lower jaw pain under the ear and neck for 11 months now. I have some lump spots in the neck and under ear which didn’t show up in the neck ultrasound and CT scan.

I don’t have any definite diagnosis yet. OMFS and ENT said it’s muscular and asked me.to do physical therapy.
I don’t have any diagnosis for eagles syndrome. I sent my reports and disc to Dr. Samji office. He dismissed my case as I am not meeting his criteria for his patient. I couldn’t find any other eagles provider yet for my diagnosis.

Meanwhile, I contacted my PCP to prescribe me something for my pain. She has put me in carbamazepine and Cymbalta before. I tried both for few weeks and didn’t help at all with my pain.
So, she put me in amitriptyline 25mg to try with. Pcp wanted me to try that for few days and see if it helps with my pain.

Anyone tried Amitriptyline and did it help with your pain? How long did you take to see relief?
I am on it for a week now and yet to see changes in my pain. It just makes me so drowsy and makes me sleep through the night which is a plus for me. I always wake up twice or thrice at night with pain. With amitriptyline , I just wake up early morning with pain. I wake up only with pain pushing me under the ear and the neck /throat. Kind of poking through something in the throat and wakes me up.

I am currently doing Physical therapy with trigger point dry needling. I started it last week and had one session of needle on the Scm so far. It gives electric shock or twitches on the ear and lower jaw area. PT wanted to dry needle all the surrounding muscles around my tmj. I have been told I have Myofascial pain dysfunction syndrome.

And coming to the second question,
Do anyone have segmented styloids? My cbct report of tmj shows my styloids as segmented. My CT neck scan report didn’t mention as segmented styloids. But the report shows values like segmented or into 2 parts.
I did ask Dr. Samji office about this and I got the response as, he doesn’t work on segmented styloids and doesn’t have anything to say about it.

I don’t know if my styloids are segmented and if I have eagles or not. Yet to get the definite diagnosis.

Adding the report here:
Addendum:

Right styloid process: Not elongated, measuring about 0.3 cm.
Right stylohyoid ligament: Calcified distal portion, which measures
about 0.8 cm. This is located about 2.1 cm from the tip of the right
styloid process.

Left styloid process/stylohyoid ligament: Borderline top normal size of
the left stylohyoid ligament, which is in continuation with the
elongated left styloid process, measuring about 2.4 cm combined. One
cannot differentiate between what is considered the left styloid process
and a calcified stylohyoid ligament in this case. In regards to Eagles
Syndrome, an elongated styloid process or a calcified stylohyoid
ligament can both result in pain. Eagles Syndrome is ultimately a
clinical diagnosis.

Two BB markers were place in the region of focal pain in the right face
and right neck. There is no focal abnormality underlying these BB
markers.

12/28/2020 3:43 PM PXRRR02R

Addendum: The left stylohyoid ligament is calcified and measures 2.4 cm,
which is borderline top normal. This is in continuation of the left
styloid process, which essentially can be considered elongated.

12/24/2020 4:26 PM RAADOCS006

Addendum: The right styloid process is not elongated. The calcified
distal portion of the right stylohyoid ligament measures 0.8 cm and is
located about 2.1 cm from the tip of the right styloid process.

12/24/2020 3:47 PM PXRRR14R

Addendum:
Additional clinical indication: Evaluation for Eagle’s syndrome.

The left stylohyoid ligament is calcified and measures 2.4 cm, which is
borderline top normal. The right stylohyoid ligament is mildly calcified
along the distal aspect on series 4, images 34-35.

Narrative
CT SOFT TISSUE NECK W CONTRAST

TECHNIQUE: CT images of the neck were obtained with intravenous
contrast. Isovue-370 was injected without complications. Dose reduction
techniques were utilized for this examination. DICOM format image data
is available to non-affiliated external healthcare facilities or
entities on a secure, media-free, reciprocally searchable basis with
patient authorization for at least a 12-month period after the study.

CLINICAL INDICATION: Lymphadenopathy, neck;Localized enlarged lymph
nodes;Cervicalgia.

COMPARISON: Neck ultrasound August 28, 2020.

FINDINGS:
Aerodigestive Structures: The nasal cavity, nasopharynx, oral cavity,
oropharynx, hypopharynx, larynx, and included trachea and esophagus
demonstrate no masses or abnormal enhancement.

Lymph Nodes: No pathologically enlarged, necrotic, or otherwise abnormal
lymph nodes.

Vasculature: Normal.

Salivary Glands: Normal parotid and submandibular glands.

Thyroid: Normal.

Visualized Intracranial Structures: Normal.

Included Orbits: Normal.

Paranasal Sinuses/Mastoids: Predominantly clear.

Included Lung Apices: Normal.

Bones/Soft Tissues: No aggressive osseous lesion. No acute soft tissue
abnormality.

Any thoughts anyone. Really appreciate it.

[vdm]

Just a thought, if you have a chance, get the whole spine checked from pelvis up to the skull base. Xrays, mri or actually anything that shows vertebraes, alignment, disks etc. As you have the “military neck”, there might be some other nuances with your spine that simply became more intense as the time goes, and now are amplifying your neck pain. Also, I can’t remember if I have seen it mentioned, but do you do any sports/exercise for your spine and in general, besides physiotherapy? It, or lack of it, might be another factor for increased pain too…
Definitely I’m not saying thst Eagle’s should be discounted, but on myself I noticed that symptoms started to get worse after I became less physically active at some point.

[Jules]

My understanding of ES is that the styloid processes can calcify & elongate in different ways, one of those is that it becomes ‘jointed’, so looks a bit like the bones of the finger, or that the stylo-hyoid ligament becomes calcified in sections. It really doesn’t matter; however it’s calcified can cause symptoms.
As for the Amitriptyline, it helped me, pretty quickly, , but it’s worth persevering with another week or so. you could increase the dose a little bit more maybe, if your doctor says that’s okay? I’ve taken 30mg when my pain was worse.

[Newuserhere]

Thanks for this thought @vdm.
I will get it checked.
I don’t do any kind of sports or exercise. I was doing some everyday workout earlier.but totally out of it since this started. Before this, I got my knee pain which came all of a sudden and kneecap moved. Had to do PT for it for a long time and stopped last March since covid started.
The reason for that knee subluxation is given as tight quad muscles and inflammation.
It took a very long time and I am still not relieved from it yet.
For this jaw and neck pain, I have been told it’s Myofascial pain dysfunction. I am also thinking about going to a rheumatologist or pain medicine doctor to check about fibromyalgia and to check trigger points.

[Newuserhere]

Thanks @Jules.
Your points of segmented really makes sense. I am not sure If mine is really segmented or the images/angle shows like that.
I am on amitriptyline 25mg and my PCP wanted to try this for few weeks. I am on this for a month. If it doesn’t make any changes, I will get back to my PCP to increase the dose or to change to lyrica.

[Newuserhere]

Just got a question about swallowing.
Is swallowing difficulty normal? I never had any issues with swallowing. All the time apart from meal time, I feel something in the throat and feels stuck in there and tight. I was able to swallow.
since last 2 days, I felt some discomfort for swallowing. It’s feel like passing through something in the throat to swallow. It’s in the middle and base of throat right side. Not sure if it’s because of Scm muscle.
I had my manual therapy on Monday. My pt did manual therapy on Scm. It was super pressure and kind of hard. He said my Scm is tight and need more pressure manual therapy there. He did massage in Scm and upper trap a lot.
I was fine Monday. He told me to squeeze and massage the scm on my own at home to get rid of those knots and to relax the muscle.
I tried to self massage the Scm before and I couldn’t get hold of it.
I tried yesterday and I was able to hold and squeeze the base of the Scm. I couldn’t hold the top of Scm behind the ear. I massaged and rubbed the middle and end of Scm. I am not sure if I did it more or in a wrong way.
Today I feel very much sore and burning , achy in the throat and neck. Scm muscle.

I couldn’t swallow today’s lunch and dinner. I felt like something stopping in the middle of throat while swallowing.
I see some reddish spots at the base of throat or Scm. May be because of rubbing.
This swallowing difficulty is new and since yesterday.

I was so nervous about it today and tried to reach out to few ENT clinic and couldn’t get a schedule. Might get one for this week tomorrow. I am going to ask the new ent about eagles syndrome diagnosis as well. I have seen an ent before and he dismissed that I don’t have ES. I didn’t see anyone else since this pain started. Been to only one ENT.

I am not sure if this discomfort and sore spin inn throat because of my Scm muscle or any symptoms of ES. .

It’s kind of burning and sore inside the throat and I feel something hurting like poking through while swallowing. Not sure if it’s the muscle tightness from the Scm. My pt did say that my Scm muscle is super tight and hard. He did dry needling on it last week. On the mid and top of Scm.
This week did one session of manual therapy on the Scm. Kind of more pressure manual therapy.
Hope this makes sense. Any thoughts?

Pain in this area. Marked as circle.
Constantly feel like something in there and poking through. Not sure if this area refers to styloids or stylohyoid ligaments. Is it ?

[beachlady]

I was diagnosed Friday with ES. My symptoms are burning in throat (for 14 months) and feeling like there is something stuck in my throat or a lump there. When I lay with my head propped up to watch TV and I swallow my throat pops and clicks. My ENT had a CT scan with contrast done on me and the Radiologist found the elongated styloid/calcified ligament issue and diagnosed me with Eagle Syndrome. I am at the very beginning of this new issue and I was originally diagnosed with acid reflux but never had any heartburn and PPIs did not work at all. I hope you are able to get some relief soon.

[Newuserhere]

Hi,
I am glad in a way that you got the diagnosis and definite reason for your pain after 14 months.
Whom did you see for the diagnosis? What’s the name of the eagles provider?
Where are you located? What’s the treatment suggested to you?
Hope you feel better soon. Good luck.

[beachlady]

Hi,
I am in FL near Clearwater. I saw Dr. Jonathan Morgan at ENT Associates in Largo, FL which is about 10 min from Clearwater. I had my CT scan done through Bay Care in Largo also at Bardmoor and their Radiologist found the Eagles. I have both elongated styloid and calcified ligament. Dr. Morgan doesn’t do Eagle surgery. There are a few in FL that do though from what I’ve been told by the Living With Eagle site moderator Isaiah. These doctors are listed on the doctor list on the site. Dr. Rui Fernandes is one and Dr. Anthony Bunnell is another. I read Dr. Scott Magnuson May do the surgery as well and he is in Celebration, FL. I’m not a medical doctor so these aren’t recommendations but just what I’ve read from the moderator of the Eagle site. Let me know how you progress with your diagnoses and if you can get another CT Scan at another place. Maybe Emory? I grew up in GA so I know Metro Atlanta pretty well. Good luck to you!!

[Newuserhere]

Thank you for the response.
I didn’t see anyone in emory. No good ENT recommdations in Emory. I had my ct scan with contrast in Piedmont. I had in December’20. I don’t think I will need another scan so soon. I will check with an ENT if they need a new one.
Why do you say to get another CT scan. I have seen few members suggesting that. I am wondering why do we need a new one ? Please let me know.
I assumed myself that the previous ct scan which is taken 3 months back will work for me. Any thoughts anyone?

[Newuserhere]

@Jules , @Isaiah_40_31
I just have a question for you.
Can we see the ENT plastic surgeon. I have got one ENT nearby and his profile says, ENT and plastic surgeon. He is very experienced doctor though.
I am planning to see him for second opinion as I didn’t see any other ENT since my pain started. Have seen only one ENT since June last year. Met him twice and during my second visit, he told me I don’t have eagles and referred Physical therapy.
Can we see ENT who is plastic surgeon? Any inputs here. I hope he should know about ED and atleast can do a review and do clinical findings. Not sure though. I asked the front staff if he know or treat ES and she is not aware about it. I totally get that because they are not aware of it unless he is into only ES surgeries.

[beachlady]

We’re they able to diagnose you with Eagles from your CT scan? I thought I read that your CT scan did not diagnose you with Eagles. If not, I would get a 2nd CT somewhere else to try to confirm if you have Eagles or not.

For the burning throat, I have had very good luck with the “Oral B Moisturizing Lozenges”. I suck on them when my throat starts to burn and it goes away within a few minutes. You can get them at Walgreens.

[Newuserhere]

Thanks for the suggestion for lozenges.

I had ct scan of neck soft tissue with contrast. My report covers the Eagles statements. But no diagnosis yet. The radiologist mentioned that it should be clinical diagnosis and noted his findings.
My styloids are shorter on my paining side.
I have added my report in this post question. Hope you saw that.

I have seen an ENT here and sent him my report. He said I don’t have eagles. I didn’t see any Eagles specialist ENT yet.
Not sure if my pain and symptoms are from Eagles or something else.

[Jules]

I don’t know obviously, but they may not know about ES, it might be worth ringing ahead to check if they do, as many doctors don’t. And you shouldn’t need another CT scan.

[Isaiah_40_31]

@Newuserhere - If the new ENT is familiar w/ ES, please tell him you do not have elongated styloids but you do have a section of your stylohyoid ligament that is calcified & that is what you believe is causing your problems. We have other members on our forum with a similar situation - short styloids but a piece of calcified ligament that is causing pain in the same area you have pain. In my non-medical opinion, that is what needs to be removed to help in your situation, but you may need to convince the doctor that is the case.

[beachlady]

I saw the report and I am learning and trying to figure this all out as well. It’s very confusing.

Well good luck to you. Let me know how it goes. I also use George’s Distilled Aloe Water from Vitamin Shoppe or Whole Foods for the throat burning as well. 1/4 cup twice a day.

Take care

[Newuserhere]

Thanks. Good luck to you as well.
Yes!! My report is very confusing. I totally agree.
I am still learning to interpret and struggling hard to get a provider for the diagnosis.

[Newuserhere]

Thanks for the response @Isaiah_40_31.
I am not sure if this new ENT is familiar with ES. I asked the front staff and they weren’t aware of it. He is a plastic surgeon ent.
I asked another clinic and they referred Dr. Del Gaudio. But I have got feedback from few members not to go to him for the diagnosis as he easily dismiss the symptoms and not much into ES diagnosis. So, I am not going to consult him.

I have a question about calicified ligaments.
Is there any normal range for calcification of ligaments. Like we have 2.5cm for styloids length as normal range. What’s the normal range for calcification ligaments. I couldn’t find it in the Google or group.

Because my previous ent said most of them will have calicified ligaments and dismissed that I don’t have eagles. He didn’t tell me any normal range though.

I would like to know if there is any normal range or length for calicified ligaments. @Jules do you have any idea?

[beachlady]

That’s a great question. I would love to know that as well. Thank you

[Jules]

The ligaments should not be calcified at all so there is no ‘normal’ range for that! Your doctor was wrong!