Welcome to our forum @JCsea! I’m glad you’ve found us & I hope we can help provide with answers that will lead you to the treatment you need to recover from your symptoms.
All of the symptoms you’ve mentioned as constants & sometimes are those we have seen w/ ES (including heart symptoms, anxiety, nausea & vocal weakness - caused by vagus nerve irritation) & also are those which tend to diminish or disappear after surgery. Most are symptoms related to cranial nerve irritation though your head pressure, lightheadedness, dizziness, brain fog, & visual changes symptoms could point to vascular compression of your internal jugular vein. ES symptoms can come & go with new ones cropping up when old ones disappear for a while. Intensity can vary frequently.
This could be related to your hyoid bone. It looks to me like the greater horns of your hyoid are longer than normal - almost touching your spine. See annotation on one of your images below.
We have many members with this problem. The loss of the cervical lordotic curve brings the styloid into closer contact w/ both cranial nerves & vascular tissues in the neck thus working to restore the lordotic curve can help relieve symptoms to some extent. Here’s a link to a great post that has more information about that. The necessary exercises are gentle but it can take diligence & time to restore the curve. STAY AWAY FROM CHIN TUCKS! If your PT is having you do chin tucks of any sort, please stop doing them. They will exacerbate your symptoms. It sounds like you were doing the opposite with the position your head was in during your cycling exercising which at the extreme could also have brought on symptoms as you noted.
It’s my personal opinion that the barium swallow will not be useful & will be a waste of your time & money. I don’t know anything about Dr. Covello so I don’t know if he’ll be of any help. I highly recommend Dr. David Cognetti who is in Philadelphia. He deals w/ ES, vascular ES & Hyoid Bone Syndrome. He’s will do virtual initial consults so you don’t need to travel if he’s too far away. He is booked out quite a ways but his office keeps a cancellation list & will add anyone who asks to be put on it.
•Dr David Cognetti, Thomas Jefferson University Hospital, Philadelphia 215- 955- 6760 (Has done many successful surgeries on members). David M Cognetti MD | Jefferson Health
Another doctor you can consider is Dr. Karuna Dewan who specifically does surgeries for Hyoid Bone Syndrome. She does not deal w/ ES though.
•Dr. Karuna Dewan, Ochsner LSU Health Shreveport - Academic Medical Center - Specializes in Hyoid Bone Syndrome surgeries
1541 Kings Hwy, Shreveport, Louisiana, 1-318-626-0050
https://www.ochsnerlsuhs.org/doctors/karuna-dewan
Needs a PCP referral
When you consult w/ any doctor going forward, please don’t give them the whole list of information you gave us. It’s fine here, but no doctor will take the time to read it all, & you may even get “dismissed” as a hypochondriac or as just being stressed. We’ve seen those scenarios too often on our forum. Be prepared just to share the 3-5 symptoms that you feel are the worst overall. You’ll have a more successful appointment that way.
Your C1 vertebra is shifted slightly to the left. I also have that problem, & it caused IJV compression for me so there’s a good chance that’s at least contributing to your vascular symptoms.
In this next image your IJV appears to be suffering some compression from your styloid & C1.
In this image the greater horns of the hyoid appear elongated & there is slight calcification of the lesser horns visible. The R IJV is either absent from this image or is very diminutive & not clearly visible to my untrained eye. Neither of your styloids appear very long, but they are somewhat thick & the angle the left one is growing is significantly different than the right one. Length can be a moot point if there are other physical features of the styloids that dispose them to causing symptoms such as thickness, curve, angle of growth, how pointed or twisted they are, etc.
I don’t know how old the images you are which you have posted but they are good enough to show there may be a couple of serious problems in your neck. Because Dr. Cognetti is booked pretty far ahead, I’d recommend phoning his office on Mon. to see if you can get a consult on his schedule. They will let you know what information you need to send in.
I hope this information helps.