Hi Xander,
The type of doctor that usually treats ES is a skull-based ENT surgeon, neurosurgeon or maxillofacial surgeon. These doctors are often cancer specialists. Understanding the type & thoroughness of a doctor’s surgical approach is important. We recommend the external (vs. intraoral) approach as the styloid can be removed back to the skull base & the stylohyoid ligaments, if calcified, can be removed from styloid tips to hyoid bone which provides the best long-term recovery from ES symptoms. Nerves & vascular tissues can also be better monitored via the external approach post op infection rate is lower.
A CT scan is the best way to diagnose ES. As Jules said, your CT needs to show the area between your hyoid bone & skull base focusing on the styloid processes & stylohyoid ligaments. Taking a look at your panoramic x-ray first to see if a CT is warranted for official diagnosis is a good idea. A CT w/ contrast will show vascular constriction when your head is in the provocative position (the position that brings on the dizziness, etc), but some doctors prefer a CT w/o contrast as it allows them to better visualize the styloids & stylohyoid ligaments. Calcification on your stylohyoid ligaments, will show up in a CT & presumably a pano x-ray, but the ligaments themselves will be invisible - only the calcified sections can be seen.
The symptoms of ES are caused by irritation of up to 6 cranial nerves that “live” in your neck in the same area as the styloid processes & stylohyoid ligaments. Elongation of the styloid(s) &/or calcification of the stylohyoid ligaments can cause irritation to these nerves. Alone each nerve when “upset” can create painful & sometimes scary symptoms. When more than one is irritated the symptoms caused can be downright debilitating. Additionally, vascular compression of the internal carotid artery &/or jugular vein can occur which creates other miserable & concerning symptoms. It does sound like you have vascular symptoms based on the symptoms you get when you turn your head. Obviously, the solution for recovery is to remove the offending bones/ligaments so the nerves &/or vascular tissues can recover. There is a series of YouTube videos called Two Minute Neuroscience . Each cranial nerve is featured in a two-minute video w/ explanation as to location, function & dysfunction of the nerve. It would be good for you to watch them. These are the nerves affected by ES: vagus, facial, glossopharyngeal, hypoglossal, trigeminal & accessory. Hopefully the information you receive will help you understand the source of some/most of your symptoms.
Wishing you the best,
Isaiah_40_31
