Hi … I am still here. I really have no answers and am in a lot of pain still. My symptoms are really making my life difficult and I have a hard time really posting in a clear concise way. I hope you are all healing and finding answers!
Below is what the imaging reports says about my styloids. If my issue does not turn out to be my styloids, then I think it would have to be a vascular issue in the brain or neck or both.
Any thoughts would be appreciated.
Here is my report:
HISTORY: Localized swelling, mass and lump, neck. R22.1 attention to the styloid processes.
PROCEDURE: CT neck without intravenous contrast. The study was performed without intravenous contrast as per referring clinician request. The absence of intravenous contrast limits evaluation. CT scan done according to ALARA (As Low As Reasonably Achievable).
Prior known CT or cardiac nuclear medicine studies performed in the last 12 months: 0
Right styloid process measures 2.3 cm in length and is within normal limits.
Left styloid process measures 2.0 cm in length and is within normal limits.
Visualized parts of the parotid and submandibular glands are normal in size.
Visualized parts of the pharynx and tongue base are unremarkable.
Larynx appears unremarkable.
Thyroid gland is not enlarged.
No lymphadenopathy visualized in the neck on this unenhanced scan.
There is mild DJD in the bones, including the cervical spine.
Limited sections through the paranasal sinuses show them to be well aerated.
Limited sections through the mastoid air cells are grossly clear.
Right styloid process measures 2.3 cm. Left styloid process measures 2.0 cm…
Based purely on length, your styloids don’t meet the typical criterion to classify them as elongated. The report doesn’t mention the condition of your stylo-hyoid ligaments which suggests they’re not calcified, though it’s possible the radiologist ignored them.
One important thing to keep in mind is that the angle of the styloids can have significant impact. Having shorter styloids does not definitely rule them out as pain generators.
I hope you’re able to find answers that address the cause(s) of your pain, so you can find some alleviation and long-term relief.
@Goose - I totally agree w/@KimberlyNYC. Elongation of the styloids is only one physical feature that can cause symptoms. Thickness, angle of growth, how twisted or pointed the styloids are can all play into causing symptoms. Radiologists don’t normally comment on anything but length which is unfortunate.
We’ve had several members whose styloids were normal, but their stylohyoid ligaments were calcified from the hyoid bone up toward but not meeting the styloids. In some cases this was not mentioned in the CT results because the radiologist was only asked to comment on the styloid processes. Another thing that causes ES type symptoms is elongation of the greater horns of the hyoid bone. This is another thing radiologists don’t look for when asked to evaluate the styloids. It would be worthwhile asking your doctor to request a re-evaluation of your CT scan to check the stylohyoid ligaments & hyoid bone.
Asking for a referral for a dynamic angiogram would also be a good idea since you do have vascular symptoms. Dynamic means the angiogram will be done w/ your head in various positions & volume of blood flow through the IJVs &/or ICAs (don’t know if they’ll do both in one shot) is assessed in each head position. If it exists, vascular compression has a greater likelihood of showing up w/ a dynamic scan than with a static scan that only evaluates your vessels w/ your head in a neutral position.
I agree with @KimberlyNYC & @Isaiah_40_31 that the width & angle are important too & can cause symptoms, so unfortunately there’s no mention of that. Also the stylo-hyoid ligament can get calcified- either in segments, from the styloid down or from the hyoid upwards, so not sure if this was checked for? We’re also seeing quite a few members here now with elongated or angled C1 processes which can narrow the space between them and the styloids & cause symptoms…
So unfortunately it’s maybe not enough to say definitively that it is or isn’t ES, but most doctors would probably dismiss those findings as the styloids are short.
So sorry that you’re in alot of pain, sending you a hug