Styloids not elongated... but are they thick?

Hi, I’ve been battling this throat pain for about 3 years now. Thought it was GPN but the neuro said the symptoms weren’t consistent with that as my pain lasts for longer periods. My MRI showed no pressure on the GP nerve anywhere.

So then I moved onto ES… I am on a 2 year waitlist for an ENT here in Vancouver but had the CT done prior to that appt. Looking at it, I see that both styloids are same length, 3cm. I am 6’4" so don’t think 3cm is long enough in my head to cause the symptoms (textbook ES) I am having so was a bit disappointed to be honest - I was hoping it would be obvious and then I could move onto the step of trying to find a surgeon.

Today I read here though it might not be the length, but rather the thickness or angle (giggity giggity)…

  1. How do these look?
  2. Am I measuring that right? (both sides are the same)
  3. Is there calcification visible in here?

Thanks for any input ya’ll might have.

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Hi and welcome!

Sorry to hear about your struggles!

I’ll give it to you short and cut out the midle man, your Styloids are longer than avarage and i agree that they’re thick aswell as the angle.

There seems to be partially calcified ligamentum styloideum also ,see images below, that could fit in with your throat pain. It could also cause restriction in jaw,tongue movement. Calcified ligaments could create tension on the surrounding muscles thus irritating facial nerves as you’ve been on to.

Another thing i notice is that your styloids are abit close to C1 Atlas, that too could cause problems and possible compression on arteries/veins.

I’ve gone ahead and marked out calcified parts with green.


It looks like you’ve lost your lordotic curve in your spine. There could also be an indication off your spine is grown together wich is thetered spinal cord syndrome but that could also be the rendering off the 3D images so have that in mind.

  • Henrik
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Hey Henrik, wow thanks for your response. I appreciate hearing that the styloids may actually be too long. I really feel like when I put my head a certain way the attacks happen so when I saw that they were on the edge of normal, I just assume with my height they weren’t the issue proportionally.

Are you in the medical field, or just a very informed/experienced moderator in this forum?

Now - to find a doctor in Canada that will share your observations… that’s the next challenge.

(I don’t think there’s anything wrong with my spine. I have never had any issues up there - might be just the angle of CT view)

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By the looks off it yess, and how the angle off them is playing out. The messurments could be telling us something different though, but there is a specific standard on how to messure styloid length, that would be a radiologist’s job to do.

My styloids was actually in the “deadzone” off being out off normal length, as it was slightly over 3,0 cm but there were calcification further down on them that made the final say about it.

What kind off attacks do you get? Can you describe the symptoms and the pain you feel ?

No im not, i have been through a hard fight and a hard journey as everyone else, that makes one learn a thing or two along the way and i find it interesting to help other people to know what to look for :blush:

That could be, often 3D images can render in a weird way. The best is to confirm everything in the ct scan.

@Isaiah_40_31 could you help us? I guess it is hard to find surgeons/doctors in Canada :face_with_spiral_eyes:

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What kind off attacks do you get? Can you describe the symptoms and the pain you feel ?

Forgive the length of this, but it’s a summary I keep for whenever asked. Its just easier to copy/paste:

Always, 24/7:
-Initially started 2.5 years ago as a sharp pain point located in the crux of my chin and throat, left of center, but this has moved slightly up over the past few months to a throbbing pain under my chin left side. It actually feels like I have a painful swollen lymph node but that’s maybe because I rub it all the time. My doctor said it didn’t feel abnormal.

-It always hurts when I swallow. Liquid, especially alcohol, 90% of the time causes a sharp pain inside my throat, again at the crux. When I am really hot, and chug a big glass of cold water… I feel the refreshing relief of the water in my chest, and excruciating pain in my throat.

-Opening my mouth to swallow/eat something hurts at the back left side of my tongue. It actually prevents me from opening my mouth properly. Big bites are almost impossible. But at the same time, I have no issue opening my mouth wide when not eating. It’s only when I go to eat something.

Sometimes (periodically, but pretty much every day) I have “attacks”:
-During an attack I get intermittent shocks to the inner-middle of my left ear.
-The back left of my tongue goes numb.
-The “soreness” in my throat intensifies.
-My jaw throbs.

-During an attack, eating something dry like a cracker or cookie etc “scratches” the inside of my throat and feels good.
-Slowly biting the numb part of my tongue provides relief. The harder I bite, the more relief there is when I let it go and the blood returns.
-While the attacks generally seem to happen randomly and as a surprise, often the pain slowly ramps up when my head is a certain way on a pillow or while laying down. It will alleviate when I adjust my head. Sometimes I wake up in the middle of the night in attack mode because my head moved to some position while asleep.

-I am 49. I had surgery when I was 21 to fix apnea issues. They removed my tonsils, my uvula, and some other tissue to make my throat wider. I also elected to have my wisdom teeth removed at the same time. It was quite intrusive and so I thought maybe scar tissue was causing glossopharyngeal neuralgia. I had an MRI along the GP nerve which ruled that out.

-I was on carbamazepine to help with the attacks. It reduces the shocks, but not the other pain. It also has side effects for me so I recently switched to oxcarbazepine but I think I need to up the dose as the shocks have returned.

No im not, i have been through a hard fight and a hard journey as everyone else, that makes one learn a thing or two along the way and i find it interesting to help other people to know what to look for :blush:

Well it’s certainly appreciated! :pray:

@Isaiah_40_31 could you help us? I guess it is hard to find surgeons/doctors in Canada :face_with_spiral_eyes:

Anyone! :slight_smile:

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Hi @BigBrosMo - I agree w/ @Henrick that your styloids are thick, angled & a bit longer than normal. In the images, it also looks to me like your hyoid bone is rotated to the left, however, that could be scan angle & not reality. Do you have any images from the front?

CT scans are done in slices & when a 3D image is measured, the space between the slices aren’t visible so aren’t taken into consideration. More often than not, surgeons find the styloids to be longer than measured when they go in to remove them. I also agree that you have bilateral stylohyoid ligament calcification. It looks more significant on the left than on the right which would also explain why your symptoms are worse on the left side.

Unfortunately, There is only one doctor listed for BC ( •Dr Mori, University of British Columbia (call first, told one member he doesn’t do surgery now), Tyler Mori, MD, FRCSC | Department of Surgery You could try calling his ofc to see whether he is doing ES surgery again or if you could get a referral to someone who does it in your province. I know of one person who had ES surgery in BC & ended up coming to the US for a revision surgery a year or two later because the BC surgery wasn’t done well. I don’t know who the surgeon was though. Though it’s difficult to see doctors in other provinces, there are a few others but further east:
•Dr. Dan O’Connell, 1E4 WMC, University of Alberta Hospital
8440 112 Street, Edmonton, AB, 780-407-4598, ( )
•Dr Eric Monteiro, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto 416-586- 4800 (possibly treat ES, he has done a surgery with Dr Ian Witterick, who no longer does ES surgery.) Our Physicians —
•Dr Michael Gupta, Hamilton, ON.
•Victoria General Hospital, Halifax, NS (one member had surgery here)
•Dr Stuart Richardson, Spring Garden Rd, Halifax, NS (Dentist, mentioned by a member back in 2014, diagnosed them and would do surgery, don’t know his experience.) Dr. Stuart Richardson - Halifax, NS - Dentist Reviews & Ratings - RateMDs
•Dr Mori, University of British Columbia (call first, told one member he doesn’t do surgery now), Tyler Mori, MD, FRCSC | Department of Surgery
•Dr Don Anderson - 3030 Lincoln Ave Unit 212, Coquitlam, BC V3B 6B4, 1-604-941-9191 (Does only shorten the styloids a bit though, so may not be enough to resolve symptoms)
•Dr Rick Jaggi, Saskatoon, SK,
•Dr Khalid (Kal) Ansari, Edmonton, AB - Dr. Kal Ansari - Doctor/Clinic/Service Provider Profile - Medicard
•Dr. Russ Murphy, Saskatoon, SK - R. Murphy - College of Medicine - Medicine | University of Saskatchewan
•Dr. Norbert Viallet, Health Sciences Centre in Winnipeg, Manitoba, Norbert Viallet - Otolayngologist - Head and Neck Surgical Oncologist at University of Manitoba | ZoomInfo
•Dr. Hodaie, via St. Michael’s or Toronto Western ENT departments/clinics
•Dr Kulbaba, Radiologist, ARC - MSK Ultrasound - Atlas Radiology Consultants will give opinions on CT scans and performs neck ultrasound
•Dr. Norbert Viallet, Winnepeg, Manitoba,

A number of our CA members have chosen to come to the US for ES surgery because the wait times are so ridiculous in CA, & their symptoms were bad enough they felt they couldn’t wait a year or more to see a doctor. I am so sorry you are in that situation yourself.

Dr. Cognetti ( •Dr David Cognetti, Thomas Jefferson University Hospital, Philadelphia 215- 955- 6760 (Has done many successful surgeries on members). Only removes ligaments if calcified. has been the “go to” doctor for our eastern CA members because the cost to see him for surgery is much lower than for many of the other surgeons on our list for the US. He is extremely experienced w/ ES surgeries & is one of the doctors who has been on our Doctors List the longest. He does telelhealth consults so you could call his ofc to see what information they need from you & at least set up a consult appointment as that alone could be very helpful. If you do have a consult w/ him, it’s important to find out if he removed calcified sections of the stylohyoid ligament as well as the styloid process.

Closer to you would be the surgeon who did my surgeries - Dr. Husein Samji ( •Dr Hussein Samji, Camino ENT Clinic, San Jose 408- 227- 6300 Camino Ear, Nose & Throat Clinic (one of the most experienced ES surgeons in the US, does external surgery.) Contact his medical assistant for a faster response. Dr. Samji doesn’t believe in vES). in San Jose, California, however, he places surgical clips in the neck during surgery which are left there & some people don’t like that idea. He also dislocates the jaw to get better access to the base of the styloid. People w/ TMJ issues sometimes have sore jaw joints for awhile after surgery because of that. I expect other surgeons use that tactic, too, but he’s the only one we know of for sure who does it.

Your symptoms sound quite miserable but on the good side, it does not sound like you have vascular compression being caused by your styloids or C1. Getting your left styloid & that section of calcified s-h ligament removed could go a long way toward helping your GPN recover thus stopping the symptoms you have.


Thank you @Isaiah_40_31 !

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I agree with what the others have said about your styloid width & angle, the calcifications on the ligaments could potentially cause symptoms too…I hope that you can find a doctor to help!

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Thank you so much everyone. I am running the files through the DICOM process linked now. It’s uploading but sllllooooowwww going (about 2/3 done since last night). I will update you @Henrik when it’s available.

Getting your left styloid & that section of calcified s-h ligament removed could go a long way toward helping your GPN recover thus stopping the symptoms you have.

@Isaiah_40_31 I really hope it is something, er, cut and dry, like that to fix. Just need a doc onboard with it. Thank you for the links. Jules had put me onto that Canadian sub before… I reached out to some docs and got nowhere. I spend much of my winters in Thailand where they have good international medical facilities in the big cities and did get in touch with an ENT there who seemed to know a few things about ES. I might explore this a little more with him if I don’t get anywhere in Canada. If I do, I will add him to the resource list.

Here are some other screenshots. Both left and right styloids appear same shape/size/angle to me, but I don’t see the calcification on the right so much.


Thanks for the info about the doctors in Thailand. If you do end up there for surgery or other treatment, and have good results, we’d love the name of the doctor you see!

In the bottom image, your head is tilted to the right. If this is your normal head position (look around - many people have a tilted head carriage) i.e. it’s the way your head sits when you aren’t consciously thinking about making it level, then your head position could be bringing your left styloid & calcified s-h ligament into greater contact w/ the nerves that are causing your symptoms. If you notice your head tends to tilt to the right, try working on maintaining it in a more neutral position to see if that helps alleviate symptoms.


Hi @Henrik

I was able to get my CT uploaded. Does this work for you?

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I’ll have a look :blush:

Seems like some off the images and series was left out, i can only find chest and abdomen series. Is it possible for you to look over and see if you’ve missed something?

As we wait on that I can post from what i’ve found so far with what i had to work with,

As noticed before, there is an unormal curvature in your spine, see images below. It looks like the curvature starts at TH1 right above your shoulder blades. But as you’ve mentioned that you don’t get any symptoms from this, i would say that it’s then just bad posture. Bad posture is something that can happen from ES as you develope tension in your neck over time to compensate for pain and tension in that area.

I would advice to work on this, if it’s just bad posture. A physcian or a good chiropractor would might be the best to see regarding this. Excercises you could do at home can also help working with this.

One off our member have made a great post about this, and includes more about our anatomy;

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Hi Henrik - you’re right, I am sorry for that upload. I have restarted it but will take awhile - I just uploaded whatever was on the cdrom I got from the hospital but for some reason the DICOM site only took the chest CT and not the throat one.

I had two CTs… bit of a story but I had bloodwork done before the first CT of my throat. I had a very high eosinophil count and it was thought at first I might have “Eosinophilic esophagitis”… but then the throat CT showed some spotting or something on the top part of my lungs that concerned the docs very much. So then they ordered the second CT focusing on my chest. I had a LOT of tests and scans over the next few weeks and was having strange symptoms of what could be blood cancer. Then… everything just went away!

Long story short… I picked up a parasite in Thailand that doesn’t live in humans… it tried to set up shop and couldn’t so it died. So, NO CANCER, but my throat still hurt. lol.

My posture isn’t the best as I work at a desk all day but I never put those two things together since I don’t have any pain. I will check out the link you sent, thanks.


Hi Henrik - updated DICOM study here:

Thank you so much again for your review!


Just referencing you here Henrik in case you didn’t see my update above.

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@BigBrosMo -
This is all I can see w/ my limited ability to manipulate images in dicom library. You do have some slight pressure on your IJV in this image caused by C1 but perhaps not enough to be causing you trouble. The styloid doesn’t look to be involved. I can’t find an image of your right IJV so can’t comment on it.


Thank you for looking at that. What should my next move or area of investigation focus on then? And do you see the calcification noted earlier above as being a factor if there’s no significant pressure on the IJV?

I can induce the pain/discomfort (slowly builds) when I tilt my head down and to the left. It’s almost as if I want a CT scan while in that position. Do they do that?

CTs can be done dynamically yes, but not all radiology departments will do them- it’s certainly the best way to see compression if yours is positional…the ‘chin tuck’ position is quite a common one for members to feel IJV compression. If you’re able to request another CT then a dynamic one would be the most helpful by the sound of it…

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