Suspicion of eagle syndrome

[Picker99]

Hi everyone, Im happy that this community exist and I found it, Ive read many peoples posts which their symptoms sounds absolutely terrifying, and I feel sorry that the doctors werent recognizing the debilitating eagle syndrome and its associated syndromes/symptoms because I have also been on the search/ the same journey of seeking answer and help. And thank you Isaiah for welcoming me into the community with such efficiency and geniunity.

I wanted to ask someone with some/or confident amount of experience with X rays and CTs. I don’t have a CT 3D reconstruction so far, but I will get into it asap for a maybe clearer and decisive view of the specific anatomy. But here are some of my X rays and CTs. Can someone give me some insights with these provided scans? Currently I don’t even know for sure that I have ES, my doctor couldn’t decide if I have an elongated styloid process or an ossified/calcified ligament he said it’s hard to determine the actual length because what you see on the x ray is a shadow, and since the attitude was dismissive the whole time during the visit he didn’t think styloid/related issues is an important factor to my symptoms, so I didn’t even move on asking the CT interpretations of the styloids. I tried to learn to read them but I have my limitations as a non medical professional.

History: I’ve always felt that globus sensation in my throat just like many people in this community, I experience throat (not sure which part specifically maybe larynx) twitching back and fourth (visually up and down mostly) as well as hyoid bone constantly moving up and down, it’s not uncontrollable, but it’s just when I stop consciously pressing it downwards to a lower position, the globus/pressuring sensation is more intense that overtime I don’t know when I started , it just became my habit. During physical activities it’s more painful because I can’t focus that much on compensating the globus sensation. And one thing is my tongue has always been deviated to the left side from as far as I could remember, I can manuever up, down, left, right perfectly and my tongue can go in to all shapes with nothing visually wrong, but whenever I relaxes my tongue it would deviate to the left side, like during breathing, speech and swallowing, as well as the uvula and my soft palate is also deviated. My neurologist didn’t see anything wrong with my hypoglossal nerves as i my motor function was existent, I’ve had a mri brainstem done and shows normal as well. So I was thinking if I do have ES, the styloid could be pressing on something that has a relationship with the right hypoglossal or other nerves? I do remember I was a singer as a kid my parent made me do 1 on 1 lessons with my piano and vocal teacher for 3 years and I enjoyed it, I don’t remember much complaints about the voice back then, and people loved listening to my kid voice as a little kid, so Im assuming my voice didn’t sound strained and croaky back then, and producing it was more natural maybe? I have many questions, but to get started i want to know if I have a elongated styloid process or a ligament that is calcified/ossified.

Below are some of my imagings, you guys are welcome to comment if you see something off or suspicious, and please feel free to give me advices! However my main question is to determine if it does look like that I have eagle syndrome from my anatomy, so far I’m confused with where and which is stylomandibular ligament and styloid ligament on top of the location of styloid process. I am also especially amateur at reading the CT slices.

Es.docx (1.1 MB)

[Isaiah_40_31]

@Picker99 - Your left styloid is significantly elongated. I can annotate images I download but because yours are in a docx format, I don’t know how to do that (not very techy here). I don’t see a styloid on your right which may just be due to my lack of experience.

If it’s any consolation, most of us here aren’t very good at reading CT slices which is why we ask for 3D images as those we can take a better stab at commenting on what they show.

To make CT images 3D you can use radiantviewer.com (for PCs) & Bee Dicom Viewer App (for Macs). Another option is dicomlibrary.com which will anonymize & convert CT imaged to 3D for you & give you a link to see your images & one to share. I used dicom library but had to get help figuring out how to see my 3D images so one of the other two means of creating 3D images might be better.

[Picker99]

That is great information provided.. Iwill get started on the 3D CT images for a clearer view asap! Thanks for taking a look at my styloids in the given imagings, I am aware of the different formats and their access to editing/annotating. I just attached a pdf version of the same document, please let me know if pdf format isn’t good for annotation and I will change it to a new format! Would you mind annotating/telling me which part of the picture is the styloid process/ligament that you saw was elongated? (and calcification if it is calcified and possible to see?)
Es.docx.pdf (979.8 KB)

Again thank you for your help

[Picker99]

I am currently in Asia for work travel, I know it is midnight in the states EST. Sleep first and take your time!

[Isaiah_40_31]

I had to take a picture of your images w/ my phone & use the mark-up feature so the “annotation” isn’t as precise as I would have liked, but you’ll get the idea. Also, your left styloid appears to be very close to the transverse process of C1 which could mean your internal jugular vein is getting pinched. Your hyoid bone isn’t in the image, & as that can also play a role in symptoms, it would be good to get a CT that includes the hyoid.

The other thing I noticed is that in the picture of your left side/styloid, you have a reversed lordotic cervical spine curve. The picture of your right side doesn’t look as bad in that respect so it could have something to do w/ your head position during imaging. We have quite a number of members who have “military neck” or “forward head posture” which causes the cervical spine to straighten out & a few with the greater extreme of reverse lordotic curve. A missing lordotic curve in the cervical spine brings the styloids closer to nerves & vascular tissues in the neck which can cause worse symptoms. Neck curve is correctable w/ gentle PT exercises (avoid chin tucks) but it can take some time to restore it so it takes consistency with the exercises. There is also a neck orthotic called the Denneroll which can be used to restore the proper cervical curve. https://www.denneroll.com/cervical-combination-order

Imaging from the internet showing proper cervical curve vs improper cervical alignment:

[Jules]

I’m even less techy than @Isaiah_40_31 , but certainly your left side looks like it’s elongated or the ligament from it has calcified (it actually doesn’t matter which, the main thing is that there’s a calcified spike in your neck right next to blood vessels & nerves which shouldn’t be there!), I’m not sure with your right side if it’s shadows/ artifact but it looks like an elongated styloid to me as well, outside of the jaw bone & at a similar angle to the left side…
I would say that it’s worth seeing a doctor with experience of ES given your ‘classic’ symptoms & looking at your x-ray…best wishes!

[Isaiah_40_31]

Here is what I think @Jules saw on the right & I agree w/ her. Can’t believe I missed it. It may extend up to the skull base but that’s not clear to me. If it doesn’t then it’s a decent section of calcified stylohyoid ligament.

[Rex]

Hi@Picker99.
You do have elongated styloids with calcified stylohyoid ligaments on both sides. They appear to be very long!!! However regular x-rays images can have distortion depending on positioning of the patient and angulation of the x-ray equipment. If a clear view of the hyoid was visble on the lateral ceph x-ray
you could determine how much of the stylohyoid ligament is calcified.
With your symtoms and the images it is a very strong probability that you have ES. Next step is a CT of the head and neck and finding a Dr familiar with ES.

[Picker99]

Ah, I thought my vertebrae, particularly C1 was a bit forward, now you’ve mentioned reverse lordotic curve, I’ve just got some info about it, I definitely have it because not just from the dislocation/curvature of the upper vertebraes, my posture has always looked something like “anterior pelvic tilt”, which is something closely related to lordosis.. but thats a bit off the main topic/issues, thank you for suggesting the denneroll.com, I will take a look at it now, it definitely makes sense that C1 dislocation messes with the veins/nerves upon the styloids. However, for the 2nd pic that you’ve annotated, do you think that could be the stylomandibular instead of stylohyoid ligament? (given that they are the two main ligaments(?) It gets confusing when the imaging provided is unclear along with my poor knowledge in the radiology field. Thank you so much anyway, Isaiah

[Picker99]

That is great findings Jules! That is a important finding that the hard thing is next to the delicate parts-nerves, blood vessels, etc.. If the ligament is calcified, does it show up on the ct scan/its conversion to 3d reconstruction? As far as I know (I have less than basic understanding so far lol) I think elongation is easier to detect than calcification or.. I might be overthinking, but given that 3d model ct is a good way to check the styloids, is it usually efficient to detect calcification of the styloids, if not, what are some other scans/imagings, that is more incriminating? Thank you for these insights

[Picker99]

Hi Rex! Thank you for the comment and findings, it’s definitely much better if I can include the hyoid bone in, which I will do some more imagings, and lateral ceph x ray, I will do that as well, it’s my goal now to determine the calcification of the stylohyoid ligaments, is that what you did for a clear view of the length/calcification of your styloids? Cheers

[Jules]

Elongation & calcification show up exactly the same on imaging…so a 3D image will show both elongated styloids & any sections of ligaments which are calcified. A CT is the best imaging to get, from the base of the skull down to the hyoid bone.

[Rex]

Hi @Picker99,

As Jules has already stated.
I do not think you need any more x-rays taken. If you have not had a recent (within 2 years) CT scan of the head and neck preferably with and without contrast you need to get one. The CT imaging should show everything that is needed for hard tissue (styloid, calcified ligaments, and hyoid) along with some information of the (CT with contrast) blood vessels also. The CT gives the best visualization and measurements (at this step) as possible. It will be interesting to see how far down the ligaments are calcified.

[Isaiah_40_31]

@Picker99

my posture has always looked something like “anterior pelvic tilt”,

I am familiar w/ this & presume it could cause a flattening of the lumbar spine (i.e. the lordotic curve would be lost), & in extreme cases, I suppose could cause lumbar kyphosis.

@Picker99

do you think that could be the stylomandibular instead of stylohyoid ligament?

Calcification of the stylomandibular ligament (called Ernest Syndrome) is much more rare than that of the stylohyoid ligament. Though I can’t say for absolute sure which ligament it is, my best guess is the stylohyoid. We’ve had one or two members who’ve had calcification of both the s-h & s-m ligaments.

[Picker99]

Got it, my doctor just ordered both 3d and non contrast CT scans, they will take a look at them.. I will make sure to update you!! Sorry for the late reply I should be able to communicate more efficiently now.

[Picker99]

Your advice is noted!! I just did my non contrast and 3d CT today, I should be able to take a look at them tomorrow when I pick them up, and my doctor will go over them in the next appointment. Sorry for replying so late, I will be able to keep up more frequent now. I see that you are also a patient in your profile, however I am not familiar with your specific symptoms, but when I get my CTs as well as doctor’s opinion/summary on them, I will drop them here, maybe that could help you in approaching your symptoms as a reference, and better/more effective communication with your doctor in the future with some insights from my case? Cheers

[Picker99]

Thanks for this explanation about the ligaments, I’ve looked up the symptoms of Ernest syndrome, I can’t say that I don’t have any of it, but as far as I understand it the globus sensation thing is more in Eagle?(Im no expert, Im sure with enough pain caused by stylomandibular ligament issues could also cause/develop somewhat of or a bad constant throat discomfort), so far I don’t even know if I have any of the two syndromes, but if I do, maybe Ernest is less likely.

I’ve just had some 3d and non contrast CT done, my doctor will take a look at them in my next appointment, just off of the top of my head 3d sounds more incrinminating unlike a side X ray picture/panoramic.., hopefully it does shows the styloids and hyoid bone more clearly. Sorry for the late reply, I can communicate more freely now. I will update you with my progress, and I will be picking up my CTs tomorrow and seeing the doctor soon.

[Jules]

Glad that you’ve been able to have the CT now! If you upload them on here make sure you anonymize them for your privacy… I think Ernest Syndrome seems to be rarer than ES, although like ES it could just be that there’s not much awareness of it & it’s underdiagnosed! Hopefully the CT will be helpful…

[Picker99]

I will make sure to anonymize them. Good reminder

[Rex]

Hi @Picker99 ,

Wow that was fast getting a CT order and having it taken. I wish it was that fast here in Missouri.
Did you go through your PCP or a specialist for the CT? Are they familiar with ES?

As far as my symptoms. If you read the into & symptoms list by Jules, I have/had 95 % of them
and they come and go along with severity. My most aggravating symptom are the vascular ones,
dizzy, brain fog, headache, neck pain, eye pressure. etc…
You are the first that I have read/seen that described deviated tongue, uvula, soft palate.
When you hear or see those things alarms bells normally go off from the MD’s point of view… But you have been seen by neuro and they did not see anything major causing it. I went to neurologist to rule out a severe and longer lasting bout of dysphagia. Upon her exam when I protruded my tongue it deviated laterally to the right. When a MD’s eyes bug out you know there may be a problem. She asks how long have you had this. I said had what. I did not realize my tongue was deviating. However I could could move it in all directions so she was not worried. So although there is a finding and they are not familiar with an etiology with what is going they tend to dismiss or refer. It is most like impingement of the glossopharyngeal nerve affecting a tongue muscle maybe genioglossus. That is related to ES but not a noted or prevalent symptom. So you may have something similar going on.
Your symptoms do not seem to be from Ernest syndrome, I could be wrong.
I feel you have ES with hyoid involvement. That is just a guess. Could be something with larynx and hyoid. That is just a guess also. Your CT should give more information. Looking forward to see the images.