Hello everyone, my symptoms started when I was six weeks postpartum and I woke up one day with severe upper tooth pain on my right side and jaw pain. I went to the dentist and they ruled out infection and sent me to a TMJ specialist. I then ordered a special splint and had been wearing it and nothing was getting better. I then started to get extreme tightness around the base of my throat and it was very prominent on my right side. I felt like I was being choked or my airway was being severely squeezed and I felt like I couldn’t breathe very well. I then saw my PCP who believed that this was silent reflux and put me on a PPI I started that and since then nothing has worked. Also believing that this was silent reflex, so I have been eating a very clean diet while also still taking the PPI and no matter what I eat my voice is hoarse. I feel like I can’t breathe some days are worse than others but I also get a very strong strangulation feeling and it’s almost always on my right side when my throat hurts on my right side. I did have a scope done and they did not see anything. I’ve seen speech therapist and they said that my vocal cords looked fine. I’ve had an endoscopy done, and all they found on the endoscopy was an inlet patch. I then thought OK maybe this is TMJ and I went to see a head neck specialist who also does jaw surgeries and he took a look at my CT scan. I had a soft neck tissue CT scan and everything was normal on it, but he wanted to see the scan so I took it up to him, and he said that my styloid is on both sides, seem to be growing inward in my neck and that they are a little thick and he said he will believe that my right styloid is causing issues.
My main symptoms are strangulation feeling like something is in the back of my throat on my right side behind my tonsil area. My vocal cords get very inflamed and I get a raspy voice. I have ear fullness, feeling like I can’t inhale sometimes through my right nostril like I have pressure on my right side in the back of my throat, and I can’t take a full breath, tons of mucus. How do my scans look?
@ashtonndawnn - I’m sorry that your account didn’t upgrade like it should have after you posted. I’ve fixed it manually so now you can post images.
Your symptoms are all ones we’ve seen listed by members over the years so we know they can be associated with ES. The pain in your tooth/teeth is likely being caused by your trigeminal nerve, the choking sensation can be caused by the glossopharngeal &/or vagus nerves. Your vocal cord irritation/voice change is related to vagus nerve irritation. Choking/strangulation/breathing issues are also likely glossopharngeal/vagus nerve related. Reflux symptoms are vagus nerve related (it’s a very busy cranial nerve!). These are among the cranial nerves we know are often irritated by elongated styloids. Excess mucous is also not uncommon & is caused by an irritated glossopharyngeal nerve.
I’m really glad the head & neck specialist you saw is familiar with ES & gave a name to what is most likely causing your symptoms. Please try posting your imaging again & make sure to cover or delete any personal information that shows up on the scans you post before posting them.
I am hoping the styloids are the issue because I have no idea what it could be. I’ve ate very clean and have lost weight thinking this was reflux but nothing is getting better. I have now uploaded my pics. He mentioned they’re not exactly super long, but they are growing inward and could be causing a lot of my issues. He has done surgery on this and I trust his work. But just figuring out if this is the issue or not.
They’re not the longest styloids we’ve seen on here but the are certainly longer than the ‘average’ , and the angle can cause symptoms too. As @Isaiah_40_31 says, you certainly have common symptoms of ES…
I’m afraid I can’t label the images for you, but as well as the styloids being long, your hyoid bone processes are quite long too, & the right looks like it’s got quite an upward curve- hyoid bone syndrome & ES symptoms are very similar, the choking sensations can happen with both.
It also looks like you’ve lost your neck’s natural curve, aka military neck, which we see quite alot. It can sometimes be the body’s way of compensating for ES symptoms by adjusting the neck, or it can be that poor posture, looking at screens alot have straightened your neck. There’s info & suggested exercises which can improve the curve in this discussion: List of my favourite resources on YouTube to learn anatomy - General - Living with Eagle
It also looks like your IJVs are flattened a bit in a couple of places- slightly around the C1 process between it & the styloid, & a bit further down possibly by soft tissue, muscles maybe. But if you’re not getting any vascular symptoms (like head or ear pressure/ fullness, dizziness, off-balance feeling, pulsatile tinnitus for example) then your body is probably coping okay- it’s not severe compression like we often see.
Have you tried any nerve pain meds at all? They can often be helpful…
And what are your next steps, are you going to try and see one of the doctors on the list?
I also thought something looked odd with my hyoid. We plan to take out right styloid process on the 28th. He seemed very knowledgeable on this surgery. I do have ear fullness, head pressure, and feel slightly off balanced. But not dizzy. It’s just nerve wracking to make sure you’re doing the right thing, but I’ve done every test it seems for reflux and everything comes back clear.
Your hyoid does look wonky, and the processes too, so it could well be causing issues …your thyroid cartilage is quite chunky which we occasionally see, sometimes that can cause issues as well. Hopefully the styloid surgery will help, but it might be worth looking into getting a consultation with a doctor who has experience of this as well?
We do also have a list of questions to ask a doctor to check their experience with ES surgery:
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
We have heard that occasionally doctors use surgical clips which are left in, it’s been suggested that these could interfere with chiropractic adjustments if needed post-surgery, so something to consider, and also we have now seen members who’ve been left in pain from the clips and needed further surgery to remove them, so do ask if they might be used.
@ashtonndawnn - I’ve annotated several of your images. Your right IJV is clearly your dominant one as it’s significantly bigger than the left side.
Your hyoid bone is very wonky (definitely a technical medical term ), & I suspect it’s contributing to your symptoms. It looks like the right greater horn is longer than the left & extends to very close to your spine which means there’s a chance it’s making contact with your internal (ICA) or external carotid artery. In the image I annotated it looks closer to the external carotid (ECA). Both greater horns look detached from the body of the hyoid. Though a bit less common, this is one variation of the hyoid bone that is considered normal. I’ve also never seen a hyoid where the greater horns had knobs on their tips.
I agree w/ @Jules that your IJVs look flattened in a some places so you could have some compression there as well as with your ECA. Your right IJV looks very engorged down closer to your collar bone. That can be a symptom of Thoracic Outlet Syndrome (TOS) which causes shoulder & arm pain & numbness. Do you have those symptoms in your right arm? If not, no worries then.
Because it appears you have vascular compression in your imaging, it would be better for you to see one of the doctors on our Doctors List who do vascular decompression as part of their ES surgeries, otherwise, you may not get reduction or elimination of the vascular symptoms you have - ear fullness, head pressure, and feel slightly off balanced. At the very least, discuss these finding with the surgeon you’re scheduled to have surgery with & ask how (s)he will deal with them during surgery.
), & I suspect it’s contributing to your symptoms. It looks like the right greater horn is longer than the left & extends to very close to your spine which means there’s a chance it’s making contact with your internal (ICA) or external carotid artery. In the image I annotated it looks closer to the external carotid (ECA). Both greater horns look detached from the body of the hyoid. Though a bit less common, this is one variation of the hyoid bone that is considered normal. I’ve also never seen a hyoid where the greater horns had knobs on their tips.
