@quediusara is this the CT with contrast? Correct axial slice, but I thought I’d see a larger contrast difference between the vascular structures vs soft tissues
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@quediusara see attached annotated image.
Your right styloid is longer than your left, given that we can see it in this image but not your left styloid. Both your IJVs are snug against your C1 transverse process. Not sure if it’s to a degree to where it can cause any problems or not. Your right styloid is fairly close to you right IJV, so I suspect with some head movements there can be some compression happening.
I’m not sure if a calcified lesser horn / lower portion of stylohyoid ligament would count as ES or not - I think @Isaiah_40_31 @Jules would know? I suspect not since the focus is not the styloid? Regardless, it can definitely be treated. Surgically removed.
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Thank you for fixing & reposting your images, @quediusara. I’m sorry your surgeon didn’t do as thorough styloidectomies for you as he did for the other person you know. I’ve seen that even w/ the surgeon who did mine. He would cut some people’s pretty short but leave others’ too long. When the transcervical approach is used instead of intraoral, the surgeons can see the nerves & blood vessels & won’t cut the styloids super short if they’re concerned they will cause nerve damage, but in the intraoral surgery, they can’t see those things in the same way so I wonder how they decide what length is short enough for a given patient?
WOW! It must have been scary to be so sick! It was the prednisone you received while in the hospital that knocked out your ES symptoms for a month. I had a similar thing happen to me. I had some hearing loss, tinnitus & vertigo from a cycling accident just prior to my second surgery. After I had the surgery, those symptoms were gone so I thought it was my styloid causing them. My doctor told me it wasn’t from the styloid, & he was right because 3 weeks after my surgery all my symptoms came roaring back. I had taken a course of prednisone for a couple of weeks after my surgery & that’s why my hearing, etc. improved briefly.
Eagle Syndrome symptoms can be caused by 1) Elongated styloid(s) 2) Calcified stylohyoid ligaments or 3) A combination of 1 & 2. So in answer to your question, there are doctors who diagnose calcified ligaments w/o elongated styloids as ES when symptoms are present. Sadly, there aren’t a lot of doctors who know that is the correct thing to do since most will only diagnose ES when the styloids are longer than normal. Calcified ligaments can be resected just like the styloids can. We’ve had a number of members who had normal styloids but their s-h ligaments were calcified from the hyoid bone up toward the styloid.
I’m pretty sure we have some research papers in our Research Paper section which discuss ligament calcification alone as causing ES.
It’s really a crime that your surgeon has been so hands off since your surgery not even answering questions you have since your symptoms have returned. I know that must be very frustrating. I vaguely recall we’ve had a couple of members who’ve had styloidectomies & calcified ligaments that were removed via intraoral surgeries. I think it required more incisions in the mouth/throat though.
I have some mild concern due to the numbness you get in your face & lips, especially if it’s always on the same side of your face, that your calcified ligament may be irritating your carotid artery. Those symptoms can point to a carotid irritation or compression.
I’m glad you can work from home so you’re able to continue working in spite of your symptoms but I’m very sorry you’re suffering in spite of having surgery.
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Been there & done that too many times!!
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I wish I knew! No answers there either. I asked him about it and I was concerned he didn’t even look at the CT scan images. One of our whatsapp group members had his images on a WeTransfer link and it was NEVER accessed by anyone. To me the surgeon just said: ‘I’ll know what I see when I open it up’. Sigh..
Could you tell me on what imagine we can see that? @TML said the ligament is highly calcified at the bottom, maybe it would be good to concentrate on that first. I know the leftover styloid ‘stump’ is very thick and probably causing some symptoms still. I don’t know where to start really.
Could it be the ligament calcification is messing up my hyoid bone, as in, making it less flexible and even pulling it out of position?
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Would that surgery be equally invasive as removing the styloid? Maybe it’s easier to find a specialist that can do that, because most surgeons I’ve went to don’t even want to do the styloid surgery. And despite seeing the same images as you saw, my former surgeon says that the styloid stump left can’t do a lot of harm according to him.
Hi TML,
How strange the left styloid didn’t show up. So I went up a few slides and then it appeared. I’m including the images. Aren’t they supposed to come up in the same image? 
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There aren’t many doctors doing hyoid bone surgery that we know of either, so I’m not sure if it would be aby easier to get that part of calcified ligament removed- I would guess it should be a bit less risky, as where the styloid is at the top is right next to the jugular foramen where the IVA, IJV & vagus nerve exit, it’s a more cramped space… Alot of even the most experienced ES doctors sometimes leave a little stump behind depending on the nerves in the area, sometimes they can be too close to safely remove any more styloid.
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As if finding someone that knows about Eagle syndrome wasn’t enough! 
There’s a specialist in Poland that does some really need, very minimal surgery, he claims he always gets the entire thing of until the base of the skull.
As for the calcified ligament, this is the ligament that is connected to my hyoid bone, right? Could the calcification mean my hyoid bone is less ‘flexible’, or could it be pulling it in a certain direction?
Thank you for your time 
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If vascular symptoms are your main problems then the calcified stylohyoid ligament at the bottom isn’t the cause because it isnt around any vascular structures. The only bones touching any vascular structures currently are your styloids and C1.
However, the vascular symptoms you described above sound more like vagus nerve compression (i.e., temperature dysregulation, feeling tired/weak). If you had said constant head pressure, pressure headaches, can’t put head below heart, ear pressure, then I would immediately think your IJVs are the issues. I think the “slapped” on left side of face must be your left calcified stylohyoid ligament, unless your left facial nerve is wrapped around the stump of your styloid or something.
If you do have intracranial hypertension symptoms then it has to be the IJVs, which would mean cutting the styloids further up and maybe a C1 shave. Given your vagus symptoms (at least what I think are vagus symptoms) maybe a C1 shave would be helpful.
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The axial view takes slices of your body from top to bottom. Your styloids are different lengths, where your right one is longer. So if you take a slice of your body where it shows the tip of your right styloid, you won’t see the left one yet because it’s shorter and won’t be in frame yet.
Your right styloid (left side of image) does come in contact with the IJV, which suggests that with certain head positions it could compress it
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@quediusara - I went back through the pictures you posted & found the 3D image that shows the somewhat significant left stylohyoid ligament calcification from the lesser horn of your hyoid. I’ve circled it in the image below. It is plenty long enough to be causing problems & would need to be removed transcervically i.e. through your neck. I would think any ENT surgeon who does transcervical styloid removal could do that for you. I agree w/ @TML, though, that it seems your worst symptoms now may have to do w/ your IJV(s) being compressed, however, if you could get both situations taken care of at the same time, that would give you a better chance of feeling better overall.
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Thank you… at least now I have a clear picture. Now the next step would be finding a doctor, hopefully in the public health system… and hope that they’ll actually listen to me. You know how they are when the patient comes in with a bunch of information and images!
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What I do have is inner ear pressure - like when you went swimming, and the high pitch tinnitus. The inner ear pressure was there first, and then the tinnitus came. It’s a high pitch, so not pulsatile. It feels like the whole area is ‘blocked’ and feels dead. But then a month ago or so I had a manual therapy session and the guy went intraoral, very close to the place of the styloid removal, and pressed the ‘eustachian tube’ point… and wow… for the first time since this began, I actually felt movement in my ear and the pressure slowly went away! I could suddenly hear ‘bubbling’, and then went on a plane and the ear actually popped several times. I went on planes a lot of other times and that ear would never pop, ever since my symptoms started. It felt very relieving!
I do have headaches, but only at the end of a (working) day and only when I had one of these hot flashes that are so debilitating.
Also, I feel like something is just ‘off’ inside my throat, like something inside it isn’t where it should be, a ‘twisted’ feeling. I love to cook but this feeling often makes me feel not hungry anymore, like I really don’t feel like eating.
My ‘bite’ is also completely ruined, which has further implications down the road… Before I knew about Eagle’s my former dentist thought the issues came from my back teeth. So he pulled quiet a lot of them - apparently just for fun. 
I’ve read on the forums that I’m not the only one who went through that…
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Thank you for looking at it! So basically I’ve had 2 failed surgeries I wish I was in the US so I could sue!
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I’m UK, so maybe others in the US can comment, but from what I’ve seen on here from US members stories, it doesn’t seem to be as easy to sue as us outside the US believe! But definitely no consolation given that your 2 surgeries haven’t helped 
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@Jules is correct. Doctors carry malpractice insurance in the US, & those insurance companies have high paid lawyers who can make a patient’s case look very weak. Most patients can’t afford lawyers who can compete w/ the lawyers hired by the malpractice insurance companies so many medical lawsuits are won for the doctors but not the patients.
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I guess I’ve been watching too much Judge Judy Oh well, … as if it isn’t hard enough already for patients!
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