Worse than I thought

[SCJeff]

I have been living with eagle’s syndrome for over 11 years. During my junior year of college I was struck with many painful and concerning symptoms mainly on the front right of my neck and jaw. I met with numerous doctors and even went to the Mayo Clinic but at every turn I felt dismissed and was told I was too young to be having health problems. My 2015 neck CT scan radiology report even said “Calcification of the bilateral stylohyoid ligaments (Eagle syndrome). This could be a source of pain.” yet the ordering ENT dismissed that and told me something to the effect of ‘If eagle’s syndrome was causing you problems, you would be chocking on your food, and I don’t do surgery for that anyway.. it’s probably too risky’. When we asked Mayo clinic about my eagle’s syndrome findings, they said its rare and likely not causing me any problems. Mayo clinic prescribed me sleeping medication and recommended I get help for anxiety - they likely thought I was just a hypochondriac.

My symptoms were enlarged/swollen and firm right side neck, lymph node pain, jaw pain, ear pain, and some pain radiating down into my right shoulder. My parents recommended I try alternative medicine and I got into acupuncture, massage, herbs, and exercise which helped me cope. For a short amount of time I did take SSRI medication which allowed me to stop worrying I was dying.

For the next 11 years I have tried to manage or ignore my symptoms. I finished my engineering degree, got a job, studied and achieved my professional license and got involved with various sporting programs and social activities. I’ve also had a couple great relationships but had to disclose I do not want to procreate because its already very difficult for me to manage my symptoms and stress. My symptoms have persisted and some new ones like 2 molar failures on bottom right jaw and now stiff rear neck.

In the last few years my neck mobility has become more restricted, especially turning right, so I began an intensive chiropractic treatment plan this at the start of 2026. My neck and head were basically fused and turned slightly left. With the adjustments my mobility has improved but it has also added some pain and soreness to rear of neck vertebrae and the adjustments don’t hold long and sometimes I would get stuck back worse. One day it suddenly dawned on me that perhaps my eagles were pulling me out of alignment so I mentioned it to my chiropractor. Next, I stumbled into some youtube videos from Dr. Hauser at Caring Medical Florida showing the relationship between elongated styloids and jugular compression and listened to some of his patient testimonies about their improvements following styloidectomies. I also watched Dr. Middleton’s videos showing ct scans in 3D and wanted to go back and look how mine compared.

I dug up that 2015 neck CT scan from My Chart and downloaded RadiAnt DICOM modeling software which converts CT scan files into 3D model and saw my very large calcified stylohyoid ligaments and used the cut tool to remove the front of face for better visualization. My right side was completely calcified and the left side partially calcified.

I continued watching and learning more about eagle’s syndrome and began to realize these structures surely explain my history of symptoms. I found Dr. Osborne’s docuseries on eagles patients and watched in complete awe the stories of healing and I related to so many of their symptoms. I felt he was the doctor I needed. I met with him via Zoom a couple weeks ago and explained my symptoms of which he said certainly makes sense, all except my neck swelling which would be rarely caused by eagles, and we reviewed my 2015 neck CT but he wanted an updated scan for surgery safety purposes. I am meeting with him again next week to review the new scan.

I had my updated neck CT scan this week and got the report back - my condition has worsened noticeably since last scan. Now both stylohyoid ligaments are fully calcified and the radiologist noted “There is compression of the right internal jugular vein between the right styloid process and the right transverse process of C1” which is accompanied by the enlarged jugular vein and explains my swollen right sided neck all these years. I’ve attached a screenshot of the new scan.

I have a mixture of validation, mourning, and hope. I long for the day I can live without these rods in my neck. So this long winded post is my introduction to the Living with Eagle’s community and start of documenting my journey. I hope to connect with and learn from others on our quest for healing.

[MGORNEAU]

@SCJeff Welcome to the forum. The moderators should be able to give you access to upload images shortly.

I had bilateral styloidectomies with Dr. Osborne in December 2025. Many of my symptoms improved or resolved after surgery, although not all of them. I had significant swelling in my face and neck, which reduced considerably afterward surgery but has not completely resolved on my right side.

Since your imaging shows compression between the styloid and C1, I would also consider obtaining a second opinion from someone who evaluates the styloids, C1, and the surrounding vascular and neurological structures together. My styloids were successfully removed, but my C1-related components were not addressed, and I will now be having an additional surgery for the debilitating symptoms that remain. This is only my experience, but with such a significant financial commitment, I think having more than one surgical opinion is worthwhile.

If you are interested in another opinion from a neurosurgeon, or from someone who works closely with one and evaluates the C1 component as well, I would be happy to share the name of the surgeon who will be performing my upcoming surgery. The moderators can also provide information on additional surgeons for possible consultations if you are interested.

[SCJeff]

Thank you for sharing your experience, I am glad you had some improvement from the styloidectomies and I would certainly like to talk to the doctors you are going to next. I understand Dr. Osborne doesn’t trim C1s, and his reasoning makes sense, but if trimming them gives better results I want to consider that too.

[MGORNEAU]

The neurosurgeon I am seeing is Dr. James K. Liu with Neurosurgeons of New Jersey. He evaluates C1-related compression and the surrounding vascular and neurological structures, and he will be performing my upcoming surgery.

The intake questionnaire is long, but it is very important to complete it thoroughly and provide as much detail as possible. The video consultation fee is $500 if you are not being seen in person through insurance. In my opinion, the consultation was well worth it. His practice also works with insurance, and my surgery will be in network, although I do have a PPO this year.

Dr. Liu is widely recognized as a top-tier specialist in his field. He is not only an exceptional surgeon but also a very kind, down-to-earth person, and that is clearly reflected in his team, who have been amazing as well.

[MGORNEAU]

I just saw your imaging, Jeff, and it literally brought me to tears. I am so sorry you have been dealing with this for so many years. The extent of the calcification is overwhelming to see, especially knowing how long your concerns were dismissed.

[lsheep]

Oh my goodness @SCJeff I am deeply sorry for the way you have been dismissed and treated! Welcome to the forum, you will find support, compassion and understanding here.

[Isaiah_40_31]

@SCJeff - I’m of the same opinion as @MGORNEAU & @lsheep! All I can say is ! No wonder your neck has been stiff & immobile, & you’ve had the jaw, teeth & neck & other symptoms you have. Your styloids aren’t just long, they’re also thick at the top.

I agree w/ @MGORNEAU, your IJVs look to be bilaterally compressed more by C1 than your styloids especially on the left side. In that case, Dr. Osborne is not the ideal doctor for your surgery. Doctors on our forum who specifically do surgery for situations like yours are Dr. Liu in NJ, who has been mentioned, Dr. Costantino in NY, Dr. Cognetti in PA, Dr. Hepworth in CO & Dr. Nakaji in AZ. Dr. Fargen in NC also does the surgery but isn’t as experienced as the others I’ve named, & it’s very difficult to get an appt with him.

Here are the images I annotated.

[SCJeff]

Thanks for your help and annotations, that’s helpful. My left side is not nearly symptomatic as my right. Thanks for the doctor referrals, I applied for a consultation with Dr. Liu and will meet with him asap.

Is there any possibility that going for a more extensive surgery with C1 shaving etc to have less reliable outcomes? And in other words, would a more conservative surgery like Dr. Osborne’s be more likely to help but maybe not fully resolve the problem like the other could? And similarly I am wondering if it could help to stagger each side’s surgery a few months.

If I just got the right side fixed I think I would feel 90% better so the left can wait if need be. My worst fear would be a super aggressive approach that made me worse off and brought unforseen problems.

[MGORNEAU]

@SCJeff I hope sharing my experience is helpful. This is such a personal decision, and because we all have different anatomy, symptoms, and circumstances, only you can decide which approach feels right for you. I can only speak from my own experience, so hopefully others will chime in as well.

I had my bilateral styloidectomies one day apart and was very glad I did. My reasoning was that I preferred to have the venous outflow recalibrate once rather than undergo two widely separated recoveries. Several members here have also reported that after the more symptomatic side was treated, symptoms on the opposite side became more noticeable or aggressive. That does not happen to everyone, and not all surgeons will operate on both sides within days of each other.

It is also important to remember that recovery is seldom linear, so regardless of which path you choose, it can take considerable time to understand the full benefit of the surgery, or surgeries. I would have better days, followed by awful days, two steps forward and one step back. That continued for me until about month four. Around month six, some symptoms that had resolved began returning, including lightheadedness, right-sided ear muffling, and tinnitus. The pressure at the back of the right side of my head is now worse than it has ever been, or perhaps I simply notice it more, and the nerve pain in my neck and face is difficult.

Even so, considering where I was at the time, what I knew, and the options available to me, I would still make the same decision again.

It is also worth remembering that CTA/CTV is primarily designed to evaluate the vessels and bony anatomy. It may not fully characterize soft-tissue involvement around C1, such as fascial bands, ligaments, scarring, or nerve-related structures. The styloids may cause changes of this nature to surrounding structures that need to be addressed for optimal relief, and some C1-related findings may fall outside the usual scope of otolaryngology. In my case, this follow-up surgery will be addressing issues at C1 that are contributing to my remaining symptoms.

I am very glad you requested a consultation with Dr. Liu. He is very easy to talk to and, based on my experience, welcomes open dialogue with patients. My initial consultation date involved a bit of a wait, but the office was able to move it up. Once I met with him, surgery was scheduled quickly, within a month.

[Jules]

Wow, those I think are the worst styloids I’ve ever seen! Not that that’s an award you want!

I do agree that it looks like significant IJV compression on your right side between the styloid and the C1 process, so a good idea to get another opinion on whether a C1 shave would be worthwhile. There are a couple of videos by doctors who do C1 shaves which might be helpful, as some doctors, including Dr Osborne, don’t agree with doing C1 shaves:

Dr Costantino IJV compression and surgery - Symptoms and Treatments / Doctor Information - Living with Eagle

A Review Of IJV Compression by Dr Aghayev - General / Research Papers - Living with Eagle

A styloidectomy alone might help, but if it doesn’t you would then have the complication of scar tissue which would make a second surgery if you needed it harder.

We’ve had quite a few members who’ve had an enlarged SCM muscle as well, which sounds like it could be what you have?

Sternocleidomastoid muscle: Anatomy and functions | Kenhub

As you’ve lived with this for so long already, (goodness knows how!) it’s worth making the right decision for your surgery!

[SCJeff]

Thank you for the links, I’ve watched the video presentations from Dr. Liu and Dr. Constantino and enjoyed learning more about treating this. I’ve applied to contact both of them. I will also watch the podcast from Dr. Aghayev but he’s far away and not in my insurance network, but the other 3 doctors are.

I wondering if just removing the right styloid is enough. In the saggital view, the C1 on my left side is touching my left IJV (green circle) but it appears not to be compressing it and neither is the left side styloid - but on the axial view, it appears to have mild compression. The only symptom on my left side is ear pain when laying down whereas my right side has ALOT of symptoms.

Additionally, my head was propped up on a pillow shaped surface in the scanner which I think is making my head posture more forward than when I am upright so perhaps C1 would not be as involved as it appears. Conversely, a forward head posture can be more comfortable because it reduces the pressure from the styloids.

Obviously I will get the opinions of the doctors and consider what you all are sharing and I am reading here. It would be nice to get it fixed in as few surgeries and soon.

Yeah my right SCM is almost always very firm and swollen, or maybe the swelling and firmness is coming from my compressed/swollen IJV underneath, I’m not sure how to tell the difference. I also have lymph nodes that get pushed up and they can be firm and painful but they remain normal size.

[Isaiah_40_31]

@SCJeff

Is there any possibility that going for a more extensive surgery with C1 shaving etc to have less reliable outcomes? And in other words, would a more conservative surgery like Dr. Osborne’s be more likely to help but maybe not fully resolve the problem like the other could? And similarly I am wondering if it could help to stagger each side’s surgery a few months.

C1 shave surgeries generally provide the best outcomes for cases involving IJV compression where the transverse process of C1 is playing a prominent role in causing the compression. On our forum, we most often see that the styloid & TP of C1 are both involved in IJV compression so both the styloid & TP of C1 need to be dealt with to achieve optimal blood outflow benefit. There are also cases where styloidectomies alone are all that are needed to give the IJVs space to open enough to reduce or eliminate vascular symptoms.

Deoxygenated blood & toxins flow out of the brain via the IJVs. Freshly oxygenated blood flows into the brain via the internal carotid arteries (ICAs). When the IJV(s) are compressed, blood can flow into the brain faster than it can leave which causes a situation of intracranial hypertension i.e high pressure in the brain. It’s that pressure that causes the feeling of pressure in the head, migraines, visual changes, brain fog/derealization, tinnitus/pulsatile tinnitus, etc., & can cause CSF leaks if left untreated.

As @MGORNEAU - noted when only one styloid is removed, the symptoms the remaining styloid is causing often flare up & become even worst than before surgery. We suspect this is because in bilateral cases, removing one styloid creates an imbalance in the muscles, tendons, ligaments, & fascia in the neck which affects already stressed/irritated nerves/soft tissues which doesn’t resolve until the other styloid is removed. With your styloids being elongated to your hyoid bone, I suspect you will experience this problem significantly.

The doctors whom I mentioned all do only unilateral surgeries as having at least 3 months of healing time between surgeries is important especially when IJV decompression is done. However, you could consider going the same route as @MGORNEAU - i.e. have bilateral surgery w/ Dr. Osborne to get the styloids out of the way then recover for some months to see what symptoms remain. If there are significant symptoms, then pursue surgery for further IJV decompression. I think your approach to having several consults is good & I hope that between them all, you get a sense of what the right approach is for you.

[Jules]

Your right side styloid is certainly chunky, so removing it will give the IJV more space to open up, but I wouldn’t want to say whether not shaving the C1 would be enough for decompression , or did you mean will just having surgery on the right side be enough and that the left side might not need removing?

As @Isaiah_40_31 says, you can make the decision after you’ve had consultations with the other doctors, hopefully the best way forward will be clear…

[MGORNEAU]

I want to stress that the route I took was specifically based on the options available to me and what was known at the time. I do not regret having surgery with Dr. Osborne, but if the full picture had been known, if I had consulted with Dr. Aghayev beforehand, and if I had known about Dr. Liu, my path would have been different.

I responded to Jeff’s post because he now has access to options I did not have at that point, and I would rather see him have the best chance of success the first time. My styloidectomies helped many symptoms, but the C1 component remained, and I am now having another surgery to address it. Since Jeff has the opportunity to obtain a broader neurosurgical assessment before making his decision, I wanted him to understand that Dr. Osborne’s approach is focused on styloid removal and not addressing C1-related components.

[Isaiah_40_31]

@MGORNEAU - I understood what you were conveying to Jeff & appreciate the information & advice you offered him. It’s good for him to learn of different approaches to help resolve his symptoms.

I’m sorry you didn’t have the resources available to you that exist now when you were deciding who to have do your surgery. My IJV decompression was my 3rd surgery but didn’t require a C1 shave. It was the easiest of my ES surgeries to recover from. I hope your recovery is easier than from the bilateral styloidectomies you had.

[SCJeff]

I had my follow up appointment with Dr. Osborne yesterday to review new imaging, and we have decided to move forward with surgery! I’ve also heard back from Dr. Liu’s office assistant that she was sending my info to Dr. Liu nurse practitioner to schedule a meeting, and I will still consult his expertise on if he thinks a more invasive C1 combination decompression is needed, but after comparing notes with you all, and carefully reading all the decompression studies @Filya shared and weighing the fact I do not have those vascular eagle’s symptoms, I think styloidectomy alone will be sufficient. Additionally, I have alot of confidence in Dr. Osborne’s results and high case count experience.

I will follow up with Osborne’s scheduler on monday, and use this weekend to decide on whether to go for right side alone or go bilaterally. I am still leaning right side alone because my left side is basically asymptomatic except for occasional left ear pain when laying horizontal, and now I am also theorizing this could be caused by the right side IJV compression becoming worse when horizontal.

I’ve had alot of trouble with the rear of my neck this year. I did a very intensive 6 month chiropractic treatment plan that left me no better and perhaps worse, so I cancelled and now I am doing strengthening and therapy exercises which I think may help. This is another reason I am leaning towards a minimal approach for my eagles. ie styloidectomy alone, and only symptomatic side, because I feel in a delicate state. I am ok some days but I keep flaring up after sleeping on it wrong. I already use no pillow or a small wedge pillow in the curve of neck but when sleeping in uncontrolled positions it causes my neck to flare up so rigidly - I think the high velocity chiropractic adjustments must have torn ligaments. Hopefully in the next couple months until the surgery I can strengthen my neck with muscle training and I will start sleeping with a neck brace to prevent flare ups. I am excited for the future and appreciate everyone’s help and advice!

[MGORNEAU]

@SCJeff Your case is complicated. Based on my own experience, I’d still encourage you to hear Dr. Liu’s full opinion before making a final decision. I truly hope you find the relief you need.

[Isaiah_40_31]

@SCJeff - I can’t remember if I mentioned to you that severe occipital (rear of neck) pain can result from collateral veins that develop to assist IJVs that aren’t draining properly. It’s not always related to other soft neck tissues. I had significant occipital pain w/ ES, & it continued well beyond my styloidectomies until I had IJV decompression. I didn’t need a C1 shave. Just had my IJV moved away from C1 & that stopped the occipital pain.

[Chrickychricky]

@SCJeff @Isaiah_40_31 I too had significant sub occipital pain (base of skull) which was the result of IJV compression. All of that completely resolved with decompression (styloid and C1) surgery. Best of luck to you.

[SCJeff]

I definitely want to hear back from Dr. Liu! His admin assistant took my records and said his nurse practitioner would reach out to me next. I also sent a contact form to Dr. Constantino’s office but have not heard anything. I regret not asking Dr. Osborne about the C1/styloid compression on the right side, but I already knew from watching an interview of him he would say relieving the pressure from the styloid is enough to free up the IJV. And also because I don’t have vascular symptoms of brain fog, head noises, tinnitus, intercranial pressure, etc I am inclined to believe that could be true for me, I believe my symptoms are classic eagles because of mainly pain related issues despite the compression.

@Isaiah_40_31 Thank you for mentioning this, yes even before my recent cervical issues, I have horrible right rear occipital pain around my collateral veins. This is the first I’ve heard about IJV decompression after eagle’s by moving the IJV! What did that involve for you and how was that accopmlished?

@Chrickychricky Thank you for sharing, we have that in common for sure. I’m so happy yours resolved with styloidectomy and C1 decompression! Who did your surgery and what led you to going that route - did you have vascular eagle’s symptoms? And have you had any cervical instability or other related issues resulting from the C1 shave? I understand this is a new technique and the doctors claim it doesn’t impact cervical stability, but when I look at anatomy diagrams there does appear to be ligaments on the transverse process foramen that would be lost due to this bone resection. Sorry for all the questions.