Eagle Syndrome

Eagle syndrome is medically known as the elongation of the styloid process and stylohyoid ligament calcification. This typically occurs with aging, and often results in sharp, intermittent pain along the glossopharyngeal nerve that is located in the hypopharynx and at the base of the tongue.

Styloid process

Right side of the skull. Styloid process shown in red – wikicommons

In new research from Turkish neurosurgeons, the doctors published their summary findings that in some cases it has been reported that carotid artery compression (the major artery in the neck that supplies blood to the neck, brain and face) can be seen due to elongated styloid process. This is called carotid artery syndrome. Carotid artery compression causes flow reduction and carotidynia or neurological symptoms (typically seen with cervical neck problems) can be seen.1

In another new paper, doctors have suggested that “Eagle syndrome should be a consideration in any patient with a carotid injury due to blunt trauma or suffering a syncopal episode which led to blunt trauma.”2

The styloid process is a piece of bone that starts at the base of the skull and attaches to a number of muscles and ligaments that are connected to the throat and tongue. Elongation of the stolid process, as well as a calcification of the stylohyoid ligament, can result in Eagle Syndrome. The stylohyoid ligament is located between the styloid process and the hyoid bone, a bone in the front of the throat, to which a number of throat muscles are attached.

Doctors at The New York Eye and Ear Infirmary of Mount Sinai Hospital have published their recommendations for Eagle Syndrome in the journal Clinical neurology and neurosurgery. Here are the study highlights:

  • A comprehensive literature review was conducted on peer-reviewed publications of Eagle syndrome across multiple disciplines in order to gain a thorough understanding of the presentation, diagnosis, and management of this disorder.
  • Diagnoses of Eagle Syndrome have increased, in part due to the awareness of physicians to patient symptomatology.
  • While cervical pain and dysphagia (swallowing difficulties) are among the typical symptoms, patients can present with a wide spectrum of benign and dangerous symptoms.
  • Treatment strategies include medical management (analgesics, corticosteroids, antidepressants, and anticonvulsants) and varied surgical approaches (extraoral, transoral, endoscopic assisted).
  • Increased understanding by providers treating patients with Eagle Syndrome allows for a more comprehensive treatment plan. With a variety of medical regimens and more definitive surgical approaches, Eagle Syndrome can be treated safely and effectively.3

Most physicians have not heard of Eagle syndrome and do not know where the stylomandibular ligament is located. For this reason, many people receiving the treatments mentioned above do not obtain relief from their pain as in the symptoms listed below.

What are the symptoms of Eagle syndrome?

People with Eagle syndrome may experience a wide range of symptoms, including pain in both the throat and the ear, vertigo and dizzinessJaw pain –  Difficult jaw opening – TMJ painVertigo (please see our article on cervical vertigo), voice alteration, cough, sinusitis or bloodshot eyes. It may feel like something is stuck in one’s throat, and swallowing may be difficult. It may also be painful to turn one’s head. Pain during swallowing, opening the mouth or turning the head may also be experienced.

If someone chronically experiences any of these symptoms, the stylomandibular ligament must be palpated. If a positive “jump sign” can be elicited, the culprit for the chronic ear-mouth pain has most likely been located. Prolotherapy injections at the stylomandibular ligament bony attachments will start the repair process. Once the stylomandibular ligament is strengthened, the chronic ear-mouth pain, tinnitus, dizziness, vertigo, and other pain complaints subside.

 

Prolotherapy Treatment of Eagle syndrome

Ear and mouth pain is often associated with a variety of diagnoses, including otitis media, otitis externa, trigeminal neuralgia, atypical facial pain or temporomandibular joint syndrome (TMJ). Treatment usually involves steroid and anti-inflammatory creams, drops and pills. In the long run, treatments such as steroids and anti-inflammatory medications can do more damage than good.

Because Eagle syndromes are caused by weakness in the stylomandibular ligament, a better treatment approach is to strengthen this ligament with Prolotherapy.

In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates long term healing.

1 Aydin E, Quliyev H, Çinar C, Bozkaya H, Oran İ. Eagle syndrome presented with neurological symptoms. Turk Neurosurg. 2016 Oct 14. doi: 10.5137/1019-5149.JTN.17905-16.6.

2 Mann A, Kujath S, Friedell ML, Hardouin S, Wood C, Carter R, Stark K. Eagle Syndrome Presenting After Blunt Trauma. Ann Vasc Surg. 2016 Nov 24. pii: S0890-5096(16)31214-6. doi: 10.1016/j.avsg.2016.07.077.

3 Badhey A, Jategaonkar A, Kovacs AJ, Kadakia S, De Deyn PP, Ducic Y, Schantz S, Shin E. Eagle syndrome: A comprehensive review. Clinical Neurology and Neurosurgery. 2017 May 6. [Pubmed] [Google Scholar]

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