Eagle syndrome (ES) is a condition that causes variable and non-specific symptoms. Patients often present with various symptoms that may include constant or recurrent throat and neck pain running into the base of the skull, head, temporals, jaws, face, and throat. It is caused by an excessively long styloid process or calcification of the attached stylohyoid ligament.
Eagle syndrome is not as rare as most would have you believe. Due to the highly variable non-specific nature or symptoms, sufferers are often misdiagnosed. Some seek care and advice from multiple healthcare providers. Eagle syndrome is often confused with or misdiagnosed as trigeminal neuralgia.
The syndrome is divided into two categories: carotid and classic. Patients with the carotid type will experience pain or discomfort at the skull’s parietal bone (side and top of the head) or the superior orbital region (top of the eye socket). In comparison, those with classic Eagle syndrome will present with the sensation of having a foreign body in the throat, leading to difficulty swallowing.
The Link Between Eagle Syndrome, Styloid Process & The Hyoid Bone
The hyoid bone is a floating bone at the top of your throat, below the tongue. Its purpose is to hold the tongue and the larynx (voice box or Adam’s apple). Also, it helps you open your mouth. The average length of the styloid process for an adult Caucasian is 20–25 mm and 15–18 mm for Asians. About 4% of the population has an elongated styloid process. Fortunately, not everyone with an elongated styloid process gets Eagle syndrome; however, this population’s risks are significantly higher.
The styloid process is a thin, pointy bone that projects down from the temporal bone. There are two styloid processes, one on each side of your upper neck. Three muscles and two ligaments attach to the styloid process:
- Stylopharyngeus muscle: The stylopharyngeus muscle lifts the larynx and pharynx (two anatomical structures at the back of your throat that helps to pass food during swallowing).
- Stylohyoid muscle: The stylohyoid muscle lifts the hyoid bone when you swallow.
- Styloglossus: The styloglossus draws the sides of your tongue up and back to help with swallowing.
- Stylohyoid ligament: The stylohyoid ligament connects your hyoid bone to the base of your skull. It elevates and suspends the hyoid bone near the throat.
- Stylomandibular ligament: This ligament originates near the base of the skull in neck tissue and the top (apex) of the styloid process and attaches to your mandible. It limits how far you can open your mouth.
The Link Between Stylohyoid Calcifications & Neck Disorders
A study published in the Journal of Rheumatology provides in-depth insight into the correlation between the ossification of the stylohyoid ligament and neck arthritis (cervical osteophytes). The study’s goal was to see whether there were any links with DISH (Diffuse Idiopathic Skeletal Hyperostosis), a progressive form of osteoarthritis. The researchers assessed CT scans from 100 patients with neck and upper back x-rays. They found significant correlations between patients with calcified (ossified) stylohyoid ligaments and those with ligamentous ossifications in the cervical and thoracic spine (neck, upper, and mid-back).
What Causes Eagle Syndrome?
Eagle syndrome (ES) is related to abnormalities (elongations or malformations) of the styloid bone and the ossification (calcification) of the stylohyoid ligament. It is more common in females; females have a three times higher chance of getting ES. The actual cause of ES is not fully understood, but there are several theories:
- Congenital issue (an abnormally long styloid process or a malformed styloid process)
- Trauma to the throat
- Patients who have had a tonsillectomy
- Thickening (overgrowth or hypertrophy) of the stylohyoid ligament
- Calcification of the stylohyoid ligament
- Excessive head and neck flexion as seen in text-neck patients (looking down or the excessive use of laptops, phones, tablets, or other hand-held devices)
- Sports injuries or whiplash injuries (especially in people with a longer styloid process)
What Does Eagle Syndrome Feel Like?
As with any disorder, ES can be mild, moderate, or severe. Patients might feel a dull, throbbing pain in the neck, throat, or jaw. Some patients will also complain that something is stuck in their throat. Severe cases of ES can cause chronic pain. Living with chronic pain can lead to anxiety, social problems (e.g., relationship issues), and depression. Therefore, getting help at an early stage is critical.
What Symptoms Are Associated With ES?
Classic symptoms for Eagle syndrome include neck and throat pain that radiates to the ear (tinnitus), face, jaw, or eye sockets. For most people, the symptoms only affect one side of the head, but they can rarely occur on both sides. The following is a list of common Eagle syndrome symptoms:
- Facial pain
- Pain in the ear (otalgia)
- Pain or discomfort in the jaw
- Dysphagia (difficult swallowing)
- Headaches and migraines
- Pain at the base of the tongue
- Pain when the tongue is extended
- Pain when turning the head and neck
- A change in one’s voice
- Ringing in the ear (tinnitus)
Due to the variable nature of its symptoms, ES is often misdiagnosed as one of many other conditions, including occipital neuralgia, headache, migraine, tonsilitis, dental infection, ear infection, jaw disorder (temporomandibular disorder or TMD), atypical facial pain syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, and mastoiditis.
How Is It Diagnosed?
Eagle syndrome is a difficult condition to diagnose. The difficulty lies in the fact that ES shares symptoms with many other conditions, as listed above. The diagnosis starts with an assessment. Our chiropractor will assess your jaws, neck, and the base of your skull. He or she will perform a set of physical examinations that include palpation, muscle testing, and range of motion to see if turning or tilting your head and neck causes increased symptoms. They will most likely send you for x-rays, a 3D-CT scan, and an MRI to assess the areas around your upper neck, styloid process, or stylohyoid ligament more thoroughly. We may also send you to an EENT (ear, nose, and throat specialist) to rule out other conditions. Having said all that, the gold standard for the diagnosis of ES is a 3D-CT scan.
What Are The Treatment Options For Eagle Syndrome?
Eagle syndrome is not as rare as most believe. Often, ES is misdiagnosed as neuralgia, ear infection, TMD (jaw issue), psychosomatic disorder, or other non-specific health issues, to name a few. The rate of misdiagnosis is due to unfamiliarity with this condition. A such, most report ES as a rare condition.
There are a few related research articles about effective therapy and treatment options for Eagle syndrome. The vast majority of published literature cites medication or invasive procedures such as styloidectomy or steroidal injections. Prescription and over-the-counter medicines have not been shown to manage ES patients effectively. In our option, surgery and steroidal injections should be the last option.
According to a new study, doctors and patients should know the complications and side effects of steroidal injections for classification and arthritis. In October 2019, the Journal of Radiology published research that looked at 459 patients who had received corticosteroid injections. Researchers reported an accelerated progression of osteoarthritis (ossification) and other effects. The study was concentrated on the knees and hips. Long-term steroid injections into the upper neck at the base of the skull should be avoided as there are cranial and spinal nerves and soft tissue there; steroidal injections to this area may lead to premature wear and tear. Moreover, Eagle syndrome is a condition related to ossification (a form of osteoarthritis) of the stylohyoid ligament, which connects to the styloid process.
Invasive Therapeutic Procedures Should Be Carefully Planned.
The styloid process runs between the internal and external carotid arteries. Also, other nearby structures include the jugular vein and the occipital artery. There are also sensitive nerve fibers that exit the neck and cranial nerves. Here is the list of cranial nerves that are close to the styloid process:
The cranial nerves V (trigeminal nerve), VII (facial nerve), IX (glossopharyngeal nerve), X (vagus nerve), XI (accessory nerve), and XII (hypoglossal nerve) have been reported to be injured by the elongated styloid process.
Therefore, any form of invasive procedure should be carefully reviewed. If the need arises, it is best to have it done by a clinician who has mastered the methods through multiple successful cases.
What Is A Non-Invasive Treatment For Eagle Syndrome?
Non-invasive therapies and treatments should always be tried before opting for an invasive procedure. Physiotherapy, as well as chiropractic care, offers great hope. However, not all physiotherapy or chiropractic centers are versed in treating Eagle syndrome patients. Eagle syndrome physiotherapy treatments require specialized skills, technology, and a thorough understanding of the condition. Chiropractic care for patients with Eagle syndrome should be performed through non-rotatory methods. The best chiropractic technique for an Eagle syndrome patient is the Activator Method.
Eagle syndrome treatment at the Chiropractic Specialty Center® is performed through specialized physiotherapy methods combined with focused chiropractic treatments using the Activator Method. Our clinical teams, techniques, and technology have helped many.