Eagle syndrome

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Eagle syndrome
Synonyms	Styloid syndrome, stylohyoid syndrome
Pronounce	N/A
Specialty	N/A
Symptoms	Throat pain, earache, dysphagia, headache, facial pain
Complications	Carotid artery dissection, stroke
Onset	Typically adulthood
Duration	Chronic
Types	N/A
Causes	Elongation of the styloid process or calcification of the stylohyoid ligament
Risks	Trauma, tonsillectomy
Diagnosis	Physical examination, imaging studies such as X-ray, CT scan
Differential diagnosis	Temporomandibular joint disorder, trigeminal neuralgia, glossopharyngeal neuralgia
Prevention	N/A
Treatment	Analgesics, corticosteroid injections, surgery
Medication	Pain relievers, anti-inflammatory drugs
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Eagle syndrome

Definition

Eagle syndrome is a recurrent pain in the middle part of the throat (oropharynx) and face.

Cause

Eagle syndrome is due to a calcified stylohyoid ligament or an elongated styloid process.

Styloid process

The styloid process is a pointed part of the temporal bone that serves as an anchor point for several muscles associated with the tongue and larynx.

Other names

1. Elongated styloid process which causes neck and facial pain tinnitus and otalgia;
2. Elongated styloid process syndrome;
3. Styloid-stylohyoid syndrome;

Signs and symptoms

• "Classic Eagle syndrome" is typically seen in patients after throat trauma or tonsillectomy
• Symptoms include dull and persistent throat pain that may radiate to the ear and worsen with rotation of the head.
• Other symptoms may include difficulty swallowing, feeling of something stuck in the throat, tinnitus, and neck or facial pain.
• A second form of Eagle syndrome unrelated to tonsillectomy causes compression of the vessel that carries blood to the brain, neck, and face (carotid artery) which cause headache and dizziness

Diagnosis

• Diagnosis is is made with clinical presentation and imaging studies.
• The classic form of "Eagle syndrome" presents as unilateral neck pain, sore throat or tinnitus.
• Sometimes the tip of the styloid process is palpable in the back of the throat.
• The diagnosis of the vascular type is more difficult and requires an expert opinion.
• One should have a high level of suspicion when neurological symptoms occur upon head rotation.
• Symptoms tend to be worsened on bimanual palpation of the styloid through the tonsillar bed.
• They may be relieved by infiltration of lidocaine into the tonsillar bed.
• Because of the proximity of several large vascular structures in this area this procedure should not be considered to be risk free.
• Imaging is important and is diagnostic.
• Visualizing the styloid process on a CT scan with 3D reconstruction is the suggested imaging technique.
• The enlarged styloid may be visible on an orthopantogram or a lateral soft tissue X ray of the neck.

Treatment

• The mainstay treatment for Eagle syndrome is surgery to shorten the styloid process called styloidectomy.

Surgery

• Traditionally, this surgery has been done using either an intraoral (through the mouth) or extraoral (through the neck) approach.
• The intraoral approach usually requires tonsillectomy, and access to the styloid process is limited.
• There is also risk of injury to major vessels.
• However, this method reportedly is safe, more simple, and an external scar is avoided.
• The extraoral approach may provide better exposure of the process and its surrounding structures.
• However, this approach results in a scar, requires going through connective tissue and may carry an increased risk of trauma to surrounding structures.
• In recent years, more minimally-invasive techniques have been used for head and neck surgery.

Endoscopic assisted surgery

• Some patients with Eagle syndrome have undergone an endoscope-assisted surgery.

Medical management

• Medical management of Eagle syndrome may include the use of pain and anti-inflammatory medications, antidepressants, and/or steroids for pain.
• The overall success rate for treatment (medical or surgical) is about 80%.

Epidemiology

• Approximately 4% of the general population have an elongated styloid process, and of these about 4% give rise to the symptoms of Eagle syndrome.
• The incidence of stylohyoid syndrome may be about 0.16%.
• Patients with this syndrome tend to be between 30 and 50 years of age but it has been recorded in teenagers and in patients > 75 years old.
• It is more common in women, with a male:female ratio ~ 1:2.

History

The condition was first described by American otorhinolaryngologist Watt Weems Eagle in 1937.

Gallery

• 
  Radiograph, lateral view showing joint-like formation in ossified stylohyoid ligament
• 
  CT scan, coronal section showing bilateral extended styloid process and stylohyoid ligament ossification (incidental finding)
• 
  3D-reconstructed CT scan showing bilateral stylohyoid ligament ossification
• 
  3D reconstructed CT scan showing elongated styloid process (right side)

FAQS

Can you help answer any of these frequently asked questions on Eagle syndrome?

Frequently asked questions about Eagle syndrome

• Does Eagle syndrome go away?

Eagle syndrome typically does not resolve spontaneously. Treatment is often required if symptoms persist.

• Can you feel Eagle syndrome?

Yes, Eagle syndrome is often characterized by a palpable lump or tenderness in the neck area.

• What does Eagle syndrome feel like?

Symptoms include throat pain, difficulty swallowing, foreign body sensation, and pain that radiates to the ear or jaw.

• Is Eagle syndrome life threatening?

No, Eagle syndrome itself is usually not life-threatening but can significantly affect quality of life.

• Can Eagle syndrome come and go?

Yes, symptoms of Eagle syndrome may fluctuate or be intermittent.

• Can the hyoid bone shift?

Yes, the hyoid bone can shift slightly, contributing to symptoms similar to those seen in Eagle syndrome.

• How do you test for Eagle syndrome?

Diagnosis involves clinical evaluation, imaging tests such as X-ray or CT scan, and examination of symptoms.

• Is Eagle syndrome rare?

Eagle syndrome is considered rare, although precise prevalence is not clearly established.

• How long does it take to recover from Eagle syndrome surgery?

Recovery from surgical treatment (styloidectomy) typically takes several weeks, with most patients improving significantly within 2 to 4 weeks.

• Can Eagle syndrome cause strokes?

Rarely, elongated styloid processes in Eagle syndrome have been associated with transient ischemic attacks (TIA) or strokes due to compression of adjacent blood vessels.

• Does Eagle syndrome cause ear pain?

Yes, ear pain (otalgia) is a common symptom of Eagle syndrome due to referred pain.

• Does Eagle syndrome cause headaches?

Yes, headaches may occur, typically related to referred pain or vascular compression.

• How common is Eagle syndrome?

Eagle syndrome is rare; it is estimated to affect around 4% of the population, with only a small fraction experiencing symptoms.

• What type of doctor treats Eagle's syndrome?

Otolaryngologists (ENT) or oral and maxillofacial surgeons commonly treat Eagle syndrome.

• How does Eagle syndrome happen?

Eagle syndrome occurs due to elongation or calcification of the styloid process or stylohyoid ligament, causing symptoms by compressing surrounding nerves or vessels.

• Why is it called Eagle syndrome?

It is named after Watt Weems Eagle, an American otolaryngologist who first described the syndrome.

• Which nerve is affected by Eagle's syndrome?

The glossopharyngeal nerve is commonly affected, leading to characteristic pain and symptoms.

• Can Eagle syndrome cause tinnitus?

Yes, Eagle syndrome may cause tinnitus through irritation of surrounding nerves or blood vessels.

• Can Eagle syndrome cause hearing loss?

While rare, Eagle syndrome could theoretically contribute to hearing changes, although direct hearing loss is uncommon.

• Is Eagle syndrome congenital?

Eagle syndrome is not typically congenital; it usually develops later in life due to calcification or elongation of anatomical structures.

• How risky is a Styloidectomy?

Styloidectomy is considered relatively safe, but as with any surgery, there are risks including nerve damage, bleeding, or infection.

• What are calcified ligaments?

Calcified ligaments occur when calcium deposits build up in ligamentous tissues, making them stiff or elongated, as seen in Eagle syndrome.

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