Eagle Syndrome

What is Eagle syndrome?

In Eagle syndrome, an elongated styloid process or a rigid stylohyoid ligament causes pain in your face, neck or throat. Your styloid process is a small, needlelike bone beneath each ear. The stylohyoid ligament extends from your styloid process to the hyoid bone at the front of your neck. Like most ligaments, it’s supposed to be stretchy. But with Eagle syndrome, it’s often hard and bony.

People experience symptoms when the bone or hardened ligament presses on nearby nerves or blood vessels.

How common is Eagle syndrome?

As few as .16% of people in the general population have this rare pain syndrome.

Only about 4% of people have an elongated styloid process. A typical styloid process is about 2.5 centimeters long (just under an inch). An elongated styloid process is over 3 centimeters (just over an inch). But only a small percentage of people with an elongated styloid process have symptoms of Eagle syndrome.

You’re three times more likely to have Eagle syndrome if you’re a person assigned female at birth (AFAB). Most people receive a diagnosis when they’re in their 30s or 40s.

What are the symptoms of Eagle syndrome?

Symptoms depend on which nerves or blood vessels come into contact with your styloid process or stylohyoid ligament.

Symptoms include:

• Pain in your face, neck or throat (often worsens when you chew, yawn, talk or turn your head).
• Feeling like something’s stuck in your throat.
• Difficulty swallowing (dysphagia).
• Ringing in your ears (tinnitus).
• Headache.
• Dizziness.

Most people with Eagle syndrome have an elongated styloid process on both sides of their head, but the majority only experience pain on one side.

What does Eagle syndrome feel like?

Pain symptoms are often similar to those in glossopharyngeal neuralgia. A styloid process that squeezes your glossopharyngeal nerve (a major nerve deep in your neck) can cause sharp or shooting pain near your tonsils or the back of your tongue. The pain may radiate to your ear.

Others describe the nerve pain associated with Eagle syndrome as recurrent, dull and throbbing.

What causes Eagle syndrome?

Symptoms occur when an elongated styloid process or a bony stylohyoid ligament places pressure on sensitive nerves or blood vessels in your head and neck. But experts continue to debate what causes the atypical structures in the first place.

In 1937, the syndrome’s namesake, Dr. Watt Eagle, proposed that sometimes, the stylohyoid ligament ossifies (turns to bone) after a tonsillectomy. Other potential causes include infections, neck injuries, or a decline in ligament elasticity due to aging.

What are the complications of Eagle syndrome?

Although it’s rare, an elongated styloid process can place pressure on nearby blood vessels, like your carotid arteries. When this happens, you may notice pain beneath your eyes or experience symptoms of a transient ischemic attack (TIA) or stroke, including:

• Numbness on one side of your face (hemiparesis).
• Dizziness.
• Blurred vision.
• Passing out or fainting (syncope).
• Changes in your speech (like slurring your words).

In Eagle syndrome, these symptoms are often episodic, which means they eventually go away. But sometimes, they signal a medical emergency (like a cut or damaged artery).

Call 911 (or your local emergency service number) or get to the ER immediately if you’re experiencing symptoms of a stroke.

How is Eagle syndrome diagnosed?

Your healthcare provider will review your medical history (including whether you’ve had surgery or an injury to your head and neck) and perform a physical exam. Sometimes, your provider can feel an abnormal styloid process when they touch your neck. Or, they may feel in the area of your tonsils inside your mouth and ask if it causes pain.

Imaging can show an abnormal styloid process or stylohyoid ligament. Tests include:

• Computed tomography (CT) scan: Uses a series of X-rays to take pictures of your styloid process and stylohyoid ligament. It recreates a three-dimensional (3D) image of these structures, so your provider can see if you have an elongated styloid process.
• Computed tomography (CT) angiogram: Takes X-ray images of blood vessels. You may need CT angiography if your provider suspects your styloid process or stylohyoid ligament is placing pressure on your carotid arteries.

What can be mistaken for Eagle syndrome?

An important part of diagnosis involves excluding conditions that can also cause symptoms of Eagle syndrome. Your provider may run tests to rule out:

• Inflammatory head and neck conditions (sinusitis, tonsillitis, insertion tendinitis).
• Temporomandibular joint (TMJ) disorders.
• Glossopharyngeal neuralgia.
• Myofascial pain syndrome.
• Head and neck cancer.
• Migraine headaches.
• Dental problems.

How is Eagle syndrome treated?

Your healthcare provider may recommend medications to manage the pain or surgery to shorten your styloid process (styloidectomy). Treatment depends on how severe your symptoms are and whether you’re a good candidate for surgery.

Medications include:

• Painkillers (analgesics).
• Antidepressants.
• Steroid injections.
• Lidocaine injections.
• Over-the-counter (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs).

Surgery to shorten your styloid process can cure Eagle syndrome. Your surgeon may perform a styloidectomy using either of two approaches:

• Intraoral (transoral): Your surgeon accesses your styloid process through your mouth. This approach won’t leave behind a scar, but it’s harder for your provider to access the area than with the extraoral approach.
• Extraoral (transcervical): Your surgeon accesses your styloid process through a neck incision (cut). This approach allows your provider direct access to the tissue but requires a longer operating time. You’ll also have a scar afterward.

Your provider can explain which approach is best according to your diagnosis.

What are the complications of a styloidectomy?

No surgery is without risks. Trauma to tissue during surgery can lead to scarring and deep infections in your throat that can be serious without treatment.

Seeing a surgeon with extensive experience performing head and neck surgeries can reduce your risk of complications like these.

Can Eagle syndrome be prevented?

There’s nothing you can do to prevent Eagle syndrome. But surgery to shorten your styloid process can eliminate your symptoms for good.

What is the outlook for Eagle syndrome?

The outlook is excellent. Approximately 80% of people who get a styloidectomy no longer experience symptoms. For many people, over-the-counter and prescription pain relievers are enough to keep the pain and discomfort at bay.

What happens if Eagle syndrome is left untreated?

Without treatment, you’ll continue to experience symptoms. It’s not a condition that improves on its own.

Still, it’s important to remember that just because your styloid process is calcified or elongated doesn’t mean you have Eagle syndrome. There are also those who have an elongated styloid process and symptoms of Eagle syndrome who get surgery to shorten the styloid process, but it doesn’t improve their symptoms.

This is why it’s important to see a healthcare provider with experience in diagnosing and managing this condition — because it can be difficult to judge who will benefit from surgery. Your provider can advise you on your treatment options.

What questions should I ask my healthcare provider?

Questions to ask include:

• What likely caused my elongated styloid process?
• Is my styloid process pressing against major nerves or blood vessels?
• What symptoms should I expect based on the nerves involved?
• Will I need surgery or medications?
• What will surgery involve?

A note from Cleveland Clinic

In Eagle syndrome, even a few extra centimeters of hardened tissue can cause pain that makes you wary of turning your head or making facial movements. The good news is that living with Eagle syndrome symptoms doesn’t have to be your new normal. Eagle syndrome is treatable. Your healthcare provider can advise you on whether you need medications or surgery.