Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
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Patient's Query
Hello doctor,
I have had persistent poking pain sensation for four years in the right side of my neck near the intersection of my jaw and ear. Pain originating below the jaw in the stylohyoid or digastric muscles that shoot up to the head and neck. I had previously done an endoscopy and was diagnosed with gastroesophageal reflux syndrome (GERD). An x-ray of my neck was suggested to be cervical lordosis. I have taken medications such as Diclofenac, Paracetamol, and Ibuprofen. However, I have not yet found the correct diagnosis after consulting various doctors. I came across Eagles syndrome during an internet search of my symptoms. I would like to know if I have Eagles syndrome.
Hi,
Welcome to iclinic.com.
I understand your concern. As I can see, you have attached (attachments removed to protect the patient's identity) an orthopantomogram (OPG), mainly taken for dental problems. However, the styloid appears to be prominent; the proper X-ray for an elongated styloid would be a paranasal sinus (PNS) X-ray Towne's view. So this pain of yours does it increase on swallowing? Is the pain more during sleeping hours at night? Is your ear examination, as suggested by your ear, nose, and throat (ENT) specialist, normal? Any ear discharge? Is the pain more on chewing hard foods than your temporomandibular joint?
Patient's Query
Hello doctor,
Thank you for the reply. Sleeping and morning times are when the pain is the least. Pain increases as the day goes on, mainly increasing as I stress more of my neck muscles. As per my reports, I also have slight anterior translatory motion in the right mandibular condyle by open mouth. Ear examinations are normal, with no ear discharge. Pain increases as I use more of my jaw and neck motions for chewing and other activities.
Hi,
Welcome back to icliniq.com.
I have gone through your X-rays (attachments removed to protect the patient's identity) , and it looks like more of temporomandibular joint dysfunction or arthritis rather than eagle syndrome. However, since your complaints are more that of Eagles syndrpme, I would like you to take the following X-rays: 1. X-ray paranasal sinus (PNS) Towne's view for the elongated styloid process. The other possible diagnosis would be cervical spondylitis. Does the pain start over your temporomandibular joint (TMJ) area and radiate to the neck, or does the pain start at the neck first?
Patient's Query
Hi doctor,
Thankyou for the reply. It starts below the jaw, close to the tonsil region, or behind the salivary gland, possibly near digastric or stylohyoid muscles. Tightening the muscles causes pain to shoot up to the neck and head. During severe pain episodes, pain is constant in the neck and jaw, with headaches sometimes. Pressing the area behind the jaw angle, I can feel a pain sensation, but massaging there or using a warm compress makes it feel better. I had a neck and spine magnetic resonance imaging (MRI) for suspecting spondylitis four years back, and it showed no abnormalities. I also have an unexplained sore throat regularly in the morning, with no other symptoms of cough and cold. In rare situations, I feel a weird irritation in the retromolar trigone area or the tongue portion near it. Also, tilting the head right and left causes strange squeaky noises below the right ear. I also sometimes have temporary ringing episodes in the ears, which last for about five-ten secs, but this also is rare. The temporomandibular joint (TMJ) issue also has a history. I was in a minor bicycle accident eight years ago in which I got hit in the face on the right-side jaw very hard. The pain went away quickly, with no discomfort after 24 hours. But since that day, my jaw started clicking. I was a kid and didn't pay much attention to it. There was no pain after that until two years ago. But, weirdly, it was okay for about five years, and then it started causing all the problems. I have included almost everything I can add. I will get the X-ray pns Towne's view and report to you.
Hi,
Welcome back to icliniq.com
I have gone through your reports (attachments removed to protect the patient's identity) and it suggests that cervical spondylitis can be ruled out. Going by the nature of your complaints, that is unilateral pain, starting somewhere near the angle of the mandible in the throat, that radiates all are typical of Eagles syndrome. I would advise you also to do a simple test and let me know; I am sure you know where your tonsils are located; take your index finger behind the tonsil on which side you feel pain and press at the region. Let me know if there's tenderness at the area when you press and any hard bony structure you can feel over there. Also the PNS X-ray, please mention to the technician Townes looking for an elongated styloid process because Towne's view is usually taken for para nasal sinuses. Regarding your temporomandibular joint (TMJ), as you have said, the trauma would have been the cause for a slight dysfunction of temporomandibular joint (TMJ), but that wouldn't cause such radiating pain. Contact me anytime if you have any other queries Happy to help.
Patient's Query
Hello doctor,
Thankyou for the reply. I have gotten back the PNS Towne's view x-ray result. Also, I couldnot correctly press the tonsil region because of my gag reflex. But I feel the muscles on the left side of the neck are a bit different than those on the right. I don't know how to explain it adequately, but I will try. Also, the muscles below the ear and the angle of the mandible are sort of loose and move around weirdly on pressing compared to the right side. Sometimes I feel some knot-like things in the muscles there as well. Does the result confirm Eagles syndrome? If so, I would like to call you using this website's call option to discuss my options for treatment. I have been dealing with this for a long time, and I would like to get it over with an operative treatment rather than conventional therapy because I have been trying it for almost four years. Thank you for being patient with me and my condition.
Hi,
Welcome back to icliniq.com.
As I had predicted, it seems to be an elongated styloid process. Since you are not willing to conventional treatment, you can go for surgical modality. Contact me anytime, and I will explain things. Thanks and regards.
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Otolaryngology (E.N.T)
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