Non-Invasive Approaches to Managing Eagle Syndrome

Eagle syndrome (ES) is a condition that can cause discomfort in the neck, throat, jaw, and ears, often leading to difficulty swallowing and other symptoms like headaches and dizziness. The condition is caused by an elongated styloid process or calcification of the stylohyoid ligament. Due to its wide range of symptoms, Eagle syndrome is often misdiagnosed as other conditions.

Accurate diagnosis involves a comprehensive evaluation, physical exams, and imaging techniques, with a 3D-CT scan being the gold standard. While invasive treatments like surgery and steroid injections are sometimes recommended, they should be considered only as a last resort due to potential complications, including nerve damage.

Non-invasive treatments such as physiotherapy and chiropractic care, particularly the Activator Method, are effective alternatives for managing Eagle syndrome. Chiropractic Specialty Center® offers an integrative approach combining these methods to provide relief and improve quality of life for patients with Eagle syndrome.

Understanding Eagle Syndrome, Styloid Process & The Hyoid Bone

The hyoid bone is a floating bone located at the top of the throat beneath the tongue, providing support to the tongue and larynx (voice box) and aiding in mouth opening. The styloid process, a slender bone extending from the temporal bone of the skull, ranges in length from 20-25 mm in Caucasians and 15-18 mm in Asians. Approximately 4% of the population has an elongated styloid process, though not everyone with this condition develops Eagle syndrome.

The styloid process connects several muscles and ligaments, which contribute to functions such as swallowing and tongue movement:

• Stylopharyngeus muscle: Raises the larynx and pharynx during swallowing.
• Stylohyoid muscle: Lifts the hyoid bone during swallowing.
• Styloglossus muscle: Helps draw the sides of the tongue upward and backward.
• Stylohyoid ligament: Connects the hyoid bone to the skull and aids in elevating the hyoid bone.
• Stylomandibular ligament: Connects the skull to the mandible, limiting mouth opening.

The Link Between Stylohyoid Calcifications & Neck Disorders

A study published in the Journal of Rheumatology explored the relationship between the ossification (calcification) of the stylohyoid ligament and neck disorders like cervical osteophytes (neck arthritis). The research indicated a significant link between calcified stylohyoid ligaments and ligamentous ossifications in the cervical and thoracic spine.

What Causes Eagle Syndrome?

Eagle syndrome is related to elongation or malformation of the styloid bone, as well as calcification of the stylohyoid ligament. It is more commonly seen in women, who are three times more likely to develop the condition. Although the exact cause remains unclear, several potential contributing factors include:

• Congenital issues (e.g., unusually long or malformed styloid process)
• Trauma to the throat
• Post-tonsillectomy patients
• Thickening (hypertrophy) of the stylohyoid ligament
• Calcification of the stylohyoid ligament
• Excessive neck flexion, as seen in “text neck” (from frequent use of smartphones or tablets)
• Sports injuries or whiplash, especially in individuals with a longer styloid process

What Does Eagle Syndrome Feel Like?

Eagle syndrome can range from mild to severe. Patients typically report dull, throbbing discomfort in the neck, throat, or jaw. Some may feel as though something is stuck in their throat. In more severe cases, the condition can result in chronic discomfort that significantly impacts one’s quality of life, contributing to issues such as anxiety, relationship challenges, and emotional distress. Early intervention is essential to prevent long-term complications.

Symptoms Associated with Eagle Syndrome

The symptoms of Eagle syndrome can vary widely. The classic signs often include neck and throat discomfort radiating to the ear (tinnitus), face, jaw, or eye sockets. Typically, symptoms affect only one side of the head, though in rare cases, they may occur on both sides. Common symptoms of Eagle syndrome include:

• Facial discomfort
• Dizziness
• Ear discomfort (otalgia)
• Jaw discomfort
• Difficulty swallowing (dysphagia)
• Headaches and migraines
• Discomfort at the base of the tongue
• Discomfort when extending the tongue
• Discomfort when turning the head and neck
• Voice changes
• Ringing in the ears (tinnitus)

Due to the broad range of symptoms, Eagle syndrome is often mistaken for other conditions such as occipital neuralgia, migraines, dental infections, temporomandibular joint disorders (TMD), trigeminal neuralgia, and glossopharyngeal neuralgia.

How Is Eagle Syndrome Diagnosed?

Eagle syndrome can be challenging to diagnose because its symptoms overlap with those of other conditions. Diagnosis typically begins with a thorough evaluation, including an assessment of the jaw, neck, and the base of the skull. Physical exams such as palpation, muscle testing, and range of motion assessments can help identify if certain neck movements trigger symptoms. Diagnostic imaging, such as X-rays, 3D-CT scans, or MRI, may be necessary to gain a clearer understanding of the areas around the upper neck and styloid process. Additionally, consultation with an ear, nose, and throat (EENT) specialist may be recommended to rule out other potential causes. Among these methods, a 3D-CT scan is considered the gold standard for diagnosing Eagle syndrome.

What Are The Treatment Options for Eagle Syndrome?

Eagle syndrome is more common than many believe, but it is often misdiagnosed as other conditions, including neuralgia, ear infections, or temporomandibular disorder (TMD). While most treatments in the literature suggest medication or invasive procedures like styloidectomy or steroidal injections, these options may not effectively manage Eagle syndrome. Surgery and steroid injections should be considered only as a last resort.

A study published in the Journal of Radiology (October 2019) analyzed 459 patients who received corticosteroid injections and found that these treatments often accelerated the progression of osteoarthritis and other issues. Long-term steroid injections into the upper neck should be avoided due to the sensitivity of the area and the proximity of cranial and spinal nerves, which may lead to unnecessary wear and tear.

Invasive Therapeutic Procedures Should Be Carefully Planned

The styloid process is located between the internal and external carotid arteries, close to vital structures such as the jugular vein and occipital artery. Several cranial nerves pass through this region, including the trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal nerves. Injury to these nerves has been documented in patients with elongated styloid processes. If surgery or other invasive procedures are considered, it is crucial to consult with an experienced clinician who has a proven track record of successful outcomes.

Non-Invasive Treatment for Eagle Syndrome

Before considering invasive procedures, non-invasive treatments should be explored. Physiotherapy and chiropractic care can provide significant relief for Eagle syndrome. However, not all chiropractic or physiotherapy centers are equipped to treat this condition. Specialized skills and technologies are required for effective management.

The Activator Method is one of the best chiropractic approaches for treating Eagle syndrome, as it ensures targeted, non-invasive adjustments. At Chiropractic Specialty Center®, we provide an integrative approach that combines physiotherapy with focused chiropractic care using the Activator Method. Our team’s expertise, combined with advanced technology, has helped numerous patients find relief from Eagle syndrome symptoms.