Conventional and 3-Dimensional Computerized Tomography in Eagle's Syndrome, Glossopharyngeal Neuralgia, and Asymptomatic Controls

Objective Eagle's syndrome (ES) is an aggregate of symptoms, including recurrent throat pain, foreign body sensation, dysphagia, or facial pain related to an elongated styloid process (SP). It resembles glossopharyngeal neuralgia and has been linked to irritation of the glossopharyngeal nerve. This study was designed to determine whether computerized tomography (CT) imaging of the stylohyoid chain (SHC) differs between asymptomatic controls (ACs), patients with glossopharyngeal neuralgia (GN), and patients with ES. Study Design Case series with chart review. Setting Tertiary otolaryngology practice. Subjects and Methods Conventional and 3-dimensional CT reconstructions of the SHC were reviewed for 10 ES, 17 GN, and 30 AC patients. Demographic and clinical symptom data were recorded. Anatomic data collected from CT scans included length of the ossified SP, anterior-posterior and medial-lateral styloid process angulation, ossification pattern of the SHC, and minimum distances between the SP tip, the internal carotid artery, and the tonsillar fossa. Results The average distance from the SP tip to the tonsillar fossa was significantly shorter in ES (12.7 mm) compared with GN (21.4 mm; P = .027) or AC (24.8 mm; P < .0005) patients. No other variables were significantly different between groups, including average SP length (ES: 48.0 vs GN: 40.3 vs AC: 40 mm; P > .05). Conclusion The SP was significantly closer to the tonsillar fossa in patients with ES compared with ACs. No significant differences were found in other measures. Distance to the tonsillar fossa may be a more appropriate diagnostic criterion for ES than SP length and may contribute to the pathophysiology of ES.