Eagle’s Syndrome

When I think of an eagle, I think about America, and when I think about America, I think about the Declaration of Independence, and when I think about the Declaration of Independence, I think about how it was signed with a pen (stylus), and when I think about a stylus, it reminds me of the styloid process. Now you have a way to remember that Eagle’s syndrome affects the styloid process.

Eagle’s syndrome was named after Dr. Walt Eagle, who in 1937 noticed the connection between a lengthened styloid process and pharyngeal pain. He came up with the word “stylalgia” to define it. This diagnosis should be considered in a patient who complains of mild, constant, unilateral, annoying throat pain. Other symptoms include trouble swallowing, facial pain, globus sensation, voice alteration, and shoulder pain. The pain feels worse with swallowing, and may radiate to the ear or behind the ear. It is more common in middle aged females. A lengthened styloid process is present in only 4-7% of the population, and just 4-10% of those individuals feel pain.

The syndrome is divided into two types defined by Dr. Eagle, which he called the classic type and the carotid artery type. The classic type is associated with tonsillectomy. The pain is caused by compression of cranial nerves V, VII, IX, and X, which may be due to scar formation. The carotid artery type is associated with a globus sensation and neck pain with movement. The pain is caused by a pinched carotid artery. Other sources of pain may be a fracture of the lengthened styloid process, a congenital lengthened styloid process, premature ovarian failure, chronic inflammation of the mucous membranes or bones, and infection.

On physical examination, the point of the long styloid process can sometimes be felt in the back of the throat between the tonsillar pillars, and should reproduce the pain. The lengthened styloid process can be visible on x-rays, which may also show calcification of the stylohyoid ligament responsible for the symptoms. The gold standard for diagnosis is relief of pain with lidocaine injection. Treatment includes NSAIDs, steroid injection, and even surgical removal or shortening of the styloid process.

Eagle’s syndrome is rare, but is an important diagnosis of exclusion. If the diagnosis is suspected, these patients should be referred to an ENT for appropriate treatment.

Sources:

Houser, Steven M., and Diana N. Traquina. "Atypical Facial Pain and Related Entities." Expert Guide to Otolaryngology. By Karen H. Calhoun, Mark K. Wax, and David E. Eibling. Philadelphia, PA: American College of Physicians-American Society of Internal Medicine, 2001. 482+. Print. ACP Expert Guide Series.

Kim E, Hansen K, Frizzi J. Eagle syndrome: Case report and review of the literature. ENT: Ear, Nose & Throat Journal [serial online]. November 2008;87(11):631-633. Available from: Academic Search Premier, Ipswich, MA. Accessed November 23, 2011.