Pain in the ear
The most common place of pain is 64.3%.
CONDITION / JAWS, MOUTH AND NECK
Eagle syndrome.
Eagle syndrome is pain in the throat, ear, angle of the jaw, or in the neck, which is associated with an elongated styloid process of the temporal bone or a calcified ligament that departs from it. The condition is rare, and an elongated process often occurs without complaints, so the diagnosis is made carefully - only when other causes of pain are excluded.
CONCEPTUAL VISUALIZATION- What it is
- Pain in the throat, ear, or neck associated with the long styloid process.
- How common
- Elongated appendage on the pictures — in 30.2% of people, but the syndrome itself is rare.
- As confirmed
- Complaints, examination and CT should match, and other causes of pain should be excluded.
- How we treat
- Medicines for nerve pain or surgery that shortens the process.
01 / WHAT IS ITWhat is
What is
Eagle syndrome.
The styloid process is a thin bony protrusion of the temporal bone below the ear. A ligament runs from it to the hyoid bone, and carotid arteries and cranial nerves pass nearby.
If the process is too long or the ligament is calcified, it can irritate these structures. There is a distinction between the classic form — pain, difficulty swallowing, tinnitus, tingling — and vascular, when the growth presses on an artery or vein. In a meta-analysis of 497 patients, 74.5% had the classic form, 23.5% had the vascular form.
The finding on the picture itself is not yet a diagnosis. In a meta-analysis of 39 studies (50,655 participants), an elongated process was seen in 30.2% of people, more often on both sides. And in one clinic, among 2,716 people examined for temporomandibular joint problems, Eagle syndrome was found in 9.
There are no agreed guidelines for diagnosis and treatment yet, so each case is analyzed separately.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
Eagle syndrome presents.
Complaints are vague and similar to diseases of the ear, throat, teeth or joints. The figures below are from a series of 56 patients of the surgical clinic (51 of them were operated on).
At the angle of the jaw
Pain at the angle of the lower jaw — in 50%.
Dysfunction of the jointthroat
Sore throat — 46.4%; there is pain in the area of the tonsil and a feeling that something foreign is stuck in the throat.
Swallowing and turning the head
More than 70% of patients noted tinnitus, difficulty swallowing and pain that worsened when turning the head.
Vascular signs
Headache and Horner's syndrome (lowered eyelid, narrowed pupil on one side) occur more often with the vascular form. The most common consequence of pressure on an artery is stroke (46.8% of cases of pressure on an artery in a review of 231 patients with vascular complications), but such complications are rarely described.
03 / REASONSWhy does it occur?
Why does it occur?
Eagle syndrome.
Many people have an elongated appendage, but complaints appear only in some of them.
A long process or ligament
Complaints are associated with lengthening of the process itself or calcification of the ligaments coming off of it.
Removed tonsils
In a meta-analysis, tonsillectomy in the past occurred more frequently in the classical form (48 of 153 cases) than in the vascular form (2 of 33).
Neck movements
Head turns as a starting point were more often described in the vascular form (12 out of 33 cases) than in the classical form (7 out of 153).
Why are they looking for him for a long time?
Due to atypical complaints, the syndrome is easily confused with other diseases. In a series of 5 patients, four had time to visit several ENT doctors before diagnosis.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Eagle syndrome usually does not require emergency care and is routinely screened for. But rarely the growth presses on the carotid artery - then a stroke is possible. Its signs are a reason to call 103, even if they have already passed.
103 immediately if:
- suddenly half of the face sags, it is difficult to smile;
- sudden weakness or numbness in an arm or leg on one side of the body;
- speech has become unclear, it is difficult to pick out words;
- suddenly blurred or lost vision in one or both eyes;
- sudden confusion of consciousness;
- sudden very severe headache;
- any of these symptoms have been present within the last 24 hours, even if they have already passed;
- the person has fainted and is not breathing;
- after fainting, the person did not regain consciousness for a minute or has difficulties with speech or movements;
- after fainting - chest pain or strong, frequent or irregular heartbeat;
- convulsions
See a doctor soon if:
Urgently, on the same day: it seems to you that the signs of a stroke were already there before, passed, and you did not consult a doctor then. In the coming days: you passed out, even if you regained consciousness quickly, particularly when turning your head. Planned: long-lasting pain in the throat, ear, at the angle of the jaw or in the neck, feeling of a foreign body in the throat, pain when swallowing or turning the head.
05 / DIAGNOSTICSAs defined,
As defined,
is it Eagle syndrome.
- Conversation
Where does it hurt, what makes the pain worse - swallowing, turning the head - what have you already tried and whether the tonsils were removed.
- Inspection and palpation
The doctor feels the area of the tonsil from the side of the mouth. If the tip of the process is felt there and the pressure reproduces the usual pain, this is an important sign. Sometimes they do a trial analgesia with a local anesthetic.
- CT
The final diagnosis is confirmed by CT, preferably with three-dimensional reconstruction of the process. There is no single "normal" length; a process longer than a third of the branch of the lower jaw is taken as a reference point, along with complaints and examination data.
- Exclusion of other reasons
Eagle syndrome is considered alongside diseases of the temporomandibular joint, the consequences of injuries, and problems with wisdom teeth. If there are neurological signs, Igle syndrome should also be considered by a neurologist.
06 / TREATMENTHow we treat
How we treat
Eagle syndrome.
There is no single treatment algorithm. The choice depends on where the appendage lies, how long it is, and how strong and persistent the complaints are. Medicines and surgery are possible.
01
Without surgery
Medication is one possible option.
- Medicines for nerve pain
- Drugs that affect neuropathic pain — as prescribed by a doctor. In a series of 5 patients from headache clinics, four improved on this treatment, one required surgery.
- What is known
- In a meta-analysis of 497 patients, 81 of 123 (65.9%) had improvement or resolution of complaints without surgery.
02
Styloidectomy
The process is shortened through the mouth or through an incision in the neck.
- The result
- In the same meta-analysis, 313 out of 320 operated patients had improvement or disappearance of complaints (97.8%). But the data was collected from 285 publications — an average of less than two patients per one. In a multicenter study of 103 patients, surgery cured 46%, helped another 34%, and had no effect in 20%.
- Through the mouth or through the neck
- In a study of 103 patients, no difference in outcome between approaches was found. In a meta-analysis of complications, access through the mouth had the highest frequency.
- Possible complications
- In a cohort of 21 patients, 24% had pain in the parotid area at the beginning of chewing ("first bite syndrome"), 19% had numbness; usually it passed in three months. In a series of 9 patients (8 operated on), three had disorders of the nerves: branches of the facial nerve, tongue movement, palate.
03
Vascular form
- What is known
- In a review of 231 patients with vascular complications after styloidectomy as the first treatment, 78.5% were cured, 2.5% relapsed; without it — 24.5% and 47.2%. Such cases are described mostly in separate reports: 150 publications on 231 patients.
07 / AT THE VALIKHNOVSKYI INSTITUTE
What
What
we will help
Patients with complaints similar to Eagle syndrome are consulted in the "New face" direction at Dr. Valikhnovskyi's Institute of Surgery. The surgeon evaluates the complaints and the CT scan and explains what options are possible. Part of the examination — to rule out other causes of pain — is carried out by specialist doctors: ENT doctor, dentist, neurologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation of a surgeon — clarification of complaints, review and assessment of previous examinations and treatment.
- CT and 3D planning — CT scan of the facial skull and a 3D model to measure the process and see how it lies in relation to neighboring structures.
- Personal plan — the team discusses appropriate next steps and sequence of stages.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How does the consultation work?
- Pictures onlineSend a CT scan and the results of an ENT doctor, dentist or neurologist, if they are available - the doctor will evaluate the situation beforehand.
- ConsultationConversation, examination and palpation from the side of the mouth.
- CTMeasurement of the process and assessment of its position.
- PlanIs treatment without surgery enough, are other specialists needed, are there reasons to discuss surgery.
- Follow-upMonitoring how complaints change and plan correction.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
If there is an elongated process in the picture, is it Eagle syndrome?
No. An elongated process is found in about a third of people, and the syndrome is rare. The diagnosis is made only when complaints, examination and CT scan coincide, and other causes of pain are excluded.
What length of the process is considered normal?
There is no generally accepted limit. A process longer than a third of the branch of the lower jaw is taken as a reference point. In a study of 103 operated patients, the mean length was 33 mm (range, 25 to 61 mm).
Is it necessary to operate?
No. Medicines and surgery are possible. The decision depends on the strength and persistence of complaints, the length and position of the process.
How is the operation done?
The process is shortened through the mouth or through an incision in the neck. In a study of 103 patients, the outcome of both approaches did not differ; according to a meta-analysis, there are more complications with oral access.
Can pain remain after surgery?
Maybe In a study of 103 patients, the operation failed in 20%. Patients who had a headache responded worse, according to a cohort of 21 patients.
Is Eagle syndrome dangerous?
Mostly it is manifested by pain. Rarely, the growth presses on the carotid artery or jugular vein; stroke is described as the most severe consequence. Signs of a stroke are a reason to immediately call 103.
Which doctor should I contact?
Traditionally, to an ENT doctor; a maxillofacial surgeon can also assess the growth and treatment options. If neurological signs are present, Eagle syndrome should be considered by a neurologist.
Sources
17 sources · systematic reviews, meta-analyses, cohorts and NHSshowCollapse
- Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysisPeerJ, 2024doi:10.7717/peerj.17423 ↗
- Eagle syndrome and vascular complications — a systematic reviewInternational Journal of Oral and Maxillofacial Surgery, 2025doi:10.1016/j.ijom.2024.09.011 ↗
- Prevalence and features of elongated styloid process on imaging studies: a systematic review and meta-analysisClinical Oral Investigations, 2022doi:10.1007/s00784-021-04285-w ↗
- Complications in intraoral versus external approach for surgical treatment of Eagle syndrome: A systematic review and meta-analysisCranio, 2024doi:10.1080/08869634.2021.2020995 ↗
- Management of eagle syndromeCurrent Opinion in Otolaryngology & Head & Neck Surgery, 2023doi:10.1097/MOO.0000000000000903 ↗
- Stylalgia and Styloidectomy: A ReviewJournal of Maxillofacial and Oral Surgery, 2023doi:10.1007/s12663-022-01720-7 ↗
- Styloid process-related internal carotid artery dissection: extensive literature review of diagnosis, treatment and outcomesNeuroradiology, 2025doi:10.1007/s00234-025-03616-y ↗
- Eagle syndrome presentation and outcomes in a large surgical case seriesLaryngoscope Investigative Otolaryngology, 2024doi:10.1002/lio2.1289 ↗
- Intraoral and extraoral approach for surgical treatment of Eagle’s syndrome: a retrospective studyEuropean Archives of Oto-Rhino-Laryngology, 2022doi:10.1007/s00405-021-06914-2 ↗
- Surgical management of patients with Eagle syndromeAmerican Journal of Otolaryngology, 2018doi:10.1016/j.amjoto.2018.05.003 ↗
- Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomyAmerican Journal of Otolaryngology, 2020doi:10.1016/j.amjoto.2019.102324 ↗
- Diagnosis and treatment of Eagle’s syndrome and possible complicationsActa Chirurgiae Plasticae, 2023doi:10.48095/ccachp202398 ↗
- Elongated styloid process (Eagle’s syndrome): a clinical studyJournal of Oral and Maxillofacial Surgery, 2002doi:10.1053/joms.2002.29814 ↗
- Eagle syndrome: toward a clinical delimitationNeurología (English Edition), 2021doi:10.1016/j.nrleng.2018.03.007 ↗
- Stroke: symptomsNHS, 2024nhs.uk/conditions/stroke/symptoms ↗
- Transient ischaemic attack (TIA)NHS, 2023nhs.uk/conditions/transient-ischaemic-attack-tia ↗
- FaintingNHS, 2026nhs.uk/symptoms/fainting ↗
The figures on the page are from these sources.
Sore throat
does it not go away?
Send CT scans and reports from doctors you've already seen. The doctor will tell you if it looks like Eagle syndrome and what to do next.