Stylalgia Revisited: Clinical Profile and Management

Eagle's syndrome is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle. The syndrome includes symptoms ranging from stylalgia (i.e. pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia, or even increased salivation or giddiness.

We describe a clinical study of 12 patients with Eagle's syndrome, along with their clinical profile and the treatment offered. Patients were diagnosed based on history and clinical examination, as well as the Xylocaine 2% tonsillar fossa injection test. A visual analog scale (VAS) was used for comparison of pain before and up to 3 months after treatment. Radiology (orthopantomogram or three-dimensional computed tomography) was used for further exploration. Nine patients underwent tonsillo-styloidectomy surgery and three underwent medical treatment with pregabalin (75 mg/day).

The majority of surgically-managed cases (88%) achieved a definitive benefit by tonsillo-styloidectomy surgery, whereas all medically managed cases achieved only short-term pain relief.

Besides the common throat diseases, the symptoms associated with Eagle's syndrome may be similar to those due to cervicofacial neuralgias, dental, or temporo-mandibular joint diseases. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations, and should not be missed. Treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia.