Patients suffering from Eagle syndrome have various complaints in the area of the pharynx and tongue. The reason for this is, for example, an atypically shaped and positioned styloid process (stylar process). The disease occurs mainly in women between the ages of 30 and 40.
What is Eagle syndrome?
The disease Eagle syndrome means “eagle syndrome” in German. The condition was first diagnosed in 1937 by Watt Weems Eagle, an otolaryngologist. That’s where the name comes from. Eagle syndrome often results in dull, neuralgic pain in the lateral region of the throat and tongue that radiates into the neck as well as toward the ear. Consequently, Eagle syndrome is characterized by pain in the throat, mouth, head, butt, and face. When swallowing, the discomfort may be exacerbated. Patients with Eagle syndrome report that it feels like a foreign body in the throat, accompanied by a compulsion to clear the throat and swallow.
Causes
Eagle syndrome involves mechanical irritation of the nerves between the stylar process and the hyoid bone. Often, inflammation, usually periosteum inflammation, is also present. The following factors can lead to irritation:
- Too long hyoid bone
- Prolonged bone process behind the ear
- Insertional tendopathy (pain conditions caused by irritation of the tendon insertions).
- Calcified ligaments (hardening of tissues).
Eagle syndrome usually occurs after injury, surgery or trauma to the truncation. Recurrent pressure on the cervical nerves and entrapment of the cervical blood vessels also result from diseases of the stylar process. Removal of the tonsils is also thought to be a cause of Eagle syndrome.
Symptoms, complaints, and signs
Eagle syndrome is characterized by a deformity of the temporal bone. In this case, the stylar process is more than 30 millimeters long. One of the most common complaints is sore throat. The foreign body sensation, which occurs in many affected persons, is perceived as very unpleasant. Pain in the throat and a pressing pain in the tonsillar fossa also occur frequently. In particular, the sensation of pain occurs during swallowing and movements of the neck. Atypical facial pain is another common symptom. However, there are also many sufferers who have no noticeable symptoms. Typical symptoms of Eagle syndrome include:
- Pain on one side of the throat and pharynx.
- Taste disturbances
- Difficulty swallowing with a feeling of pressure or pain in the chest and upper abdomen area
- Feeling that there is a foreign body in the pharyngeal area
- Slightly swollen neck above the hyoid bone.
- When swallowing unilateral crackling in the throat.
- Jaw pain
- Earache
- Joint pain
- Rheumatic complaints
- Altered voice
- Cough
- Dizziness and balance symptoms
- Appetite changes
Diagnosis and course
The symptoms that occur in Eagle syndrome sometimes shift over months and sometimes they weaken somewhat. However, the clinical picture can be very persistent, so that there is rarely a true freedom from symptoms. Eagle syndrome also often ends in chronic permanent pain. The diagnosis is usually made by an ear, nose and throat specialist, but the disease is not always recognized immediately, since the symptoms can also apply to different diseases. Palpation of the tonsil lodge (area of the tonsils), a computer tomography and an X-ray examination are the first measures that can be used to diagnose Eagle’s syndrome. In Eagle’s syndrome, diagnostic imaging reveals a stylar process that is atypically positioned, unusually long, and bent medially or laterally. The stylar process protrudes beyond its normal length of 30 millimeters. Examination methods may reveal calcification.
When should you see a doctor?
If the typical deformity of the temporal bone is noticed, it should definitely be clarified by a doctor.In case of facial pain, taste disturbances, swelling in the neck area and other typical symptoms of Eagle syndrome, a visit to the doctor is also recommended. If complications such as dizziness and balance symptoms, changes in appetite or rheumatic complaints develop, this must be clarified quickly and treated if necessary. People who have already suffered from periostitis are particularly at risk. Eagle syndrome can also occur after injuries, operations or severe trauma. Anyone who is affected by these risk factors should quickly see their family doctor with the symptoms mentioned above. Other contacts are the ENT physician, various internists and specialists for the respective symptoms. In a medical emergency, the emergency medical service should be contacted or the affected person must be taken immediately to the nearest hospital. Comprehensive medical treatment and follow-up care is generally required for Eagle syndrome. Accompanying this, a physiotherapist may also need to be consulted.
Treatment and therapy
To treat Eagle syndrome, nonsteroidal anti-inflammatory drugs are primarily used. This serves the goal of eliminating acute pain. Very gentle on the stomach and also anti-inflammatory are the so-called COX-2 inhibitors. Muscle relaxants such as baclofen can also be helpful as a supplement. These therapies are successful in many cases and often the disease no longer occurs. However, severe pain can sometimes only be relieved by centrally acting analgesics such as tramadol, for example in the brain or spinal cord. Painkillers can often be saved by combining them with pain-distancing drugs for depression, some of which are also effective for pain. With all medications, attention must always be paid to the risk of habituation or even dependence on the pain medications. In severe regressive cases, when treatment has no effect or the symptoms become chronic, the tip of the stylar process must sometimes be surgically removed. Further multimodal treatment concepts, which take place in a special pain clinic, also often bring good results. Here, for example, acupuncture and physical therapy such as T.E.N.S., heat or cold applications are used. As a general rule, the earlier the therapy is initiated, the better the chances of success. However, if the pain has already been present for a longer period of time, it can be assumed that chronification grades II, if not III, are already present. In these cases, a treatment based only on the body is often no longer sufficient, so that an additional psychotherapeutic intervention should take place. Unfortunately, such treatments are often not possible on an outpatient basis, since very few psychotherapists in private practice have the appropriate further training with regard to special pain psychotherapy.
Outlook and prognosis
Although Eagle syndrome is due to an elongated styloid ossis temporalis process, only about four to ten percent of those affected by it actually suffer from symptoms. The symptoms are very diverse and also vary in severity among individuals. Therefore, the prognosis of the disease depends on the predominant symptoms. It is not a serious, but sometimes very distressing disease. Complications are almost non-existent. However, the quality of life of those affected is often severely limited by the permanent pain and difficulty in swallowing. Simple pain therapy is usually unsuccessful. Good success is often achieved by treatment with a combination of non-steroidal anti-inflammatory drugs and muscle relaxants. However, if the pain is very severe, centrally acting analgesics such as tramadol must be used. However, lasting success is rarely achieved with drug treatment. Therefore, surgical shortening of the stylar process should also be considered for difficult-to-treat and chronic pain. Surgical intervention is the only way to achieve complete freedom from symptoms. However, since this operation may be associated with risks such as facial paralysis or injury to the carotid artery, it is usually performed only in cases with severe pain.However, drug treatment with painkillers must be permanent, as the pain immediately returns after they are discontinued. However, this can lead to drug dependence.
Prevention
Since the causes are not yet clearly understood, targeted prevention is also not possible. In general, it is advisable to strengthen the immune system to ward off disease.
Aftercare
The measures and possibilities of aftercare are very limited in Eagle syndrome in most cases. The affected person is therefore primarily dependent on rapid diagnosis and treatment of this disease to prevent further complications and discomfort. Eagle syndrome cannot heal itself, as it is a genetic and congenital disease. If the affected person wishes to have children, genetic testing and counseling can also be performed to possibly prevent the syndrome from being passed on to descendants. In most cases, Eagle syndrome sufferers are dependent on taking medication. The doctor’s instructions should always be followed, and the medication should be taken correctly and regularly. In case of doubt or questions and uncertainties, a doctor should always be contacted. Since Eagle syndrome can also lead to psychological upsets and depression, it should be accompanied by psychological treatment. Talks with friends or with the own family are also very useful in order to alleviate such complaints permanently. In many cases, contact with other sufferers of this disease can also be useful.
This is what you can do yourself
The patient can help himself in everyday life by participating in relaxation techniques. These serve to relieve stress and counteract the sensation of pain. Through various methods such as meditation, yoga, or autogenic training, patients often succeed in establishing an inner balance. Relaxation promotes a sense of well-being, which is important for building new resources to fight the disease. Even if the patient suffers from a loss of appetite, he should eat a healthy, balanced diet to strengthen his own immune system. Food intake is essential in order not to build up further discomfort. The intake of sufficient fluids is equally important and necessary. In everyday life, additional stressors are to be avoided. Activities should be redistributed so that the patient can get enough rest and relaxation. Mental support or emotional assistance can be helpful for the patient. The patient should let those around him know what is important to him, how he is feeling and seek help as soon as necessary. Despite the illness and the impairments in everyday life, the meaning of life should not be lost sight of. Sufficient motivation for recovery and a positive basic attitude for improving the existing quality of life should be preserved or, if necessary, always rebuilt.
