Retroauricular pain caused by Eagle syndrome: A rare presentation due to compression by styloid process elongation

Abstract

Eagle syndrome is a rare condition presenting with retroauricular pain (usually as main symptom) associated with dysphagia, headache, neck pain on rotation and, much rarelier, stroke. This occurs due to styloid process elongation. Sometimes, there is also styloid ligament calcification, which can cause compression of nerves and arteries and the symptoms above. Treatment can be conservative with pain modulators (e.g. pregabalin) or infiltrations (steroids or anesthetics drugs). In refractory cases, surgical approach aiming to reduce the size of the styloid process can be performed. We present a rare case of Eagle syndrome (documented by computed tomography) with good response to clinical treatment.

From Diagnosis to Treatment: Eagle Syndrome

“…ES should be considered as a differential diagnosis of pain-involving conditions of the occipital and retroauricular regions, particularly if it presents with dysphagia, foreign body sensation in the neck or an increase in the symptoms following the rotation of the head [5]. A thorough clinical and radiological examination is of vital importance in diagnosis of the condition.…”

“…Symptoms of ES may include retroauricular and occipital pain, which worsens with lateral rotation of the head, dysphagia (difficulty during swallowing), odynophagia (pain during swallowing), tinnitus, tenderness during palpation at the retroauricular region, weakness on the tongue, altered speech, intermittent loss of taste, neck swelling, dry mouth, limited mouth opening or, if carotid compression is present, it may present with episodes of fainting or stroke [1,[3][4][5]. An ESP may remain asymptomatic as long as it does not impinge on adjacent structures [3].…”

“…Non-surgical (conservative) treatment includes the use of pain modulators such as non-steroid anti-inflammatory drugs, pregabalin or gabapentin, transpharyngeal local infiltrations of anesthetic solutions or steroid medications into the tonsillar fossa, or neck exercises [1,4,5]. Transpharyngeal manipulation involving manual fracturing of the styloid process is another documented approach although it carries a high risk of injury to the adjacent neurovascular structures 1 .…”

“…Despite the fact that non-surgical treatment options help reduce the pain, their effects last for a short period of time, particularly when the elongation or calcification is substantial. Therefore, surgery is considered the primary treatment modality in ES as it provides the most favorable outcome by eliminating the compressing (mechanical) factor in its entirety [4,5]. Surgical treatment includes two main approaches, intraoral (transoral) or extraoral (transcervical).…”

“…The pathogenesis of this syndrome is still debatable [1]. ES may be treated non-surgically or surgically depending on the severity of the symptoms [5].…”