Muhamad Ariff Sobani¹, Noor Shairah Mat Barhan1, Abdul Azim Al-Abrar Ahmad Kailani¹ ², Norazila Abdul Rahim¹, Masaany Mansor¹

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection via intraoral or cervical approaches. We describe a rare case of bilateral Eagle syndrome in a 46-year-old female  who presented with chronic foreign body sensation in the throat but aggravated following fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray do not reveal any foreign body and the patient was treated conservatively. Incidentally, cervical x-ray also revealed an elongated styloid process bilaterally. Upon follow-up, the patient was still symptomatic thus, a CT scan with contrast of the neck was requested which reported no foreign body but the presence of bilateral elongated styloid process which suggest  Eagle Syndrome. The patient was subjected to Transoral endoscopic assisted of bilateral styloidectomy following tonsillectomy. There was complete resolution of the symptoms postoperatively. This approach is recommended to avoid external scarring and minimize postoperative pain. Eagle syndrome is diagnosed based on a combination of physical examination and radiological findings. The treatment options may vary based on the severity of symptoms.

Keywords: Eagle Syndrome; Elongated Styloid Process; Transoral; Endoscopic; Styloidectomy

1. 1Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi Mara (UiTM), Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia. 
2. 2Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia

Correspondence to: 

Muhamad Ariff Sobani1, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia. Email: [email protected]