Styloid syndrome is a collective term for symptoms such as pharyngeal foreign body sensation, sore throat, or referred ear pain, head and neck pain, and increased salivary secretion caused by an elongated styloid process or its abnormal position or shape stimulating adjacent blood vessels and nerves. It is commonly seen in adults.

bubble_chart Pathological Changes

The causes of the disease are complex. ① **Excessive styloid process length**: The average normal length of the styloid process is about 2.5 cm; exceeding this length is considered excessive. The styloid process originates anteriorly and medially to the stylomastoid foramen of the temporal bone, appearing as a slender cylindrical structure. Its distal end extends inward and downward, situated between the internal carotid artery and the external carotid artery. An excessively long styloid process causes its distal end to extend into or near the tonsillar fossa, leading to a foreign body sensation in the throat, regardless of whether a tonsillectomy has been performed. If it compresses nerve endings, symptoms such as sore throat may occur. An elongated styloid process may also compress or rub against the carotid artery, affecting blood circulation and causing pain in the corresponding area. However, some individuals with an excessively long styloid process may remain asymptomatic. ② **Abnormal styloid process orientation or morphology**: In some patients, the length of the styloid process falls within the normal range, but its orientation or morphology is abnormal, or an anomalous carotid artery position may cause contact between the two, leading to symptoms such as headaches. ③ **Tonsillitis and post-tonsillectomy scar traction**: These may also contribute to the onset of the disease. ④ **Glossopharyngeal neuritis**: This condition is closely related to the disease.

The onset is slow, with a variable duration of illness. Pain in the tonsillar area or base of the tongue is common, often unilateral and not severe, radiating to the ear or neck, and worsening during swallowing. A sensation of a foreign body or obstruction in the throat is relatively common, usually on one side, more noticeable during swallowing, and sometimes aggravated by speaking, turning the head, or at night. It may also cause cough. When the cervical stirred pulse is compressed or rubbed, pain may radiate from one side of the mandibular angle upward to the head, neck, or face. Occasionally, symptoms of neurasthenia such as tinnitus, drooling, or insomnia may occur.

Physical examination: Palpation of the tonsillar area may reveal a hard, cord-like or spiky protrusion, and the patient may report this as the site of discomfort, which can induce or worsen throat pain. It is often unilateral and excessively long. X-rays of the styloid process often show excessive length, deviation, or curvature.

bubble_chart Diagnosis

This condition is often overlooked. For individuals aged 20 or older experiencing sore throat, foreign body sensation in the throat, along with neck pain, ear pain, or headache, this disease should be considered. Palpation and styloid process imaging should be performed, and if necessary, tonsil surgery exploration may be conducted. This condition needs to be differentiated from pharyngitis, glossopharyngeal neuritis, glossopharyngeal neuralgia, and styloid fracture.

bubble_chart Treatment Measures

Surgical treatment is the primary approach. The indications should be determined based on the patient's condition. Patients with an elongated styloid process but no symptoms or mild symptoms may not require surgery. Surgery can be performed if the patient has significant symptoms and strongly requests it. Common surgical methods include the transoral tonsillar approach or the external cervical approach to shorten the styloid process.