Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine.

PURPOSE: To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS: Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.

Review article: Otalgia as presenting symptom of myocardial infarction.

OBJECTIVE: There are many etiologies for otalgia, most of which are benign conditions. However, it can also be the initial symptom for life threatening emergencies such as a myocardial infarction (MI). This case report and review of literature describes diagnosis of MI with the initial primary complaint of unilateral otalgia. PATIENT: A 77-year-old female with intermittent left-sided otalgia with exertion for many years that recently worsened. In the clinic, she had a normal otologic exam and denied any other associated symptoms. The following day, her symptoms progressed to otalgia radiating down her arm and dyspnea on exertion. After progression of symptoms, a nuclear stress test was performed revealing a large and severe apical infarct. INTERVENTIONS: Diagnosis of referred otalgia from a cardiac source. She had subsequent medical management of cardiac risk factors and treatment of angina. RESULTS: Resolution of otalgia with medical management for coronary artery disease (CAD) after treatment of unstable angina. CONCLUSIONS: Otologists should be aware of the atypical presentations of angina because a missed diagnosis is potentially fatal. Otalgia, either unilateral or bilateral, may be the only presenting symptom of underlying cardiac ischemia and a high index of suspicion is needed for early diagnosis. Patients with otalgia related to exertion, no abnormal findings on otoscopic examinations, and significant risk factors for cardiac disease should undergo systematic evaluation including a cardiac rule out.

Epidemiology and risk factors for extension of necrotizing otitis externa.

PURPOSE: Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension? METHODS: French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone. RESULTS: Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%). CONCLUSION: Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN.

Efficacy of rehabilitative therapies on otologic symptoms in patients with temporomandibular disorders: A systematic review of randomised controlled trials.

BACKGROUND: The term temporomandibular disorder (TMD) indicates a set of musculoskeletal conditions involving temporomandibular joint (TMJ), masticatory musculature, and related anatomical structures. Pain is the most common clinical manifestation of TMD, and the auditory system might be involved and affected, through tinnitus, dizziness, otalgia and ear fullness sensation. OBJECTIVES: The aim of this systematic review of randomised controlled trails (RCTs) was to evaluate the efficacy of rehabilitative approaches on otologic symptoms in patients with TMD. METHODS: PubMed, Scopus and Web of Science were systematically searched from the inception until 8th October 2023 to identify RCTs presenting participants with a diagnosis of TMD associated with otologic signs and symptoms, rehabilitative approaches as interventions, and modification of the otological symptoms as outcome. RESULTS: Out of 931 papers suitable for title/abstract screening, 627 articles were assessed for eligibility. Five studies were included reporting the efficacy of occlusal splint therapy, low-level laser therapies, and physical therapy in patients diagnosed whit secondary otalgia or tinnitus associated with TMD. No RCTs evaluating other otologic symptoms, ear fullness, dizziness or vertigo were found. CONCLUSIONS: Results of this systematic review suggested that rehabilitative approaches might be effective in improving secondary otalgia and tinnitus in TMD patients. Thus, further RCTs with a higher level of evidence and more representative samples should be conducted to better understand the effects of TMD therapy on otologic complains.

Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses.

OBJECTIVES OF REVIEW: To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria. EVALUATION METHOD: All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author. RESULTS: 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found. CONCLUSIONS: Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management.

Temporomandibular treatments are significantly efficient in improving otologic symptoms.

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.

An unusual presentation of scrub typhus in a child: a case report.

BACKGROUND: Scrub Typhus (ST) is an acute, febrile zoonotic disease caused by the bacterium Orientia tsutsugamushi which is endemic to the Asia-Pacific region. Infected adults rarely present with sensorineural hearing loss and otalgia. Though few cases of pediatric cases are known to present with otalgia, no pediatric cases of sensorineural deafness complicating ST have been reported to date. CASE PRESENTATION: A 5-year-old, previously healthy girl presented with a one-week history of high-grade intermittent fever, Headache and right ear pain with a recent onset of reduced hearing. She had a fever up to 39 °C, cervical lymphadenopathy, bilateral pleural effusion with diffuse infiltrations, and mild hepatosplenomegaly with no evidence of rash. Her initial examination was normal except for mildly enlarged tonsils. Unilateral right ear hearing loss was noted using Weber's test. Evidence of progressive, mild anemia, and raised inflammatory markers was noted. Diagnosis of scrub typhus was confirmed by positive detection of Orentia tsutsugamushi IgM antibodies on rapid diagnostic test and the presence of chigger mite in the right external auditory canal on repeat examination. She responded dramatically to the empirical treatment of ceftriaxone and doxycycline. On follow-up, she did not have any residual hearing loss and her ear pain had resolved completely. CONCLUSION: Acute onset hearing loss or severe otalgia with or without findings should be an important diagnostic clue for suspecting scrub typhus in patients who present with a history of fever especially in endemic areas.

A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review.

OBJECTIVE: Present two cases of nervus intermedius neuralgia (NIN) in which patients described unilateral deep ear pain as their primary complaint and present a summary of NIN cases reported in the literature. BACKGROUND: The nervus intermedius is a tiny branch of the facial nerve that, with neuralgia, can present as a deep ear pain (NIN). The International Classification of Headache Disorders, 3rd edition, (ICHD-3) criteria for an NIN diagnosis include a unilateral deep ear pain with possible radiation that occurs in paroxysms with sharp pain and a tactile trigger. METHODS: A PubMed search was conducted for NIN and geniculate neuralgia. Two patients recently diagnosed with NIN at a single clinic were selected for case reports to highlight the variability of symptom presentation. RESULTS: The two cases reported here and the 127 cases reported in the literature show a wider range of presentations than included in the ICHD-3 criteria, including variable pain radiation sometimes diagnosed as concurrent trigeminal, glossopharyngeal, or occipital neuralgia. Pain was reported as constant or paroxysmal, as well as dull, sharp, or neuralgiform with inconsistent presence of triggers. While ICHD-3 does mention reported taste change, lacrimation, and salivation, the literature reports a much wider range of potential features associated with NIN. Optimal medical treatment is unclear given the predominance of surgical reporting of positive response to microvascular decompression, nerve sectioning, or other procedures. The two cases described here were successfully managed medically. CONCLUSION: NIN can present as described in the ICHD-3, but a more variable presentation may be possible. More studies are needed to clarify presentation, optimal medical treatment, and surgical indications for patients with NIN, especially when patients have no clear neurovascular conflict on neuroimaging.

Posterior condylar canal dural arteriovenous fistula as a rare cause of glossopharyngeal neuralgia: A case report.

BACKGROUND: The symptoms of dural arteriovenous fistula (dAVF) vary according to the location of the fistula and the pattern of venous drainage. Here, we report the case of a patient with a dAVF-induced glossopharyngeal neuralgia. CASE DESCRIPTION: We report a case of a patient with right glossopharyngeal neuralgia caused by a posterior condylar canal (PCC) dAVF. The glossopharyngeal neuralgia was accompanied by persistent tinnitus and repetitive right side otalgia, as well as ipsilateral shoulder and throat pain, lasting for about 30 s. However, there were no specific findings on otoscopic examination. Cranial magnetic resonance imaging was performed to determine the cause of the symptoms, and a right PCC dAVF was observed. The dAVF was successfully obliterated using transvenous coil embolization. After embolization, the patient's symptoms were completely resolved. CONCLUSION: Although glossopharyngeal neuralgia caused by dAVF is rare, it can present due to intracranial lesions located adjacent to the glossopharyngeal nerve or vagus nerve. Brain MRI is therefore required to identify secondary causes in all patients with glossopharyngeal neuralgia.

Biannual Differences in Interest Peaks for Web Inquiries Into Ear Pain and Ear Drops: Infodemiology Study.

BACKGROUND: The data retrieved with the online search engine, Google Trends, can summarize internet inquiries into specified search terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms. OBJECTIVE: The aim of this study was to analyze World Wide Web interest peaks for "ear pain," "ear infection," and "ear drops." METHODS: We used Google Trends to assess the public online interest for search terms "ear pain," "ear infection," and "ear drops" in 5 English and non-English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our search terms were most relevant to the topics of ear pain, ear infection, and ear drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks. RESULTS: In the first part of the study, it was revealed that "ear infection," "ear pain," and "ear drops" were the most relevant search terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries' 3 primary search terms. The subsequent analysis revealed winter interest peaks for "ear infection" and "ear pain". On the other hand, the World Wide Web search for "ear drops" peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values <.001). CONCLUSIONS: It can be concluded that individuals affected by otitis media or externa, possibly the majority, look for medical information online. Therefore, there is a need for accurate and easily accessible information on these conditions in the World Wide Web, particularly on differentiating signs and therapy options. Meeting this need may facilitate timely diagnosis, proper therapy, and eventual circumvention of potentially life-threatening complications.

Increased incidence of otitis externa in covid-19 patients.

OBJECTIVE: The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia. METHODS: 257 cases who were confirmed positive for COVID-19, were examined otoscopic and endoscopic for otitis externa, onset of starting symptoms of otitis externa and its relation to days of infection with COVID-19 were documented and the prevalence of otitis externa with anosmia in the study group were estimated. RESULTS: Increased incidence of otitis externa in COVID-19 patients (18% of study group) and symptoms starting mainly between the 5th to 8th day of COVID-19 infection. Combined otitis externa and anosmia occurred in 13% of study group. CONCLUSIONS: Otitis externa has a relation to COVID-19 infection. Further research needed to study its pathogenesis and mechanisms.

The receptive field for visceral pain referred orofacially by the vagus nerves.

BACKGROUND: The nociceptive receptive field of the vagus nerves in animals includes virtually the entire thoracic, abdominal and laryngopharyngeal regions. However, the role of the vagus nerves in the transmission of visceral pain in humans, with the exception of pain from coronary artery diseases, is believed to be insignificant. AIM: The purpose of this report is to map out the clinical visceral pain receptive field of the vagus nerves relative to its nociceptive counterpart in animals. MATERIALS AND METHODS: The PubMed database and PMC were searched for case reports of patients with orofacial pain believed by the author(s) of the article to be referred from underlying non-cardiac thoracic, laryngopharyngeal or abdominal diseases. Reports of diseases for which non-neural explanations for the orofacial spread of pain were suggested were excluded. RESULTS: A total of 52 case reports of jaw pain and/or otalgia referred from laryngopharyngeal and noncardiac thoracic sources were discovered. In addition, a multicenter prospective study found that 25.8% of more than 3,000 patients with thoracic aortic dissection experienced pain in the head and neck region. In stark contrast, no case reports of orofacially referred pain from abdominal diseases were found. DISCUSSION: The results indicate that the laryngopharyngeal and thoracic portions of the vagal receptive field are capable of referring pain orofacially while the abdominal portion is not. The roles of the somatotopic organization of the trigeminal sub nucleus caudalis and neuromodulation in this referral of pain were discussed. CONCLUSION: Referred orofacial pain can lead to delayed diagnosis and poorer outcome in visceral diseases.

An emergency medicine-focused review of malignant otitis externa.

INTRODUCTION: Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality. OBJECTIVE: This narrative review provides an overview of malignant otitis externa for emergency clinicians. DISCUSSION: MOE is an invasive external ear infection that spreads to the temporal bone and can further progress to affect intracranial structures. Complications of advanced MOE include cranial nerve involvement, most commonly the facial nerve, and intracranial infections such as abscess and meningitis. The most common causative agent of MOE is Pseudomonas aeruginosa, but others include methicillin-resistant Staphylococcus aureus and fungi. Major risk factors for MOE include diabetes mellitus, immunosuppression, and advanced age. Red flags for MOE include severe otalgia (pain out of proportion to exam) or severe otorrhea, neurologic deficits (especially facial nerve involvement), previously diagnosed otitis externa not responsive to therapy, and patients with major risk factors for MOE. Examination may show purulent otorrhea or granulation tissue in the EAC, and culture of EAC drainage should be performed. Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base. When suspecting MOE, early consultation with an otolaryngologist is recommended and antibiotics with pseudomonal coverage are needed. Most patients with MOE will require admission to the hospital. CONCLUSIONS: MOE is a rare, yet deadly diagnosis that must be suspected when patients with immunocompromise, diabetes, or advanced age present with severe otalgia. Rapid diagnosis and treatment may prevent complications and improve outcomes.

Is Otalgia be a symptom of anxiety in children?

One of the common causes of ear pain (Otalgia) in children is the pain felt in the temporomandibular region due to bruxism, usually accompanied by stress and anxiety. The diagnosis and treatment of anxiety at an early age will affect the future lives of children. Our aim in the study was to investigate the presence and subtypes of anxiety in children with otalgia due to bruxism. In our study, 86 children aged between 6 and 16 years old who had ear pain and whose pain and tenderness were detected in the temporomandibular joint area and 40 healthy children were included as the control group. The children in both study groups were administered the Spence Children's Anxiety Scale (SCAS) test by the clinical psychologist. There was no statistical correlation between the children with bruxism and normal children (p > 0.05). While anxiety rate was 82% in children with bruxism, this rate was found to be 12.5% in normal children, this result was also statistically significant (p < 0.01). According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, it was observed that the performance anxiety was high in the 6-12 and 12-16 age group. However, obsessive symptoms were mostly observed in the 12-16 age group while separation anxiety was detected in children in the 6-12 age group.

Differential diagnosis of ear pain.

Ear pain, otalgia, can have many etiologies. Some of these conditions, e.g. impacted ear wax, can be solved easily directly in the outpatient office. On the other hand, inflammations and its complications can also endanger patients life. Situation is complicated due to secondary otalgia, when the source of pain is localized in another body region, e.g. oropharynx. Stubbing pain in the ear should be in this case perceived as a warning sign, because it could be caused by spread of primary disease to the parapharynx. Aim of this paper is to provide a summary of the most often causes of ear pain correlated with their typical clinical features, It should help to recognize serious conditions, which can endanger patient´s life.

The frequency of involvement of head & neck sites in referred otalgia - An experience at a tertiary care hospital.

OBJECTIVE: To determine the frequency of involvement of distant head & neck sites which share sensory innervations with the ear in referred otalgia. METHODS: This prospective study was conducted in the Department of ENT at Hayatabad Medical Complex, Peshawar, during the period from July 1, 2017 to December 31, 2017.*Non probability convenience sampling technique was used to include patients in the study. Patients with true 'otogenic pain' as determined on clinical examination or imaging studies were excluded from analysis. Only those who presented with referred ear ache were included in the study to determine the frequency of involvement of distant head & neck sites in 'referred otalgia'. Otalgia was designated as "Unknown Origin" when the ear and distant sites too were found normal. RESULTS: Out of a total of 150 patients, there were 81(54%) males and 69(46%) females. The ages ranged from 5 to 66 years with a mean age of 29.15 years. The commonest age groups involved were 21-35 years and 36-55 years. Referred otalgia of tonsillar origin was found in 47(31.3%) of patients followed by that of dental origin in 35(23.3%). Otalgia due to pharyngitis, rhinosinusitis and cervical origin was 24(16%), 8(5.3%) and 6(4%) respectively. Otalgia due to temporomandibular joint was noted in 12(8%) of females and 3(2%) of males & that of "unknown origin" affected 5(3.33%) of females and 2(1.3%) of males. CONCLUSIONS: The ear should be examined in detail in patients presenting with earache to look for indigenous pathology. In the presence of a 'Normal Ear', it is important to examine the tonsils, teeth, pharynx and the nose & paranasal sinuses as the possible sites of origin of earache.

Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study.

PURPOSE: One of the most common complications of hyperbaric oxygen (HBO2) therapy is middle ear barotrauma (MEB), occasionally causing otalgia. The objective of this study was to evaluate the effect of dried salted plum consumption on MEB and otalgia associated with HBO2 therapy. MATERIALS AND METHODS: Patients undergoing the first chamber session of HBO2 therapy were included in the present prospective randomized controlled trial. The Valsalva maneuver was administered to all patients before HBO2. The patients were randomly divided into two groups: one that ate a dried salted plum during HBO2 treatment and the other that did not. An otoscopic examination was performed after HBO2 therapy. The MEB was graded according to Teed scores. The degree of otalgia was recorded using the Visual Analog Scale (VAS). RESULTS: Ninety patients were enrolled. The overall incidence of MEB (Teed score grade 1~4) was 39.6% (21 of 53) for patients administered a dried salted plum versus 37.8% (14 of 37) for the control group (P=1.000). The incidence of mild MEB (Teed score grade 1~2) and severe MEB (Teed score Grade 3~4) between the two groups was not significantly different. Otalgia was present in 5.7% (3 of 53) of patients administered a dried salted plum versus 18.9% (7 of 37) for the control group (P=.085). No patients administered a dried salted plum had a VAS score ≥4 for otalgia versus 10.8% (4 of 37) for the control group (P=.026). CONCLUSIONS: Dried salted plum consumption does not decrease the incidence of MEB, but may ameliorate the severity of first chamber session HBO2-induced otalgia.

Referred otalgia in patients with thyroid cancer: Case series from Saudi Arabia.

INTRODUCTION AND IMPORTANCE: Referred Otalgia is very unlikely to be the first presentation of thyroid carcinoma, however, it is important to examine thyroid in cases of otalgia lacking any evidence of primary origin. CASE PRESENTATION: We report five cases of thyroid carcinoma, variant types, presented by secondary otalgia in Al-Baha region, KSA followed by proper surgery and patient relief during the last eight years. Patients' ages ranged from 25 to 65 years old. CLINICAL DISCUSSION: Thyroid inflammation, including acute and subacute thyroiditis, was reported as a possible cause of the pain referred to the ear and the angle of the mandible, however otalgia caused by thyroid cancer is an extremely rare presentation. CONCLUSION: Otolaryngologists should be aware that thyroid cancer may be associated with otalgia in any age group, however extremely rare. With very limited sources for this clinical entity, we recommend further studies on the different varieties of thyroid cancer presentations and the possibilities of the unexplained otalgia.

External Auditory Canal Squamous Papilloma Presenting with Otitis Externa and Severe Bony Erosion.

We present a case of a 68-year-old lady with an insidious progressive history of otorrhea, otalgia, and reduced hearing for 3 months. She was treated for malignant otitis externa and was treated with systemic antibiotic but showed subtherapeutic response to treatment. She underwent examination under anaesthesia and biopsy with tumour debulking of the right ear via posterior auricular approach and histopathological examination revealed squamous papilloma of the external auditory canal. She recovered well after surgery and was asymptomatic during follow-up.

Role of the Surgical Approach in the Treatment of Eagle Syndrome.

Introduction Eagle syndrome is a rare and an often misdiagnosed entity in otorhinolaryngology. Objective To determine the efficacy of the surgical treatment for Eagle syndrome. Methods The present prospective study included 25 patients who presented with complaints of pain in the throat, ear, and neck, as well as difficulty and/or pain while swallowing; they were assessed for Eagle syndrome. As per patient profile, we performed a clinical assessments along with orthopantomograms (OPGs), three-dimensional computed tomography (3D CT) scans, and cone beam computed tomography (CBCT). Pain was assessed pre- and postoperatively through the Numerical Rating Scale-11 (NRS-11), whose score ranges from 0 to 10. Microscopic tonsillo-styloidectomy was performed in cases in which the conservative treatment failed to relieve pain. Results The mean age of the entire study population was of 36.08 ± 7.19 years, and the male-to-female ratio was of 1.08:1. Referred otalgia was the commonest (44%) complaint. Radiologically, out of 25 patients, 20 patients presented elongated styloid processes. The longest symptomatic styloid process measured radiographically was of 64.7 mm while the shortest was of 28.2 mm. Out of 20 patients, 12 underwent surgery. The postoperative pain assessment through the NRS-11 was performed on day 0 (3.83 ± 0.83), day 7 (1.5 ± 0.52), week 4 (0.5 ± 0.52), and week 12 (0.41 ± 0.51). By 12 weeks, 7 patients were symptom-free, while 5 patients still reported mild pain. Conclusion Eagle syndrome associated with an elongated styloid process is not a rarity, but it often goes undiagnosed. Microscopic tonsillo-styloidectomy shows excellent results in the management of patients with Eagle syndrome.