Elongated Styloid Processes of the Temporal Bone as a Cause of Dysphagia

An otherwise fit and healthy 75-year-old man presented with a 2-year history of intermittent dysphagia and odynophagia localized predominantly around the suprasternal notch. His symptoms were most noticeable when he swallowed saliva, although he was able tolerate a fairly normal diet with no holdup or regurgitation. Examination of his oropharynx was normal. Flexible nasendoscopy showed an unremarkable postnasal space, pharynx, and larynx, although there was some evidence of mild post-cricoid edema. Barium swallow suggested the presence of a cricopharyngeal bar with early formation of a pharyngeal pouch. He was commenced on a proton pump inhibitor and antacid for suspected laryngopharyngeal reflux. When this failed to control or improve his symptoms, he underwent upper endoscopy, which ruled out esophageal abnormality. He subsequently underwent injection of botulinum toxin into the cricopharyngeus muscle to treat cricopharyngeal hypertrophy. This provided only limited symptomatic relief. It was noted from the patient’s medical history that he had undergone bilateral tonsillectomy 2 years earlier for an enlarged right tonsil. He reported that his symptoms seemed to have started soon after this. A computed tomography (CT) scan of the neck revealed bilateral elongated styloid processes (Figure 1). This was also demonstrated on his previous barium swallow (Figure 2). The patient underwent bilateral surgical excision of the styloid processes. This was successful in achieving a partial response to his symptoms. He was discharged from our care