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Odynophagia: Diffenretial diagnosis Eagle syndrome
Introduction Odynophagia is a common cause of an ENT consultation. Inflammation and tumors of the oropharynx and hypopharynx should be considered, the Eagle syndrome is a rare differential diagnosis.
Case report A 76-year-old patient presents himself with odynophagia, weight loss and pain in the tongue / ear. There has been intermittent pain for years in the area of the tongue/tonsil and the tongue base of the right site. Currently it came to an exacerbation of the symptoms in the context of an infection. Clinically there was an ulcerous mass of the tongue base and a suspicious cervical lymph node. The histology of the performed panendoscopy and cervical lymphatic gland exstirpation because of the suspected metastatic oropharyngeal carcinoma was inconspicuous. So on the assumption of deep tongue tonsillitis antibiotics and analgesics were presumed. After four weeks inconspicuous mucous membrane of the oropharynx were revealed, but the pain symptoms were persistent. Because of a palpation pain of the right tonsillar fossa, an Eagle syndrome was suspected and hast been confirmed by a CT scan which showed a prolonged process of styloid on the right site. This was followed by transoral resection.
Conclusion In case of an intermittent odynophagia an Eagle Syndrome should also be considered. The extension of the styloid process is described in 4-7 % of the population, of which about 4-10 % have symptoms. Therefore CT is the first-choice diagnostic. In case of failure of conservative therapy, the surgical removal of the styloid process from enoral or extraoral is very promising. In the case described tongue base tonsillitis seems to have led to an exacerbation of the symptoms.
Article published online:
10 June 2020
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