If you would have asked me about Eagle Syndrome in graduate school, I would have asked you what you were talking about. Anyone treating Muscle Tension Dysphonia as a voice pathologist should at least be aware that this disorder exists. I had the pleasure of interviewing Grace Olmsted, MA, CCC-SLP recently, who actually had the rare syndrome. I want to share with you the things she went through so you can more effectively treat your patients.
But It’s Not MTD!
Grace grew up singing many genres of music, primarily jazz, musical theatre and classical. She received her Vocal Performance degree from Baldwin Wallace and went on for her MAster’s in Speech-Language Pathology at University of Massachusetts. She states her symptoms started very similar to Muscle Tension Dysphonia: an intense pain near the base of her tongue, vocal fatigue and aphonia, even some mild dysphagia to solid foods. She was fixated on the symptoms that were affecting her singing and searched for answers. After seeing many ENT’s, a gastroenterologist and endocrinologist, she was sent to chiropractor, psychiatrist and eventually to alternative medicine. No one, not even her voice specialist SLP, could find out what was wrong with Grace. Her videostroboscopy looked normal, and voice therapy was not recommended. “In retrospect,” Grace says, “it’s heartbreaking to think that someone in a voice care position dismissed my complaints because there was no evidence of pathology from stroboscopy.” She says her feelings were 100% real.
No One Listened
From there, she actually treated herself after learning techniques in her SLP graduate program including upper body relaxation, laryngeal massage, yawn sigh. This was all temporarily helpful, but all that was not treating her underlying cause. Grace recalls the emotional roller-coaster that she experienced after voice care, medication, diet changes, therapy and esophageal dilation all yielded no improvement in her symptoms. She even had conversations with herself, questioning her career as an SLP and as a singer, “How could I treat others’ communication disorders when I couldn’t figure out my own?”
What is Eagle Syndrome?
It is a rare musculoskeletal condition affecting the styloid process by either elongating it or calcifying the stylohyoid ligament. The styloid process is a small part of the temporal bone found on the side of your throat. Muscle tension from calcification and elongation can result in nerves, muscles, veins and arteries to be affected on one or both sides of the throat. Globus sensation, a diagnosis given to people who feel “lumps” in their throat from a variety of causes, occurs. It is so rare that 4% of the population have an elongated styloid process and of that 4%, only 4% experience symptoms. There are other variants of a hyoid syndrome as well, which can sometimes be successfully treated with nonsteroidal anti-inflammatory drugs.
After searching online, Grace eventually came across a Wikipedia article on Eagle Syndrome. Her ENT ordered a CT scan and sure enough, that was her diagnosis. Her ENT learned something new, and Grace then had 2 surgeries about 3 months apart, one for each side. She does say recovery was challenging, but worth it as she now feels 80% improved, with occasional globus sensation, but no more “tusks” pushing against her tongue. She wants to educate others that she now has vocal freedom, but most importantly she has peace of mind. She says, “Listening to your body is incredibly important- if something feels wrong, attend to it, and hopefully you will eventually find your answers.”
Grace Olmstead can be contacted at golmsted@gmail with any questions.
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.
References: Hardin FM, Xiao R, Burkey BB: Surgical Management of Patients with Eagle Syndrome, 2018, American Journal of Otolaryngology, sept-Oct;39(5):481-484