The eagle is landing

As a GP in Edinburgh, I read with great interest the article ‘The eagle is landing,’ in your September 2012 issue.1

Some 12 years ago, I was diagnosed with glossopharyngeal neuralgia, secondary to Eagle syndrome. The saga started quite simply during a family holiday, with a discharging ear infection treated with ciprofloxacin. I saw three consultant ENT surgeons, for ear pain radiating to the back of the throat, and swallowing difficulty. I also saw a general physician for nausea, an ophthalmologist for blurred vision, and a neurologist for tingling of the tongue associated with difficulty in articulation. The pain and weight loss resulted in my being unable to practice for 4 months.

I was investigated, with blood tests, MRI, and CT scans which were all reported normal, hence the very uncomfortable situation of ‘medically unexplained symptoms’. As a GP this was particularly bewildering and professionally undermining. The diagnosis of Eagle syndrome was finally made by a consultant radiologist following a re-referral to neurology some 15 months later.

The aetiology is, in my case, unclear. I personally suspect that the ciprofloxacin and/or the ear infection may in fact have caused some calcification in the stylo-hyoid ligament. What further complicated my case was that repeated treatment with ciprofloxacin seemed to help the undiagnosed neuralgic symptoms. This remains unexplained.

The lack of knowledge of this condition in all the clinicians involved (including myself) lead to an inability to recognise the clinical features and delayed the diagnosis. However, on a positive note this did allow time for natural resolution of symptoms over 2–3 years.

My experience was a humbling one, and I feel that I have more empathy with other patients who have medically unexplained symptoms. Although I consider mood disorder in such patients, I do accept that an unknown physical aetiology may be present.

Following my experiences, I was left wondering how many cases I had potentially missed. Over the last 10 years I have considered the diagnosis in only two or three patients and not diagnosed any patients with Eagle syndrome. Therefore, my personal opinion is that this is a rare condition. The symptoms, that can range from distressing to life threatening, and cross several specialities, make Eagle syndrome a difficult diagnosis. I would certainly welcome further awareness, research on aetiology, management, and natural history of this interesting condition.

• © British Journal of General Practice 2012