Glossopharyngeal neuralgia

Definition
Glossopharyngeal neuralgia is a condition marked by repeated episodes of severe pain in the tongue, throat, ear, and tonsils, which can last from a few seconds to a few minutes.

Causes, incidence, and risk factors

Glossopharyngeal neuralgia is believed to be caused by irritation of the ninth cranial nerve. Symptoms usually begin in people over 40 years of age.

In most cases, the source of irritation is never discovered. Nevertheless, tumors or infections of the throat and mouth, compression of the glossopharyngeal nerve by neighboring blood vessels, and other lesions at the base of the skull can sometimes cause this type of neuralgia (nerve pain).

Symptoms

Symptoms include severe pain in the areas connected to the ninth cranial nerves. This includes the throat, tonsillar region, posterior third of the tongue, nasopharynx (back of nose and throat), larynx, and ear. The pain is episodic and may be severe. It can sometimes be triggered by swallowing, chewing, speaking, laughing, or coughing.

Signs and tests

Tests will be done to identify an abnormality at the base of the skull, particularly tumors. These may include x-rays, CAT scan of the head, and head MRI. Sometimes the MRI may show evidence of inflammation of the glossopharyngeal nerve.

To determine whether a blood vessel is compressing the nerve, pictures of the brain arteries may be obtained using magnetic resonance angiography (MRA) or conventional angiography (x-rays of the arteries with a dye).

Occasionally, certain blood tests may be needed when the diagnosis is not clear, to rule out other causes of peripheral nerve problems (neuropathy), such as high blood sugar.

Treatment

Treatment is aimed at controlling pain. Unfortunately, over-the-counter pain killers such as aspirin and acetaminophen are not very effective for the relief of neuralgia. The most effective drugs are actually anti-seizure medications, like carbamazepine, gabapentin, and phenytoin. Some anti-depressants like amitriptyline are sometimes tried with variable degrees of success.

In severe cases, when pain is difficult to treat, surgery aiming at decompressing the glossopharyngeal nerve may be required. This surgery is generally considered effective. If a cause of the neuralgia is identified, the treatment of choice is the control of the underlying problem.

Expectations (prognosis)
Prognosis depends on the underlying cause and the effectiveness of initial treatment. Surgery is considered effective for cases that do not benefit from medications.

Complications
Decreased pulse and fainting may occur when pain is severe. Side-effects of medications may complicate treatment.

Calling your health care provider
Call your health care provider if you have symptoms suggestive of glossopharyngeal neuralgia. See a pain specialist if pain is severe to be sure that all options for controlling pain are available to you.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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