Glossopharyngeal Neuralgia

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia is a rare medical condition characterised by repeated episodes of sharp or shooting pain in the ears, tongue, throat, or tonsils. This pain lasts from a few seconds to a few minutes.

Associated Anatomy

The ears, tongue, tonsils, or throat

Glossopharyngeal Neuralgia Causes

While the exact cause behind glossopharyngeal neuralgia is unknown, studies indicate the following factors may lead to the development of the condition.

  • Blood vessels pressing on the glossopharyngeal nerve.
  • Infections or tumours at the base of the skull.
  • Medical diseases, such as Sjorgen’s disease, multiple sclerosis, and Eagle’s syndrome.
  • Cancer or infection in the mouth and tonsils.
  • Intracranial lesions.

Glossopharyngeal Neuralgia Symptoms

Glossopharyngeal neuralgia is characterised by a sharp or stabbing pain on one or both sides. It causes pain in the areas connected to the glossopharyngeal nerve, such as:

  • Back of the tongue
  • Voicebox (larynx)
  • Throat
  • Tonsils
  • Ears
  • Back of the throat and nose (nasopharynx)

In severe episodes, it can result in symptoms such as:

  • Syncope (fainting)
  • Arrhythmia (irregular heartbeat)
  • Bradycardia (slow heartbeat)

The episodes of pain recur several times during the day and can disrupt an individual’s sleep. The following factors may trigger this condition.

  • Chewing
  • Coughing
  • Sneezing
  • Yawning
  • Cold beverages
  • Laughing
  • Speaking
  • Touching a blunt object to one’s tonsils

Glossopharyngeal Neuralgia Treatment

Depending on the severity of the pain, your doctor may recommend the following glossopharyngeal neuralgia treatments.

  • Medications - In most cases, anticonvulsants and antidepressants are prescribed as the first line of treatment to manage the pain and depression associated with the condition.
  • Surgery - In severe cases, doctors opt for surgical procedures when medications fail to provide relief. Surgical procedures such as microvascular decompression are conducted where a Teflon sponge is put between the glossopharyngeal nerve and the compressed vessel to relieve the pain.

Risk Factors of Glossopharyngeal Neuralgia

Since the exact cause behind glossopharyngeal neuralgia is unknown, studies suggest that the following factors may increase the risk of developing this condition.

  • Individuals over 50 years of age
  • Cervical or vascular malformations
  • Injury to the base of the skull
  • Autoimmune diseases
  • Multiple sclerosis
  • Structural abnormalities caused by facial lesions

Stages of Glossopharyngeal Neuralgia

The glossopharyngeal neuralgia nerve starts at the lower end of the brain stem and ends deep in the throat. As a result, the pain radiates across the tonsils, throat, tongue, and ears. While it is commonly observed on one side, the pain can spread to the other side as well.

Typical Test of Glossopharyngeal Neuralgia

The doctor will conduct a detailed physical examination and collect your medical history to get a better understanding of your health. For proper diagnosis, your doctor may recommend one of the following tests.

Blood tests - A battery of blood tests is conducted to rule out possible infections.

Imaging tests - Your doctor may recommend a CT scan or an MRI to get a detailed image of the head to see if any tumour or blood vessel is pressing on the nerve.

Primary Prevention of Glossopharyngeal Neuralgia

Since the exact cause behind glossopharyngeal neuralgia is unknown, currently there are no medical strategies that can be used to prevent the development of the condition. If you experience sharp or stabbing pain in the tongue, tonsils, throat, or ears, consult a doctor immediately to get the right treatment.

Secondary Prevention of Glossopharyngeal Neuralgia

Doctors may use the following treatment options to manage the condition.

  • Anticonvulsant or local anaesthetics to provide relief.
  • If the medications fail to do so, doctors go for surgical interventions such as microvascular decompressions to provide long-term relief from the pain.
  • Ensure that you follow the doctor’s instructions and go to follow-up appointments to track the progress of the condition.

Epidemiology of Glossopharyngeal Neuralgia

Studies suggest that glossopharyngeal neuralgia is a rare medical condition observed in:

  • Individuals over the age of 50
  • 1 in 100,000 people every year
  • It is equally seen in both males and females
  • 74% of patients have spontaneous remissions
  • 12% of the patients experience bilateral pain
  • The annual recurrence rate is low as 3.6%

Expected Prognosis of Glossopharyngeal Neuralgia

The prognosis of individuals with glossopharyngeal neuralgia depends on the possible cause behind the condition and their response to treatment. While some people respond very well to medications, some may require surgical interventions. Multiple episodes of severe pain accompanied by bilateral pain are poor prognostic indicators.

Natural Progression of Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia can start in your throat and spread to your tonsils, tongue, and ears. While it is commonly observed on one side, it can spread to the other side as well. Severe pain can result in difficulty swallowing, loss of appetite and weight loss.

Pathophysiology of Glossopharyngeal Neuralgia

The glossopharyngeal neuralgia is located at the base of the stem, which moves along with the vagus nerve passing the internal jugular vein to the base of the tonsils, tongue, and glands of the mouth. The activation of the vagus and glossopharyngeal nerves can result in pain, fainting, and irregular heartbeats.

Possible Complications of Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia may result in possible health complications. These include syncope (fainting), arrhythmia (irregular heartbeats), bradycardia (slow heartbeat), hypotension (low blood pressure), seizures, weight loss, difficulty swallowing, difficulty speaking, damage to the carotid artery, hypoperfusion (reduced blood flow), and cerebral hypoxia (less oxygen in the brain). In rare cases, one might experience side effects of the prescribed medications.

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