Overview
Glossopharyngeal is a nerve that originates in the brain stem and travels down to the throat, where it helps control swallowing and speech. It also supplies sensation to the back of the tongue and parts of the roof of the mouth. The Glossopharyngeal nerve is one of the cranial nerves. It is responsible for conveying taste sensations from the back of the throat and controlling certain muscles in the neck and throat. Damage to this nerve can result in pain in the throat, mouth, and ears and difficulty speaking and swallowing. Glossopharyngeal neuralgia (GN) is a relatively rare condition that causes episodes of sharp pain in those regions. There is currently no cure for glossopharyngeal neuralgia.
Causes of Glossopharyngeal
The main cause of Glossopharyngeal neuralgia (GPN) is irritation of the ninth cranial, known as the glossopharyngeal nerve. Although the source of this irritation is often not found, there are a few reasons found to be responsible for this type of nerve pain that creates pressure on the glossopharyngeal nerve, such as:
- Blood vessels pressing the glossopharyngeal nerve
- Growth at the base of the skull
- If there is an infection or presence of a tumour on the throat and mouth.
Signs and Symptoms of Glossopharyngeal
There are many signs and symptoms of severe pain occurring in episodes in the areas connected to the ninth cranial nerve, such as the ear, throat, voice box, back of the tongue, back of nose and throat, and tonsil area. Normally this pain is triggered by the following reasons:
- Drinking cold beverages
- Chewing
- Swallowing
- Speaking
- Coughing
- Sneezing
- Laughing
- Yawning
- Touching
Possible Treatment
The treatment to start is to control pain. Drugs such as anti-seizure medicines or antidepressants may help people with severe pain. At times, the application of local anaesthetics to the affected region may help for a shorter duration.
If the condition is very bad in terms of unbearable pain and no medication is helpful, surgery is performed known as microvascular decompression, wherein the nerve can be cut (rhizotomy). Both are known to provide relief to the patients to get rid of the severe pain.
Risk Factor
There is no indicated risk factor associated with the treatment of glossopharyngeal neuralgia. However, in many cases, after surgery, there are side effects that may include loss of sensation in the mouth and throat in many cases.
Stages / Grades
There are no stages or grades of this condition, but the pain episodes may last for seconds or a few minutes. This pain might occur during the day or night.
Typical Test
Tests are recommended to identify underlying reasons, too, such as a tumour at the base of the skull. The following tests are performed:
- MRI of the head
- CT scan of the head
- X-ray of the head
- Blood tests
- CT angiogram
- MRA – Magnetic resonance angiography
Primary Prevention
There is no way one can prevent having this condition. The first-line treatment is medication to relieve GPN, and if it does not work, the second-line treatment is surgery. Eighty per cent of patients who undergo this surgery see effective results.
Secondary Prevention
One can avoid the known reasons triggering the pain and, after surgery, take precautions.
Epidemiology of Glossopharyngeal
Glossopharyngeal neuralgia is considered an extremely rare condition. The study done from 1945 to 1984 showed a crude incidence rate of 0.7 per 100000 population. The incidence was seen to be equal in both sexes. The overall rates increase with age in both males and females. In another study and review of the data on 217 patients with glossopharyngeal neuralgia from the years 1922 to 1977, it was found that 57% of the cases were in patients over 50 years of age, 43% in patients between 18 and 50 years of age.
Expected Prognosis
It depends upon the underlying cause of the problem and pain and the result of the treatment protocol in terms of the effectiveness of medication and surgery for those who do not benefit from medicines.
Natural Progression
If the pain is left untreated, the frequency will keep on increasing. It might be due to any serious underlying condition which cannot be left unnoticed. It is not life-threatening but has many related health issues affecting the normal running of life.
Pathophysiology
The glossopharyngeal nerve is a very small nerve, often called ‘the neglected cranial nerve’, which runs deep in the neck. Any kind of infection, inflammation, or compressive etiologies across the nerve’s path from the organs to the brainstem sometimes results in hyperexcitability of the nerve and produces severe pain.
Possible Complication
Possible complications of GPN may include:
- difficulty in speaking
- difficulty in swallowing food
- damage to the carotid artery or internal jugular artery
- slow pulse rate
- fainting due to severe pain
- side effects of the medicines
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