Glossopharyngeal Neuralgia Overview:
Glossopharyngeal Neuralgia (GPN) consists of recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, part of the ear, and/or the area under the back of the jaw. The pain is due to malfunction of the 9th cranial nerve (glossopharyngeal nerve) The glossopharyngeal nerve helps move the muscles of the throat and carries information from the throat, tonsils, and tongue to the brain.
Glossopharyngeal neuralgia is believed to be caused by irritation of the ninth cranial nerve, called the glossopharyngeal nerve.
Glossopharyngeal neuralgia has been reported to impact about one person in 2000 people living with multiple sclerosis.
People have brief attacks of excruciating pain, affecting one side of the tongue or throat and sometimes an ear.
Sometimes glossopharyngeal neuralgia occurs when an abnormally positioned artery compresses the glossopharyngeal nerve near where the nerve exits the brain stem.
The long, pointed bone at the base of the skull (styloid process) is abnormally long and compress the nerve.
Rarely, the cause is a tumor in the brain or neck, an abscess, a bulge (aneurysm) in an artery in the neck (carotid artery), or multiple sclerosis.
Attacks are brief and occur intermittently, but they cause excruciating pain. Attacks may be triggered by a particular action, such as chewing, swallowing, talking, yawning, coughing, or sneezing. The pain usually begins at the back of the tongue or back of the throat. Sometimes pain spreads to the ear or the area at the back of the jaw. The pain may last several seconds to a few minutes and usually affects only one side of the throat and tongue.
Pain in the below regions:
- Middle ear
- Sudden drop in blood pressure
It can sometimes be triggered by:
Diagnosing Glossopharyngeal Neuralgia:
The diagnosis is made on clinical grounds alone; that is, no specific test can be done to prove the diagnosis in any given patient. The pattern of episodic ear and/or throat pain, often triggered by touching the palate or tonsil is strongly suggestive of the disorder. High resolution MRI or CT imaging of the brainstem may reveal the presence of vascular compression, tumors, or demyelinating lesions involving the ninth cranial nerve. High resolution CT scanning of the neck can reveal the presence of an elongated styloid process, suggestive of Eagle syndrome. Trigeminal neuralgia is a related disorder in which there is pain in the face. Distinguishing the two disorders is done based upon the location of the pain. Pain that distinctly involves the ear or throat is the classic distribution seen in glossopharyngeal neuralgia.
- A test using a cotton-tipped applicator and an anesthetic
- Magnetic resonance imaging
- Sometimes computed tomography
Glossopharyngeal neuralgia is distinguished from trigeminal neuralgia (which causes similar pain) based on the pain’s location or results of a specific test. For the test, a doctor touches the back of the throat with a cotton-tipped applicator. If pain results, the doctor applies a local anesthetic to the back of the throat. If the anesthetic eliminates the pain, glossopharyngeal neuralgia is likely.
Magnetic resonance imaging scan (MRI) is done to check for tumors or lesions associated with the ninth cranial nerve, called the glossopharyngeal nerve.
A Computed tomography scan (CT) may be done to determine whether the styloid process (slender projection of bone) is abnormally long.
Causes of Glossopharyngeal Neuralgia:
Glossopharyngeal neuralgia is believed to be caused by irritation of the ninth cranial nerve, called the glossopharyngeal nerve. Symptoms usually begin in people over age 40.
Glossopharyngeal neuralgia is typically caused by compression of the glossopharyngeal nerve. Compression of the nerve by an adjacent artery and/or vein can occur near the brainstem. Compression of the nerve more distally in the neck by an elongated styloid process (a bone in the neck) can cause this pain syndrome as well, and this is called Eagle syndrome. Additionally, Glossopharyngeal neuralgia can be caused by a tumor or infection in the region of ninth cranial nerve or by multiple sclerosis.
In most cases, the source of irritation is never found. Some possible causes for this type of nerve pain (neuralgia) are:
- Blood vessels pressing on the glossopharyngeal nerve
- Growths at the base of the skull pressing on the glossopharyngeal nerve
- Tumors or infections of the throat and mouth pressing on the glossopharyngeal nerve
- Neurological diseases.
Treatment of Glossopharyngeal Neuralgia:
- Carbamazepine (Tegretol)
- Oxcarbazepine (Trileptal)
- Gabapentin (Neurontin)
- Phenytoin (Dilantin, Phenytek)
- Topiramate (Topamax)
- Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)
- Pregabalin (Lyrica)
- Baclofen (Lioresal, Gablofen)
Rhizotomy is a surgical procedure to sever nerve roots in the spinal cord. The procedure effectively relieves chronic back pain and muscle spasms. For spinal joint pain, a facet rhizotomy may provide lasting low back pain relief by disabling the sensory nerve at the facet joint.
Percutaneous Radiofrequency Rhizotomy:
Percutaneous stereotactic rhizotomy (PSR) is usually performed by a neurosurgeon as an outpatient procedure in a radiology department or an operating room. The procedure typically takes about 1 to 2 hours.
PSR can relieve neuralgia (nerve pain) by destroying the part of the nerve that causes pain and by suppressing the pain signal to your brain. The surgeon passes an electrode introducer (hollow needle) through the skin of your cheek into the selected nerve at the base of the skull. A heating current, which is passed through the electrode, destroys some of the nerve fibers. The entire nerve is not destroyed. However, damaging the nerve causes mild to major facial numbness in that area. A degree of facial numbness is an expected outcome of the procedure and is necessary to achieve long-term pain relief.
Who is a candidate?
PSR can provide pain relief for many patients with trigeminal neuralgia, glossopharyngeal neuralgia, or other neurological diseases (e.g., cluster headache) when medications become ineffective. PSR can be effective in treating patients of all ages including those with multiple sclerosis and those with some types of tumors. Patients often choose to undergo PSR because it poses lower surgical risks than those of a major operation such as microvascular decompression (MVD). Although facial numbness results, PSR is one of the most effective procedures because it provides lasting pain relief with few risks of serious side effects.