Glossopharyngeal neuralgia

Glossopharyngeal neuralgia is characterized by shock like pains in the territory of the glossopharyngeal nerve. It is in every way similar to tic douloureux except for the distribution of the pain and the customary site of the triggering stimulus. It is generally located near the tonsil although the pain may extend deep into the ear. It is usually triggered by swallowing or chewing.Glossopharyngeal neuralgia sometimes results from nerve compression by an aberrant, pulsating artery similar to that in trigeminal neuralgia and hemifacial spasm.

Glossopharyngeal neuralgia usually begins after age 40 and occurs more often in men. 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 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. The goal of treatment is to control pain. If oral drugs are ineffective, topical cocaine applied to the pharynx may provide temporary relief. Carbamazepine, phenytoin, gabapentin, baclofen, and tricyclic antidepressants may be used to ameliorate the pain of glossopharyngeal neuralgia. Some anti-depressants like amitriptyline are sometimes tried with variable degrees of success. If these drugs are ineffective, applying a local anesthetic (such as cocaine) to the back of the throat may provide temporary relief.

When a blood vessel is identified as compressing the glossopharyngeal nerve, surgery may be performed to move the vessel or to position a teflon felt pad between the blood vessel and the nerve, in order to attempt to mitigate any pressure that is exerted on the nerve. Surgical options, including nerve resection, tractotomy, or microvascular decompression, should be considered when individuals either don’t respond to, or stop responding to, drug therapy. This surgery is generally considered effective. If a cause of the neuralgia is found, treatment should control the underlying problem.