What Is Glossopharyngeal Neuralgia?

Glossopharyngeal neuralgia is a type of paroxysmal pain that occurs in the area of the glossopharyngeal nerve. The nature of pain is very similar to trigeminal neuralgia, and it is also divided into two categories: primary and secondary. Pain occurs on one side of the tongue, throat, tonsils, ears, and back of the lower jaw. Sometimes the pain is mainly the ear. There are more cases of men than women, and they usually develop after age 40.

Basic Information

English name

glossopharyngeal neuralgia

Visiting department

Internal medicine

Multiple groups

Men over 40

Common locations

Posterior pharyngeal wall, tonsils, tongue base, etc.

Common causes

Demyelination of nerves, tumors, local arachnoiditis, aneurysms, etc.

Common symptoms

Paroxysmal pain, with wasting, dehydration, laryngospasm, arrhythmia, and hypotensive syncope

Causes of glossopharyngeal neuralgia

It may be the result of a "short circuit" between the afferent impulses of the glossopharyngeal nerve and the vagus nerve caused by demyelination of the nerve. Can also be found in the jugular foramen, skull base, nasopharynx, tonsils and other tumors, local arachnoiditis or aneurysms, these are called secondary glossopharyngeal neuralgia. In recent years, the development of microvascular surgery has found that in some patients, the glossopharyngeal nerve is compressed by the vertebral artery or the posterior inferior cerebellar artery.

Clinical manifestations of glossopharyngeal neuralgia

According to the different causes, the glossopharyngeal neuralgia can also be divided into two types: primary glossopharyngeal neuralgia and secondary glossopharyngeal neuralgia.

Primary glossopharyngeal neuralgia

The etiology of primary glossopharyngeal neuralgia is still unclear and may be due to nerve desheathing. Its clinical manifestations are:

(1) Pain occurs at the base of the tongue, throat, tonsils, ears, and back of the lower jaw. Pain is sometimes the main manifestation.

(2) Seizures and pain characteristics With trigeminal neuralgia, pain usually occurs suddenly and stops suddenly. The duration of each episode is usually several seconds or tens of seconds, and generally does not exceed two minutes. It can also show severe pain such as knife cutting, acupuncture, tearing, burning, and electric shock.

(3) Predisposing factors often cause pain when swallowing, talking, coughing or yawning.

(4) Trigger point Often there are trigger points, most of which are in the posterior pharyngeal wall, tonsils, root of the tongue, etc. A few can be in the external ear canal.

(5) Other symptoms Swallowing action often induces painful episodes. Although there are no abnormalities during the intermittent episodes, but they are afraid to induce pain and do not dare to eat. Patients often have weight loss, dehydration, laryngospasm, arrhythmia, and hypotensive syncope. symptom.

(6) The nervous system examination is normal.

Most common glossopharyngeal neuralgia clinically belongs to primary glossopharyngeal neuralgia, which temporarily has no good analgesic effect.

2. Secondary glossopharyngeal neuralgia

Some cerebellar pontine horn tumors, arachnoiditis, vascular diseases, nasopharyngeal tumors or styloid processes can irritate the glossopharyngeal nerve and cause pain in the glossopharyngeal nerve subregion, which is called secondary.

Glossopharyngeal neuralgia examination

There were no abnormal findings in the nervous system examination. There may be trigger points at the base of the tongue and the tonsil.

Glossopharyngeal neuralgia diagnosis

1. Ask about the location and nature of the pain in the medical history, whether it is related to diet, and whether the pain is radiating to the ears.

2. Instruct patients to eat and observe the conditions that induce pain. If the trigger point is at the tonsil fossa, apply the cocaine solution to the affected side of the pharynx to see if the pain is relieved.

3. Check the nasopharyngeal and posterior groups for positive signs.

Differential diagnosis of glossopharyngeal neuralgia

It is often distinguished from trigeminal neuralgia and pain caused by nasopharyngeal tumors invading the pharyngeal and skull base structures.

Glossopharyngeal neuralgia treatment

Drug treatment

(1) Sodium phenytoin is administered orally.

(2) Vitamin B ₁ , B ₁₂ and so on.

(3) Carbamazepine is administered orally. Drug treatment often achieves satisfactory clinical effects in the early stages of onset, but with the aggravation of pain, the drug often loses its effect gradually within months or years.

2. Nerve block

The method is percutaneous puncture radiofrequency treatment of the jugular foramen. It is suitable for:

(1) Those who are ineffective in drug treatment or cannot tolerate adverse drug reactions;

(2) Those who are old or poor in general and cannot tolerate microvascular decompression surgery;

(3) Cases with multiple sclerosis. The main problems with this method of treatment are high pain recurrence rate, dysphagia due to nerve damage, drinking cough and hoarseness.

3. Microvascular decompression surgery

Microvascular decompression is currently the safest and most effective surgical treatment, with a cure rate of 99%. Surgical treatment applies to:

(1) Failure of medication or percutaneous puncture;

(2) The general condition of the patient is good, there is no serious organic disease and can tolerate the operation;

(3) Exclude those with multiple sclerosis or cerebellopontine angle tumors. In most patients, the pain disappears after surgery.

4. Closed Therapy

At the midpoint of the line between the mandibular angle and the mastoid, 10% procaine is injected vertically under the skin to relieve pain.

Glossopharyngeal neuralgia prevention

1. Tumors in the jugular foramen, skull base, nasopharynx, tonsils, etc., and secondary arachnoiditis or aneurysms secondary to this disease, should pay attention to changing bad habits, such as: irregular life, smoking, drinking, Partial eating, eating particularly irritating, excessively greasy food, etc.

2. Regular physical examination is important to enable early detection and early treatment of tumors.