(See also Overview of the Cranial Nerves.)
Glossopharyngeal neuralgia 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.
The cause is often unknown but sometimes is an abnormally positioned artery that puts pressure on (compresses) the glossopharyngeal nerve.
People have brief attacks of excruciating pain, affecting one side of the tongue or throat and sometimes an ear.
Doctors diagnose the disorder based on what the pain is like and whether a local anesthetic applied to the back of the throat eliminates the pain.
Certain anticonvulsants or antidepressants, baclofen, or a local anesthetic may relieve the pain, but surgery is sometimes needed.
Glossopharyngeal neuralgia, a rare disorder, usually begins after age 40 and occurs more often in men.
Often, its cause is unknown.
But sometimes glossopharyngeal neuralgia occurs when
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.
In glossopharyngeal neuralgia, 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.
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 (MRI) is done to check for tumors. Computed tomography (CT) may be done to determine whether the styloid process is abnormally long.
The same drugs used to treat trigeminal neuralgia—anticonvulsants (carbamazepine, oxcarbazepine, gabapentin, or phenytoin), baclofen, and tricyclic antidepressants (see Table: Drugs Used to Treat Depression)—may help.
If these drugs are ineffective, applying a local anesthetic (such as lidocaine) to the back of the throat may provide temporary relief (as well as confirm the diagnosis).
However, for permanent relief, surgery may be needed. The glossopharyngeal nerve is separated from the artery that is compressing it by placing a small sponge between them.