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) and the 10th cranial nerve (vagus nerve). These nerves move the muscles of the throat. The glossopharyngeal nerve also carries information from the throat, tonsils, and tongue to the brain, and the vagus nerve helps control heart rate, blood pressure, and muscle in some internal organs.

• The cause is often unknown but sometimes is an abnormally positioned artery that compresses the glossopharyngeal or vagus 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, baclofenSome Trade Names
  LIORESAL
  , 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 results from an abnormally positioned artery that compresses the glossopharyngeal or vagus nerve near where the nerve exits the brain stem. 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.

Symptoms

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. In 1 to 2% of people, the heartbeat is affected. It slows so much that it stops temporarily, causing fainting.

Diagnosis

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.

Treatment

The same drugs used to treat trigeminal neuralgia—carbamazepineSome Trade Names
TEGRETOL
, oxcarbazepineSome Trade Names
TRILEPTAL
, gabapentinSome Trade Names
NEURONTIN
, phenytoinSome Trade Names
DILANTIN
, baclofenSome Trade Names
LIORESAL
, and tricyclic antidepressants (see Mood Disorders: Drugs Used to Treat Depression)—may help. If these drugs are ineffective, applying a local anesthetic (such as cocaine) 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 and/or vagus nerve is separated from the artery that is compressing it by placing a small sponge between them (see see Cranial Nerve Disorders: Taking the Pressure Off a Nerve).

Last full review/revision September 2012 by Michael Rubin, MDCM