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Glossopharyngeal Neuralgia


Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Sep 2020| Content last modified Sep 2020
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Glossopharyngeal neuralgia is characterized by recurrent attacks of severe pain in the 9th and 10th cranial nerve distribution (posterior pharynx, tonsils, back of the tongue, middle ear, under the angle of the jaw). Diagnosis is clinical. Treatment is usually with carbamazepine or gabapentin.

Glossopharyngeal neuralgia is rare, more commonly affecting men, usually after age 40.

Etiology of Glossopharyngeal Neuralgia

Rarely, the cause is a tumor in the cerebellopontine angle or the neck, a peritonsillar abscess, a carotid aneurysm, or a demyelinating disorder.

Often, no cause is identified.

Symptoms and Signs of Glossopharyngeal Neuralgia

As in trigeminal neuralgia, paroxysmal attacks of unilateral brief, excruciating pain occur spontaneously or are precipitated when areas innervated by the glossopharyngeal nerve are stimulated (eg, by chewing, swallowing, coughing, talking, yawning, or sneezing). The pain, lasting seconds to a few minutes, usually begins in the tonsillar region or at the base of the tongue and may radiate to the ipsilateral ear.

Occasionally, increased activation of the vagus nerve due to its connections with the glossopharyngeal nerve causes sinus arrest with syncope; episodes may occur daily or once every few weeks.

Diagnosis of Glossopharyngeal Neuralgia

  • Clinical evaluation, often including response to anesthetics

  • MRI

Diagnosis of glossopharyngeal neuralgia is clinical.

Glossopharyngeal neuralgia is distinguished from trigeminal neuralgia by the location of the pain. Also, in glossopharyngeal neuralgia, swallowing or touching the tonsils with an applicator tends to precipitate pain, and applying lidocaine to the throat temporarily eliminates spontaneous or evoked pain.

MRI is done to exclude tonsillar, pharyngeal, and cerebellopontine angle tumors and metastatic lesions in the anterior cervical triangle. X-rays or CT can be done to look for an elongated styloid process below the ear, which could be compressing the nerve. Local nerve blocks done by an otolaryngologist can help distinguish between carotidynia, superior laryngeal neuralgia, and pain caused by tumors.

Treatment of Glossopharyngeal Neuralgia

  • Usually antiseizure drugs

If oral drugs are ineffective, local anesthetics can provide relief. For example, topical cocaine applied to the pharynx may provide temporary relief. However, surgery to decompress the nerve from a pulsating artery (microvascular decompression) may be necessary. If pain is restricted to the pharynx, surgery can be restricted to the extracranial part of the nerve. If pain is widespread, surgery must involve the intracranial part of the nerve.

Key Points

  • The pain of glossopharyngeal neuralgia is similar to that of trigeminal neuralgia.

  • Distinguish glossopharyngeal neuralgia from trigeminal neuralgia based on the pain's location and response to touching and to lidocaine applied to the pharynx.

  • Do MRI to distinguish glossopharyngeal neuralgia from tumors and metastatic lesions.

  • Treat as for trigeminal neuralgia (usually with antiseizure drugs).

  • If drugs are ineffective, try local anesthetics, but microvascular decompression may be necessary.

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Test your knowledge
Numbness is defined as loss of sensation, either partial or complete. Numbness can occur from dysfunction anywhere along the pathway from the sensory receptors up to the cerebral cortex. A patient with dysfunction in which of the following CNS areas is most likely to present with facial and body numbness on the same side, plus an inability to perceive multiple stimuli of the same type simultaneously?
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