Glossopharyngeal neuralgia manifests with a pain that is sharp and stabbing in nature. It is generally localized in the throat but can also radiate to the ear or the other way around. The localization of the pain is critical in establishing the diagnosis. Structures and organs involved include the base of the posterior part of the tongue, the tonsils, the pharynx, the mandibular angle, the inner ear and the eustachian tube [8].

Pain in glossopharyngeal neuralgia occurs in episodes but with a gradual and subtle onset that can last for 30 seconds. There is a continuous presence of an ache in the region of the pain, even in the absence of a pain crisis. The pain more typically occurs during the days and can last for months at times. It is associated with particular triggers such as swallowing cold fluids, talking, chewing, sneezing, contact with the gums or the oral mucosa, cleaning of the throat, jerky movements of the head, moving the jaw in the lateral direction or raising the hand on the side of the pain. The pain can sometimes be further triggered by establishing contact with the skin around the ear on the affected side as well as by touching the external auditory canal [9].

Glossopharyngeal neuralgia may also be associated with a number of other symptoms such as vomiting, a sensation of edema in the face, tinnitus, vertigo and involuntary movements. It may be difficult to distinguish from intermedius neuralgia especially when they present similarly with decreased hearing. Furthermore, giant cell arthritis can also present with a pain with similar characteristics.

Vagoglossopharyngeal neuralgia is a subtype of the condition that is associated with vagal symptoms such as convulsions, asystole and syncope. This is caused by the intricate anatomical relationship between the glossopharyngeal nerve, the intermedius and the vagus and may complicate evaluation by neurologists and neurosurgeons [10].

In comparison to trigeminal neuralgia, the exact location of pain is only later clearly identified by the patient, making diagnosis difficult from the first clinical encounter.

• Severe Pain

  OBJECTIVE: Glossopharyngeal neuralgia is rare but causes severe pain. We retrospectively evaluated preoperative MR images of patients with glossopharyngeal neuralgia caused by neurovascular compression. [ncbi.nlm.nih.gov]

• Dentist

  This can help the dentist and patient avoid oral procedures that will not alleviate the painful symptoms. [ncbi.nlm.nih.gov]

  Focal lesions that persist should command a referral to a dentist or oral surgeon. [checkorphan.org]

  Related documents Nervous System True or False Intro Nerve Conduction Services Abstract Method and laser apparatus for nerve treatment WangCellTableHW_JW Pain Therapy Nerve Transfer Surgery to Restore Hand Function Dear dentist link - Trigeminal Foundation [studylib.net]

  In the county there are five general dentists, three dental hygienists, and one public health-centered dental clinic. The clinic employs a full-time dentist and dental hygienist. [docplayer.net]

  Karger AG, Basel References Horowitz M, Ochs M, Carrau R, Kassam A: Trigeminal neuralgia and glossopharyngeal neuralgia: two orofacial pain syndromes encountered by dentists. J Am Dent Assoc 2004;135:1427-1433. [karger.com]

• Epilepsy

  An adolescent girl presented with severe, lancinating tonsillar pain exacerbated by swallowing 6 weeks after initiation of left vagus nerve stimulation for intractable epilepsy. [ncbi.nlm.nih.gov]

  Drugs that are commonly used to treat epilepsy can improve the pain as well as certain antidepressants. [symptoma.com]

  BOARD乳癌 CARDIAC PRACTICE Cardio-Coagulation Cardio-Lipidology Cardio-Renal Diabetes Clinical Respiration Coagulation & Inflammation DEPRESSION JOURNAL Diabetes Frontier Diabetes Frontier Online Diabetes Horizons -Practice and Progress- DIABETES UPDATE Epilepsy [med.m-review.co.jp]

  Grape Seed Extract for... by gert 05-14-2019 07:02 PM 260 1,816 Epilepsy (4 Viewing) For support and discussion about Epilepsy and Seizure Disorders. [neurotalk.psychcentral.com]

  Epilepsy Behav. 2011, 20: 407-409. 10.1016/j.yebeh.2010.12.017. [jmedicalcasereports.com]

• Unconsciousness

  C) combine both conscious and unconscious information processing. D) occur in the cerebrum. E) All of the answers are correct. The only sensation that is received directly by the cerebrum is A) olfaction. B) gustation. C) hearing. D) vision. [quizlet.com]

  He reported attacks of unconsciousness in paroxysms in a young barrister. Rushton in 1981 [ 8 ] reported four instances of syncope in 217 patients at the Mayo Clinic. [karger.com]

  C) combine both conscious and unconscious information processing. D) occur in the cerebrum. E) All of the answers are correct. E) All of the answers are correct 115 124) The only sensation that is received directly by the cerebrum is A) olfaction. [easynotecards.com]

  An unconscious young man with signs of morphine poisoning entered admission office. His respiration is shallow and infrequent which is caused by inhibition of respiratory centre. What type of respiratory failure is it? A. [de.slideshare.net]

• Pallor

  The majority of cases experience pallor, followed by hypotension associated with bradycardia, leading to loss of consciousness associated sometimes with clonic movements. [scielo.br]

  Leukemia 29.A 12y.o. boy who suffers from bronchial asthma has an acute attackof asthma: evident expiratory dyspnea, skin pallor. What type of alveolar ventilation disturbance is it? A. Obstructive B. Restrictive C. Throracodiaphragmatic D. [de.slideshare.net]

• Cough

  It can be triggered by talking, yawning, coughing and swallowing. Classically, patients experience a unilateral lancinating and excruciating pain described as electrical shock-like pain in the areas around the ear, tongue, or the mandibular angle. [ncbi.nlm.nih.gov]

  These episodes can be triggered by swallowing, particularly cold liquids, and actions such as yawning, sneezing, or coughing. [aaroncohen-gadol.com]

  Many individuals with GN relate the attacks of pain to specific trigger factors such as swallowing, drinking cold liquids, sneezing, coughing, talking, clearing the throat, and touching the gums or inside the mouth. [ninds.nih.gov]

  It is commonly provoked by swallowing, talking or coughing and may remit and relapse in the fashion of trigeminal neuralgia. [ihs-klassifikation.de]

• Yawning

  It can be triggered by talking, yawning, coughing and swallowing. Classically, patients experience a unilateral lancinating and excruciating pain described as electrical shock-like pain in the areas around the ear, tongue, or the mandibular angle. [ncbi.nlm.nih.gov]

  These episodes can be triggered by swallowing, particularly cold liquids, and actions such as yawning, sneezing, or coughing. [aaroncohen-gadol.com]

• Hoarseness

  Immediate complications occurred in 6 cases, consisting of poor wound healing in 3 cases, and CSF leakage, hoarseness, and dystaxia in 1 case each. [ncbi.nlm.nih.gov]

  Possible complications of radiofrequency rhizotomy include hoarseness, vocal cord paralysis, and difficulty swallowing. [aaroncohen-gadol.com]

• Unilateral Throat Pain

  A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. [ncbi.nlm.nih.gov]

• Sore Throat

  I started with a sore throat that went away for a brief period then came back. Went to my PCP with the complaint and therefore tried anti-biotics, allergy medication & testing for thyroid. Everything came back normal so I said enough! [medhelp.org]

• Dysphagia

  Neurological examination elicited a faint dysphonia associated with paradoxical dysphagia. [ncbi.nlm.nih.gov]

  Mild dysphagia and hoarseness occurred postoperatively, but resolved completely within 2 months. [surgicalneurologyint.com]

• Vomiting

  […] throat, and touching the gums or oral mucosa, sudden movements of the head, raising the arm on the side of the pain, touching the external auditory canal, the side of the neck, and the skin anterior to the ear may also trigger the pain. [1,6] Tinnitus, vomiting [explainmedicine.com]

  It was severe over a period of time, to the point where it made me vomit, and ended up in an emergency room screaming. They contacted Dr. McLaughlin. He was immediately astute… Right Parietal Lobe Osteoma Dr. [princetonbrainandspine.com]

  A 22-year-old woman with rapidly progressive MS was admitted to the hospital because of new-onset nausea, vomiting, and severe ataxia. Four years earlier she had experienced numbness of her lower extremities accompanied by dizziness. [baillement.com]

  […] the day Frequency increases over time, leading to certain disabilities Severe enough to rouse one from sleep Areas Where Pain is Felt Back of nose and throat (nasopharynx) Back of tongue Middle ear Jaw Tonsil area Neck Rare Features of GPN Tinnitus Vomiting [primehealthchannel.com]

• Nausea

  A 22-year-old woman with rapidly progressive MS was admitted to the hospital because of new-onset nausea, vomiting, and severe ataxia. Four years earlier she had experienced numbness of her lower extremities accompanied by dizziness. [baillement.com]

  I wound up on 1800 mg of neurontin, like you, and have dealt with pretty bad nausea this time around. I did try lyrica for a while, but it actually made the pain worse! [neurotalk.org]

  Side effects such as drowsiness, nausea, rash, and blood count abnormalities might occur. Patients are monitored with blood tests to ensure that the drug(s) is at a safe level. [aaroncohen-gadol.com]

  Possible side effects include: feeling drowsy and tired skin irritation and rashes nausea It may be also be possible to use lidocaine spray to ease pain temporarily. [medic8.com]

• Slow Pulse

  Complications of GPN may include: Slow pulse and fainting may occur when pain is severe Damage to the carotid artery or internal jugular artery due to injuries, such as a stab wound Difficulty in swallowing food and speaking Side effects of the medicines [medlineplus.gov]

  Possible Complications Complications of GPN may include: Slow pulse and fainting may occur when pain is severe Damage to the carotid artery or internal jugular artery due to injuries, such as a stab wound Difficulty in swallowing food and speaking Side [ufhealth.org]

• Tachycardia

  This patient's hypotension was refractory to the administration of atropine sulfate and occurred in the presence of sinus tachycardia, suggesting that baroreceptor vasodepressor activity was selectively elevated. [ncbi.nlm.nih.gov]

  Tachycardia C. Rise of arterial pressure D. Dyspnea E. Cyanosis 129. A 47-year-old man with myocardium infarction was admitted to the cardiological department. [de.slideshare.net]

  The loss of parasympathetic outflow with vagus nerve blockade could cause tachycardia and hypertensive response. [51] Once the patient becomes refractory or intolerant to medications, surgery is the next treatment option. [dx.doi.org]

• Skin Rash

  Side effects may include drowsiness, unsteadiness, nausea, skin rash, and blood disorders. Therefore, patients are monitored with periodic blood tests to ensure that the drug levels remain safe. [mayfieldclinic.com]

  There was no skin rash. Seven weeks after the onset of symptoms, we performed high-resolution brain MR imaging to evaluate the trigeminal nerve pathway. [ajnr.org]

• Eruptions

  Supra-eruption of tooth 14 B. Loss of vertical dimension C. Loss of canine disclusion D. Mesial drift of tooth A periapical radiograph of the affected tooth shows a radiolucency at the apex of the mesial root. [docplayer.net]

• Tinnitus

  Microvascular decompression is a surgical treatment for cranial nerve disorders such as trigeminal neuralgia, hemifacial spasm, vertigo, tinnitus, glossopharyngeal neuralgia, and spasmodic torticollis. [drjho.com]

  Glossopharyngeal neuralgia may also be associated with a number of other symptoms such as vomiting, a sensation of edema in the face, tinnitus, vertigo and involuntary movements. [symptoma.com]

  […] cleaning the throat, and touching the gums or oral mucosa, sudden movements of the head, raising the arm on the side of the pain, touching the external auditory canal, the side of the neck, and the skin anterior to the ear may also trigger the pain. [1,6] Tinnitus [explainmedicine.com]

  […] throughout the day Frequency increases over time, leading to certain disabilities Severe enough to rouse one from sleep Areas Where Pain is Felt Back of nose and throat (nasopharynx) Back of tongue Middle ear Jaw Tonsil area Neck Rare Features of GPN Tinnitus [primehealthchannel.com]

• Otalgia

  Glossopharyngeal neuralgia is a rare and often controversial cause for odynophagia and otalgia. The otolaryngologist, head and neck surgeon may be the primary physician called upon to diagnose and treat this entity. [ncbi.nlm.nih.gov]

  Primary juvenile otalgia. J. Neurosurg. 20, 895–898 (1963) Google Scholar 3. Golding-Wood, P. H.: Tympanic neurectomy. J. Laryng. 76, 683–693 (1962) Google Scholar 4. Ekbom, K. A., Westerberg, C. E.: Carbamazepine in glossopharyngeal neuralgia. [link.springer.com]

• Facial Pain

  Tew JM: Therapeutic Decisions in Facial Pain. [mayfieldclinic.com]

  A 68-year-old woman presented with severe paroxysmal facial pain which could not be controlled by medical therapy. [ncbi.nlm.nih.gov]

  […] management for patients suffering with facial pain syndromes. [pacificneuroscienceinstitute.org]

• Polyuria

  On the 6th day of treatment a patient with acute renal insufficiency developed polyuria. Diuresis intensification at the beginning of polyuria stage of acute renal insufficiency is caused by: A. Renewal of filtration in nephrons B. [de.slideshare.net]

• Seizure

  Microvascular decompression resulted in complete relief of glossopharyngeal neuralgia, cardiac syncope, and seizure. The mechanism of glossopharyngeal neuralgia associated with cardiac syncope is discussed. [ncbi.nlm.nih.gov]

  Approximately 10% of all cases will suffer from seizures, and some patients may also experience autonomic dysfunction manifesting with bradycardia and a decrease in sympathetic muscle tone. [symptoma.com]

  After the insertion of a temporary pacemaker through dissection of the right basilar vein, bradyarrhythmia and seizures were controlled ( fig. 3 and 4 ). [scielo.br]

• Convulsions

  A diagnosis of convulsive syncope resulting from classic glossopharyngeal neuralgia was made. Carbamazepine led to steady remission. [ncbi.nlm.nih.gov]

  The pain is accompanied by bradycardia or asystole and, at times, syncope with associated convulsions. 1-5 This report describes the clinical picture and hospital course of a patient with this syndrome whose syncopal attacks were prevented by a cardiac [jamanetwork.com]

  […] vagus nerve during severe neuralgic pain may cause exaggerated vagal response manifesting as cardiac dysrhythmia, bradycardia, and hypotension, with cerebral hypoxia. [1,9] Involutary moments Above mentioned mechanism with cerebral hypoxia will lead to convulsive [explainmedicine.com]

  Complex pattern of convulsive syncope in glossopharyngeal neuralgia: Video/EEG report and short review. Epilepsy Behav 2011;20:407-9. 12. Sinay VJ, Bonamico LH, Dubrovsky A. Subclinical sensory abnormalities in trigeminal neuralgia. [dx.doi.org]

  Vagoglossopharyngeal neuralgia is a subtype of the condition that is associated with vagal symptoms such as convulsions, asystole and syncope. [symptoma.com]

• Dizziness

  Again the pain responded to carbamazepine but required a high dose (1200 mg daily) which was accompanied by troubling side effects (drowsiness and dizziness). In addition she was not completely pain free. [jnnp.bmj.com]

  I am concerned about the negative side effects with any medication as there is dizziness, and they make you really tired among many other things. My life is altered and now I need to learn all I can on how to deal with this. [medhelp.org]

  Four years earlier she had experienced numbness of her lower extremities accompanied by dizziness. A few months later she developed right-side optic neuritis and weakness of her left hand, and was diagnosed with MS. [baillement.com]

• Vertigo

  Microvascular decompression is a surgical treatment for cranial nerve disorders such as trigeminal neuralgia, hemifacial spasm, vertigo, tinnitus, glossopharyngeal neuralgia, and spasmodic torticollis. [drjho.com]

  […] touching the gums or oral mucosa, sudden movements of the head, raising the arm on the side of the pain, touching the external auditory canal, the side of the neck, and the skin anterior to the ear may also trigger the pain. [1,6] Tinnitus, vomiting, vertigo [explainmedicine.com]

  Glossopharyngeal neuralgia may also be associated with a number of other symptoms such as vomiting, a sensation of edema in the face, tinnitus, vertigo and involuntary movements. [symptoma.com]

  Frequency increases over time, leading to certain disabilities Severe enough to rouse one from sleep Areas Where Pain is Felt Back of nose and throat (nasopharynx) Back of tongue Middle ear Jaw Tonsil area Neck Rare Features of GPN Tinnitus Vomiting Vertigo [primehealthchannel.com]

The diagnosis of glossopharyngeal neuralgia is established by examining the full clinical picture, in addition to performing imaging and laboratory tests. Patients typically experience a stabbing pain that presents in a unilateral fashion in the throat. They can also complain of pain in the tongue and in the ear. Other characteristic symptoms include intense pain that is triggered by contact with the tonsils or the soft palate. Patients with a highly suggestive presentation may undergo further testing.

A swab test is performed by making contact with the back of the throat, followed by an application of anesthetic. This, in turn, is followed by further contact, in the attempt to re-establish a painful reaction. A finding consistent with glossopharyngeal neuralgia is the absence of pain after the administration of an anesthetic.

Imaging modalities can also be useful in establishing the diagnosis. Computed tomography (CT) and magnetic resonance imaging (MRI) will help visualize any compression of the ninth cranial nerve due to cancerous growths or particular tumors [11]. Eagle syndrome is suggested when imaging reveals a long styloid process that is impinging on the nerve.

Workup of glossopharyngeal neuralgia proceeds similarly to that of trigeminal neuralgia. Diagnosis is contingent on establishing the exact location of the pain in the face. Unilateral pain in the throat and the ears is suggestive of the diagnosis.

Pharmacotherapy is usually the initial treatment of choice in the majority of cases. Anticonvulsants play a prominent role and medications that generally show benefit include gabapentin, oxcarbazepine and carbamazepine [12]. Painkillers bought without a medical prescription are generally ineffective. Antidepressants can sometimes be employed in conjunction with anticonvulsants or on their own. Common side effects involved with the most used drugs are fatigue, confusion, nausea, rash and a general irritation of the skin. In case a particular drug causes bothering side effects, the dose can be lowered or it can be substituted with another drug. Lidocaine is sometimes useful when a quick effect is needed; for example, in cases where pain is preventing the patient from swallowing. Response to treatment can be monitored with blood tests and can also be used to adjust the dose of drugs as well as the kind and combination of medication that is being used.

Failure to respond to treatment, especially when the nerve structure is compressed, can prompt the physician to opt for surgery. The surgical procedure of choice is called microvascular decompression. It aims to decrease the pressure on the nerve by changing the direction of the blood vessels [13]. General anesthesia is necessary to perform the procedure and may require the patient to spend at least one night in the hospital.

Microvascular decompression is performed by first undergoing a craniotomy, in which an incision behind the ears is made in the skull. This allows the visualization of the ninth cranial nerve and permits the surgeon to access the area where the nerve connects to the brainstem. He can then divert the course of the blood vessels and relieve the pressure over the nerves. Microvascular decompression has a high success rate (averaging 85%) and is usually followed by the placement of a sponge over the nerve for additional protection. Potential complications may take place although the benefit outweighs the risks. Some side effects of the operation include infection, bleeding, facial muscle weakness, visual problems and numbness.

On the other hand, Eagle syndrome is treated by reshaping the styloid process through minimally invasive methods. Patients who do not respond to the abovementioned procedure may ultimately require high stimulation of the cervical spinal cord.

Prognosis varies from case to case. Some patients may experience only one attack of glossopharyngeal neuralgia, while others may suffer from recurrent episodes over months and years. These generally occur in clusters, separated by remission periods that can either be long or short. Morbidity associated with the condition includes weight loss due to a fear of drinking, eating and chewing given the association of these activities with the disease.

The underlying causes of glossopharyngeal neuralgia are still uncertain, but it is thought that damage to the nerve occurs, either due to the ageing process or from other causes that lead to its deterioration. This, in turn, results in the failure of correct transmission of the somatic and autonomic nervous signal from the involved structures to the brain. Common causes that end up in leading to significant damage to the nerve include direct injury, infection in its vicinity, multiple sclerosis, malignancies of the oral cavity and compression by a blood vessel [4]. The latter represents the most common cause. Eagle syndrome is a very rare entity, characterized by a long styloid process that directly compresses the nerve.

Incidence of glossopharyngeal neuralgia is thought to vary between 0.2 and 0.7 in every 100,000 individuals every year [5]. Thus, it is a very rare condition and can account only for 0.2% to 1.3% of all causes of facial pain. Nonetheless, incidence may be underestimated due to poor awareness in the general population. Unlike trigeminal neuralgia, glossopharyngeal neuralgia is more common on the left side of the face with a ratio of 3:2. In addition, bilateral involvement is also more common in trigeminal neuralgia than glossopharyngeal neuralgia. Approximately 10% of all cases will suffer from seizures, and some patients may also experience autonomic dysfunction manifesting with bradycardia and a decrease in sympathetic muscle tone [6]. Very rarely, glossopharyngeal neuralgia can only manifest as syncope without any pain.

The ninth cranial nerve, also called the glossopharyngeal nerve, contains both sensory and motor fibers. Sensory input in the nerve is somatic in nature and originates from the posterior base of the tongue, the mastoid, the middle ear, the oropharynx and the eustachian tube. The tympanic part of the Jacobson's nerve carries sensory innervation to the mastoid and the inner ear. Additional non-somatic special sensory input is transmitted from the carotid body and sinus as well as the posterior third of the tongue. The latter carries taste fibers whereas the chemoreceptors are present in the carotid body and baroreceptors in the carotid sinus [7]. On the other hand, motor fibers innervate the stylopharyngeus muscle and parasympathetic fibers in the parotid gland.

The carotid sinus nerve may play an important part in the pathophysiology of the disease. This branch carries fibers from both the carotid sinus and body and is involved in respiratory function as well as in the circulatory reflex. Its involvement can account for the presence of arrhythmias in glossopharyngeal neuralgia.

There are no current preventive measures for glossopharyngeal neuralgia.

Glossopharyngeal neuralgia is a medical condition that describes damage to the glossopharyngeal nerve, the ninth cranial nerve, that can lead to excruciating pain in areas it innervates as well as occasional disturbances in its autonomic function [1]. Glossopharyngeal neuralgia is a very rare condition and, unlike trigeminal neuralgia, it tends to affect the left side more than the right [2]. Causes are multifactorial, but the most common involves direct pressure from nearby blood vessels. Other potential etiologies include infection, malignancy, multiple sclerosis and trauma. Patients present with a very sharp pain in the area of distribution of the nerve, in particular in the throat, with radiation to the ear [3]. The pain tends to occur in episodes separated by periods of remission. Some patients may only suffer one episode while others have recurring crises for years at a time. The pain is usually triggered by chewing, swallowing and touching the base of the tongue or the gums. Other associated symptoms include vertigo, tinnitus and, in some cases, seizures, loss of sympathetic tone and syncope. The latter are caused by the involvement of nerve fibers coursing in the carotid sinus and body. Diagnosis is established after assessing the full clinical picture, performing physical exam procedures and occasionally with imaging. Strong localization of the pain is critical in the establishment of the diagnosis. Imaging can also help in detecting any tumors or lesions that might be compressing the nerve. Treatment is primarily directed at controlling symptoms. Over the counter pain medications are generally ineffective and, instead, anticonvulsants are the preferred pharmacotherapeutic agents. Antidepressants may also be used alone or in combination with anticonvulsants. Surgery is reserved for resistant cases and consists of craniotomy, followed by a relief of the vascular pressure over the nerve.

Glossopharyngeal neuralgia is a medical condition that describes the irritation of a very important nerve that originates in the brain and supplies several structures in the face and the thorax. Irritation occurs generally due to compression from nearby vessels but can also be caused by infection, malignancy, multiple sclerosis or a long styloid process, a bone that is normally part of the cranium. Patients present with severe pain that is localized in the area of the distribution of the nerve. This region encompasses the posterior third of the tongue, the throat and the inner ear. The pain is shooting and sharp and tends to be triggered by chewing, swallowing or by touching the gums or the oral cavity. Some cases can also be associated with seizures, loss of muscle tone and syncope. This is because the nerve also carries fibers that are involved in maintaining posture, breathing and heart rhythm. Diagnosis is established clinically with history and physical exam, although in some cases imaging may reveal a lesion or a tumor compressing the nerve. It is critical to confirm the local nature of the pain. Most cases present with unilateral pain on the left side. Treatment is directed at controlling the associated pain. Over the counter medications are generally not effective. Drugs that are commonly used to treat epilepsy can improve the pain as well as certain antidepressants. Surgery is only reserved for resistant cases, and is performed by making an incision in the skull, accessing the nerve and diverting the compressing vessels.

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