Glossopharyngeal neuralgia

 What is glossopharyngeal neuralgia and what are the causes?

 Glossopharyngeal neuralgia (GPN) is an extreme stabbing, burning or electric shock type of intense pain in the tongue, throat, ear, and tonsils. The attacks can last from a few seconds up to a couple of minutes. The pain is connected to the ninth cranial nerve which is also called the glossopharyngeal nerve. This nerve is connected to the brainstem at the upper medulla and travels through the back of the throat, tongue, tonsil and ear, hence why such intense pain is felt in these areas.

GPN usually affects people over the age of 50. Often, the cause for GPN is unknown and diagnosed as irritation. This is because abnormalities may occur where the nerve signal is disrupted and causes abnormal signals to pass through the nerve which ultimately causes pain. Other possible causes may be a tumour or infection in the mouth area which affects the glossopharyngeal nerve. Blood vessels or growths compressing the nerve and sometimes multiple sclerosis are also causes.

Symptoms and triggers  

The symptoms of GPN is extremely intense pain in the ear, tonsil area, back of the tongue and nose and usually only one side of the throat. It is intermittent and sporadic, as mentioned it can last from a few seconds up to a couple minutes. It can also get more frequent and painful over time. Some people describe the pain as the worst pain they have ever experienced. Sometimes people who experience this pain are able to notice certain triggers that bring on the pain. This is an extremely helpful way to help manage the pain by avoiding the triggers. Some of the triggers may be:

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  • Chewing

  • Swallowing

  • Talking

  • Yawning

  • Laughing

  • Coughing

  • Sneezing

 

Diagnosis and treatment

 To diagnose GPN a doctor will begin by going through your medical history and current symptoms you are experiencing. A physical examination may also take place where a cotton tipped swab will touch the back of your throat. This is performed to see you experience any pain, if there is pain then some local anaesthetic will be applied and the doctor will try again, if the anaesthetic works and you cannot feel the pain then it is likely you have GPN.

Other ways of diagnosing glossopharyngeal neuralgia is by performing an MRI or sometimes a CT scan.

To treat GPN your doctor may want to try a conservative route first of call. Anti-convalescent drugs like carbamazepine, oxcarbazepine, gabapentin, or phenytoin may be prescribed to see if they help neutralise the pain.

A microvascular decompression is an option for more permanent relief, but usually a last resort if other methods have not worked.

A microvascular decompression is performed to stop the compression between the blood vessel and the nerve root. This is done by placing a sponge between them. Firstly a craniotomy will be performed by making a small incision behind the ear and drilling a 1-inch opening in the occipital bone. The dura is exposed which is a protective sheet or covering of the brain. The dura is moved to expose the brain. Once the glossopharyngeal nerve is found, a Teflon sponge is permanently placed in-between the glossopharyngeal nerve and blood vessel to stop the compression. The dura is then closed with sutures and a small titanium plate will cover the skull opening with small screws in place, this is because the bone from the skull is not replaced. The skin is then sutured together and dressing is placed.

You will spend a couple of days in hospital recovering and will be assessed by your surgeon and nurses before discharge. Recovery will take a couple of weeks but this can be in the comfort of your own home. A follow-up appointment will be made to check your wound and see if the surgery has worked.

 This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.