Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 96. Cranial Nerve Disorders

Topics: Introduction | Internuclear Ophthalmoplegia | Palsies of Cranial Nerves That Control Eye Movement | Trigeminal Neuralgia | Bell's Palsy | Hemifacial Spasm | Glossopharyngeal Neuralgia | Hypoglossal Nerve Disorders

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia consists of recurring attacks of severe pain in the back of the throat near the tonsils and back of the tongue due to malfunction of cranial nerve IX (glossopharyngeal nerve), which supplies the throat, tonsils, and tongue.

Glossopharyngeal neuralgia, a rare disorder, usually begins after age 40 and occurs more often in men. Its cause is unknown.

Symptoms

As in trigeminal neuralgia, attacks are brief, occur intermittently, but cause excruciating pain. Attacks may be triggered by a particular action, such as chewing, swallowing, coughing, or sneezing. The pain usually begins at the back of the tongue or back of the throat; sometimes pain spreads to the ear. The pain may last several seconds to a few minutes and usually affects only one side of the throat and tongue. The pain may radiate to the ear. In 1 to 2% of people, the heartbeat is affected: It slows so much that it stops temporarily, causing fainting.

Diagnosis and Treatment

Glossopharyngeal neuralgia is distinguished from trigeminal neuralgia 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 an attack results, the doctor applies a local anesthetic to the back of the throat and repeats the test. If the anesthetic prevents an attack, the diagnosis is glossopharyngeal neuralgia.

See the figure Taking the Pressure Off a Nerve.

The same drugs used to treat trigeminal neuralgia--carbamazepine, phenytoin, baclofen, and tricyclic antidepressants (see Section 6, Chapter 96)--may be helpful. If these drugs are ineffective, applying a local anesthetic to the back of the throat may provide temporary relief. 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.