Glossopharyngeal Neuralgia: Causes, Symptoms, Diagnosis and Treatment

Glossopharyngeal neuralgia (GPN) is an uncommon illness that can cause excruciating, stabbing, or shooting pain in the tonsils, middle ear, or back of the tongue.

The pain travels along the glossopharyngeal nerve, which is located deep within the neck. It provides support for the rear of the tongue, throat, parotid gland (one of the salivary glands), middle ear, and eustachian tube.

Painful episodes usually come and go and can last anywhere from a few seconds to many minutes. The discomfort may return several times in a single day. It may not reappear for a few weeks or months in certain cases.

Certain behaviours can trigger an excruciating episode, including:

• Drinking cold beverages
• Chewing
• Eating
• Spitting in the throat
• Sneezing and coughing
• Placing a hand over the gums

Individuals suffering from this disorder sometimes avoid eating, drinking, or chewing because they fear these activities may trigger a severe attack. Over time, this might lead to weight loss.

GPN frequently only affects one side of the head. One of the glossopharyngeal nerve's many branches is the tympanic branch, which receives impulses from the mastoid and middle ear.

Another important branch is the carotid sinus nerve, which provides blood to the carotid body and the carotid sinus, which is an enlargement of the carotid artery near the primary branch point. After excruciating attacks, potentially fatal symptoms like syncope, bradycardia, or arrhythmia (irregular heartbeat) may appear. Cardiac arrest rarely occurs in the absence of unpleasant episodes.

Causes Of Glossopharyngeal Neuralgia

Often, there is no clear cause for the disease. The glossopharyngeal nerve may become irritated and painful due to a blood vessel squeezing it near the brainstem. In certain cases, an extended styloid process of a neck bone near the nerve may be the source of pain. We term this condition Eagle syndrome.

Trauma resulting from an accident or medical procedure can potentially cause glossopharyngeal neuralgia. Infections, vascular abnormalities, and tumours are additional possible causes. Glossopharyngeal neuralgia in MS patients may be brought on by a malfunction of the fatty membrane that surrounds and protects the nerve, known as the myelin sheath.

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Symptoms Of Glossopharyngeal Neuralgia

Patients report an attack as a scorching or stabbing pain, or as an electrical shock that may last for a few minutes or seconds. Swallowing, chewing, talking, coughing, yawning, or laughing might trigger an attack. Some said they felt like they had a sharp object lodged in their neck. Typical symptoms of the discomfort include the following:

Typical symptoms of the discomfort include the following:

• When one side of the throat is impacted
• May last for a few days or weeks before going into remission for months or even years.
• Becomes more prevalent with time and has the potential to be fatal

Additionally, about 10% of patients have potentially deadly episodes of irregular heartbeats caused by local involvement of the vagus nerve, which includes:

• A calm heartbeat
• Sudden drop in blood pressure and syncope
• Feeling of fainting
• Seizures

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How is Glossopharyngeal Neuralgia (GPN) Diagnosed?

The location of the pain is important in the diagnosis of glossopharyngeal neuralgia because this condition may exhibit symptoms resembling those of trigeminal neuralgia. One diagnostic test is insufficient to determine the presence of GPN. You will be examined by an ear, nose, and throat specialist to rule out other conditions. The tonsils or back of the tongue are two examples of areas the doctor may press to feel for pain.

The doctor will ask whether any particular movements hurt, like eating or speaking. An MRI or CT scan may be necessary to determine whether a tumour or blood vessel is compressing the nerve.

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How is Glossopharyngeal Neuralgia (GPN) Treated?

Most of the time, anticonvulsant drugs are the initial course of treatment. If medication therapy is ineffective or the patient has troublesome drug side effects, surgery may be necessary.

Medications

• Anticonvulsants: Gabapentin, pregabalin, phenytoin, oxcarbazepine, carbamazepine, and other antiseizure medications are commonly prescribed to GPN patients.
• Antidepressants: Physicians may also prescribe amitriptyline and other antidepressants to patients who suffer from depression as a result of excruciating pain.
• Anaesthetics: Local anaesthetics can be injected to block a nerve or applied topically to uncomfortable areas like the back of the throat.

Surgery

The pain associated with GPN can be reduced using a variety of surgical procedures. The most common one is microvascular decompression, which will be covered in more detail later. If Eagle syndrome a disease in which an expanded styloid is compressing the nerve is diagnosed, or if a tumour is found to be compressing the nerve, a different type of surgery may be required.

Microvascular decompression is the most often used surgical technique for the treatment of glossopharyngeal neuralgia. It is carried out under general anaesthesia. The surgeon will create a small incision and opening in the bone behind the ear on the side of the head where the discomfort is experienced. 

Using a microscope, endoscope, or both, he or she will inspect the nerve and search for any blood vessels squeezing it. Once the nerve and artery have been isolated, a small, permanent Teflon sponge is placed between them, squeezing it. When the treatment is over, the surgeon will repair the bone and close the wound.

Microvascular decompression is the most effective long-term and short-term treatment. It is successful in around 90% of cases and reduces the chance of pain recurrence. If a patient is unable to undergo microvascular decompression surgery due to other medical concerns, a less invasive procedure may be used.

Using a Gamma Knife (GK or SRS) for Radiosurgery: This is significantly more commonly used for trigeminal neuralgia, a similar ailment of a different nerve than it is for glossopharyngeal neuralgia, a rare and difficult-to-treat condition. The subject is put through an MRI or CT scan while wearing a frame. Treatment is administered by a neurosurgeon and a radiation oncologist working together.

The glossopharyngeal nerve is targeted using high-precision software, and it is then partially damaged by applying a concentrated quantity of radiation to the nerve. The back of the throat may become slightly numb as a result, but some of the pain may be relieved.

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