What is Glossopharyngeal Neuralgia?
Glossopharyngeal neuralgia is a condition in which the ninth cranial nerve, called the glossopharyngeal nerve gets affected. Any kind of irritation of this nerve can lead to a set of complaints seen in glossopharyngeal neuralgia. As the nerve supplies the back of the throat, tongue and ear region, symptoms of glossopharyngeal neuralgia are mainly located in these areas.
In glossopharyngeal neuralgia, pain is felt in the tongue, back of throat, tonsils and ear region due to the irritation of the nerve. Sharp, sudden pains can be felt like electric shocks and can be very severe sometimes. While the pains in glossopharyngeal neuralgia can last for few seconds to minutes in most cases, it may last for long in some people. It is important to understand the causes of glossopharyngeal neuralgia and the associated symptoms to be able to manage the condition effectively.
Causes of Glossopharyngeal Neuralgia
Glossopharyngeal neuralgia originates from damage to the ninth cranial nerve, called the glossopharyngeal nerve. This nerve supplies to the back of tongue and throat area.
Some of its branches also supply the tonsils, ear and the region around the jaw joint.
While the cause of glossopharyngeal neuralgia, can vary from person to person, depending on their condition, in most cases, irritation of the glossopharyngeal nerve is present. In some people, when the exact cause may not be known, then glossopharyngeal neuralgia can be considered as idiopathic.
Some of the causes that can be related to glossopharyngeal neuralgia in most people include conditions that cause compression, damage or irritation of the glossopharyngeal nerve, like injuries, growths or arterial compression.
Nerve Injury – Common Cause of Glossopharyngeal Neuralgia
The glossopharyngeal nerve passes through a region behind the ears and the neck. As this region it is exposed to greater risk of injuries and damage to the nerve can occur. Certain activities, injuries or sports can increase the risk of injury to the glossopharyngeal nerve. Injuries or trauma to this region can commonly occur during sports, due to direct blow over the neck and ear region, or a fall causing nerve injury.
Vehicular accidents, rear or front end collisions and neck injuries too can commonly cause damage to the glossopharyngeal nerve causing glossopharyngeal neuralgia. Sudden neck movements or a blow can damage or irritate the glossopharyngeal nerve situated in this region. Any other condition that compresses or damages the nerve can contribute to the causes of glossopharyngeal neuralgia.
Glossopharyngeal Neuralgia Caused Due to Nerve Compression from Artery
Arterial compression is yet another common cause of nerve compression that can cause glossopharyngeal neuralgia. A blood vessel near the brainstem, most commonly an artery can exert pressure over the nerve and result in pain in the area supplied by the glossopharyngeal nerve.
Glossopharyngeal Neuralgia Caused Due to Tumor
Glossopharyngeal neuralgia can also be caused due to a lesion, growth or tumor in the region, through which the glossopharyngeal nerve passes. The growth or tumor can cause compression of the glossopharyngeal nerve, which irritates the nerve and can cause glossopharyngeal neuralgia.
Some other conditions that affect the regions around the area through which the glossopharyngeal nerve passes, can irritate the nerve causing glossopharyngeal neuralgia. These include
- Oral Conditions – Dental problems or disorders of the mouth can affect the nerve in the region. Any inflammation, infection or tooth abscess can irritate the nerve and cause glossopharyngeal neuralgia. Infections and dental carries extending deep can cause nerve pain, tooth extraction or other dental problems can cause glossopharyngeal neuralgia. Other conditions that can cause glossopharyngeal neuralgia include infections in the oral cavity, gum abscesses or infection of the glands.
- Glossopharyngeal Neuralgia Caused Due to ENT (ear, nose and throat) Related Conditions – Nasal conditions and inflammation of the paranasal sinuses, inflammation or infections extending to the ears can cause glossopharyngeal neuralgia. Ear related conditions causing inflammation of structures or injury to the nerves too can cause glossopharyngeal neuralgia. Any growth or tumor in or around the ears can compress the glossopharyngeal nerve and be a cause of glossopharyngeal neuralgia.
- Viral Infections – Viral infections can commonly affect the ear, nose and throat causing common cold, throat infections, etc., which can cause pain in throat or sometimes, such inflammation can even irritate the nerve. This can cause glossopharyngeal neuralgia in some cases. Certain viral infections also tend to affect the nerves and cause glossopharyngeal, for example, herpes virus, mumps infections, swelling and inflammation of glands too can cause glossopharyngeal neuralgia.
- Nerve Related Conditions – Some conditions that affect the nerve in the ear or throat region can cause nerve damage, resulting in glossopharyngeal neuralgia. For example, spinal cord problems, conditions affecting the brainstem or the central nervous system like multiple sclerosis, too can cause damage to the nerve and glossopharyngeal neuralgia.
- Medical Conditions - Certain medical conditions like diabetes or other neuropathies, which cause nerve damage can present with their complications and cause glossopharyngeal neuralgia. Rheumatic conditions and musculoskeletal problems that affect the muscles making them stiff and painful, too can sometimes exert pressure on the nerves supplying the face, especially when the head, neck and shoulder muscles are involved. Conditions like affecting the muscles and soft tissues, polymyalgia rheumatica, fibromyalgia can also contribute to nerve pain. Any other medical condition that can affect the glossopharyngeal nerve, compress the nerve or damage it in any way can cause glossopharyngeal neuralgia. Hence any history or presence of other medical conditions must be studied when evaluating a case of glossopharyngeal neuralgia.
- Others – Other causes that can lead to glossopharyngeal neuralgia need to be considered. Cysts or fluid filled sacs, can exert pressure on the glossopharyngeal nerve, and cause pain in the areas supplied by the nerve. Tumors, lumps or growths of any kind too can cause glossopharyngeal neuralgia.
Symptoms of Glossopharyngeal Neuralgia
Glossopharyngeal neuralgia, is a fairly uncommon condition as compared to other problems of nerve damage, however it can be noted in some cases. Women may be at an increased risk of glossopharyngeal neuralgia and elderly population may also experience it. People experiencing glossopharyngeal neuralgia often complaint of sudden, sharp and severe pain in the face region, extending from the ears to the throat. The exact location of pain may vary from person to person.
Common symptoms of glossopharyngeal neuralgia include sharp, electric shock like pains, which give a feeling of sudden jamming in the area. This may be accompanied with a sensation of burning pain, as typically originating from nerve irritation. The location of the glossopharyngeal nerve is around the ears and throat, hence activities related to the ears and movements of the jaw joint often worsen the pain in glossopharyngeal neuralgia. Areas most commonly affected include back of tongue, back of nose and throat, tonsils, voice box and ear region.
Common activities like talking, reading, singing, yawning, eating, chewing and even swallowing may be difficult and painful. Symptoms of glossopharyngeal neuralgia also include throat pain, more commonly on the affected side, may be associated with a sensation of something sharp being lodged in the throat. Coughing, sneezing too can aggravate symptoms of glossopharyngeal neuralgia.
Pain in glossopharyngeal neuralgia can last for varying duration. In some, pain may last for few days or weeks, while in some it may last longer. In most cases, symptoms of glossopharyngeal neuralgia or an episode may usually last for few seconds, when the pain is truly unbearable. Symptoms of glossopharyngeal neuralgia may subside for some time but often reappear later on or may be triggered by certain factors.
As time passes, most complaints of glossopharyngeal neuralgia may worsen and begin interfering with daily activities, if left untreated. Difficulty in chewing and swallowing can affect food intake in many people and may also result in loss of appetite, weight loss and weakness. As talking causes pain in glossopharyngeal neuralgia and when daily life gets affected, people may interact less with others, increasing the risk of emotional disturbances and depression.
Some people may also show symptoms of glossopharyngeal neuralgia in association with problems of related nerves. These symptoms can include changes in blood pressure and fainting, which may be considered as complications of glossopharyngeal neuralgia.
Diagnosis of Glossopharyngeal Neuralgia
Diagnosis of glossopharyngeal neuralgia begins with thorough history taking. History may reveal conditions that can be possible causes of glossopharyngeal neuralgia. Any previous injury or trauma to the head or neck area must be enquired and appropriately evaluated. Previous history of surgeries, ear or dental treatment and similar other procedures or medical treatment is noted.
Details about the symptoms of glossopharyngeal neuralgia are noted and co-related with the history. Assessment for glossopharyngeal neuralgia is very crucial and must be done in a systematic manner. The location, nature of pain and the duration for which it lasts must be considered. As different people present with different symptoms, each symptom of glossopharyngeal neuralgia must be enquired about. The number of pain episodes and their repetition needs to be considered. Aggravating factors and other triggers can give a clue to the possible causes and aid in diagnosis of glossopharyngeal neuralgia.
The next step towards making diagnosis of glossopharyngeal neuralgia, include clinical examination and neurological testing. The physician examines the area supplied by the glossopharyngeal nerve, assesses the functioning of the parts and evaluates muscle control in the area. Physician may test chewing, tasting, swallowing functions and other activities related to the performance of the glossopharyngeal nerve. Physician may make use of a local anesthetic and try to elicit a pain response by triggering some sensitive areas supplied by the glossopharyngeal nerve.
Causes of glossopharyngeal neuralgia are kept in mind considering the history of the patient and the possibility of nerve compression is determined with the help of these tests. History taking and primary assessment of the patient gives an idea and appropriate investigations for glossopharyngeal neuralgia may be ordered.
Investigations for Glossopharyngeal Neuralgia
Clinical examination, history and assessment can reveal most possible causes of glossopharyngeal neuralgia; however certain investigations may be required to rule out possible serious causes of glossopharyngeal neuralgia. Also, for a known history of previous injury or surgery, certain investigations may be considered to assess the status of injury or surgery, its relation to causes of glossopharyngeal neuralgia.
Some of investigations for diagnosis of glossopharyngeal neuralgia or to rule out other conditions include:
Magnetic resonance imaging (MRI) – MRI scans may be considered to detect injuries, tissue damage, soft tissue involvement or compression of nerves and blood vessels. It also helps to determine the presence of growths, tumors or any abnormalities with blood vessels. MRI is ordered for the area possibly involved in the causes of glossopharyngeal neuralgia. MRI can also help to determine the involvement of intervertebral discs in case of cervical spine or when neck is involved with other head or facial structures as a cause of glossopharyngeal neuralgia. Specialized MRI scans can be useful in detecting blood clots, arteriovenous malformations and other disorders of the arteries and veins, which can be the causes of glossopharyngeal neuralgia.
Other investigations to diagnosis of glossopharyngeal neuralgia.
Electromyogram (EMG) – This test helps to study the activity of the muscles of the face, throat and related areas. It can help in diagnosis of glossopharyngeal neuralgia. Stimulation of the nerve can show relevant changes and contractions in the muscles, which are recorded. This can also help to rule out or confirm diagnosis of any other nerve involvement.
Nerve Conduction Study (NCS) – This helps to study the pattern and conduction of signals through the nerve. Changes in the nerve conduction are recorded, which can aid in possible diagnosis of glossopharyngeal neuralgia.
Angiogram – When involvement of a blood vessel, an aneurysm or compression of the glossopharyngeal nerve due to an artery is suspected, study of the arteries can help. An angiogram may be performed to confirm the diagnosis of glossopharyngeal neuralgia or to plan further surgical treatment, in some cases.
Other investigations that can help to rule out other conditions causing glossopharyngeal neuralgia may be ordered, as appropriate.
Treatment of Glossopharyngeal Neuralgia
Treatment for glossopharyngeal neuralgia includes medications, injections and in certain cases, which do not respond well to any treatment, surgical options may be considered.
Medications to Treat Glossopharyngeal Neuralgia
Medications are effectively used for treatment of glossopharyngeal neuralgia. These include
- Muscles relaxants, which help to relax the overstrained and over stimulated muscles, thus providing some relief in involuntary muscle twitching.
- Anti-convulsant medicines are also used to treat glossopharyngeal neuralgia, as these help to block the pain and signals sent by the irritated glossopharyngeal nerve.
- Relaxants and anti-depressants may be given in people, who experience anxiety or stress. Medications to manage post-traumatic stress disorder may be considered in those experiencing glossopharyngeal neuralgia due to nerve injury or trauma.
- Application or injection of local anesthetic agents may be considered in some cases, were pain in the throat is unbearable and interferes with routine activities. It helps to cause numbness in the area, which can aid in eating, swallowing and helps to prevent dehydration or weakness.
Most of these medicines have side effects like dizziness, nausea, gastric disturbances, etc. These medicines that can provide relief from glossopharyngeal neuralgia need to be taken with physician’s advice and any side effects must be discussed to find a solution.
Physical Therapy - Physical therapy for glossopharyngeal neuralgia may be applied. It uses modalities to relax tense muscles, reduce pain, discomfort any muscle spasm, which may be considered, as appropriate. Electrical nerve stimulation (TENS) and similar techniques that help to relax muscles and relieve irritated glossopharyngeal nerve may be considered.
Nutritional Therapy – Glossopharyngeal neuralgia may be considered to occur due to loss of protective covering of the nerve and certain nutrients can help in managing it. Deficiency of certain vitamins and minerals may be related to the complaints of glossopharyngeal neuralgia. In such cases, along with a healthy diet, nutritional supplements may be advised. Magnesium, calcium, iron or other minerals and vitamin B12, folic acid and B complex may help to manage glossopharyngeal neuralgia in some cases. Vitamin and mineral supplements may be prescribed, as appropriate in such cases.
For persons with glossopharyngeal neuralgia, who are unable to eat, increased fluid intake is essential. Nutritional drinks and consumption of food in liquid form may be considered.
Surgical Treatment of Glossopharyngeal Neuralgia
Surgery for glossopharyngeal neuralgia may be considered depending on the cause. The aim of surgical treatment for glossopharyngeal neuralgia may be to release the nerve from compression, remove the structures causing nerve compression or to cut the nerve to reduce pain signals. If tumors or similar growths are the cause of glossopharyngeal neuralgia, appropriate treatment includes operating and removing them.
Procedures like rhizotomy or rhizolysis are performed in different ways to treat glossopharyngeal neuralgia. These are aimed at damaging the nerve, which helps to block the pain signals.
Some surgeries of glossopharyngeal neuralgia include:
- Microvascular decompression – This is the commonest option, when the cause of glossopharyngeal neuralgia is a small artery is causing compression of the glossopharyngeal nerve. This surgical procedure includes removing or shifting the blood vessels in close proximity to the nerve root to relieve symptoms of glossopharyngeal neuralgia. Some risks of this procedure include damage to the nerve or blood vessels causing weakness of the face, throat, recurrence of pain later on and reduced hearing or stroke.
- Radiosurgery – In this treatment for glossopharyngeal neuralgia, a focused dose of radiation is directed at the root of the nerve. The patient’s head is kept still during the treatment to deliver focused radiation, which destroys the nerve root.
Apart from these, there are certain procedures for treatment of glossopharyngeal neuralgia, or nerve rhizotomy which can be performed include:
- Glycerol injection – In this treatment for glossopharyngeal neuralgia, an injection of sterile glycerol is injected at root of the nerve. This may be considered in some cases of glossopharyngeal neuralgia, to help relieve the pain and discomfort.
- Radiofrequency rhizotomy or thermal lesioning – Also called as Percutaneous Stereotactic Radiofrequency Rhizotomy. In this procedure, heating current or radiofrequency is used to damage the nerve, which can help to relieve nerve pain and reduce discomfort associated with it. It also known as or RF ablation or RF lesion.
Complementary Treatment Options of Glossopharyngeal Neuralgia
Some people with glossopharyngeal neuralgia may find complementary therapies helpful. These include:
Alternative Medicine – Alternative therapies like Homeopathy, Ayurveda, Acupuncture or other healing techniques may be helpful in some cases of glossopharyngeal neuralgia. Yoga therapy and stress management, relaxation techniques may also be useful. Meditation and breathing techniques are believed to help in managing pain conditions and can be practiced under expert guidance.
Counselling and Psychotherapy – Support from a counsellor can help people with glossopharyngeal neuralgia as interference with daily activities can make managing the condition difficult. Interacting with family, friends and professional therapists can help to deal with the situation better.
Diet - A diet rich in whole grains, healthy fats, fresh fruits, vegetables and plenty of water can be helpful in managing nerve pain conditions like glossopharyngeal neuralgia. Drinking plenty to water and fluids to maintain electrolyte balance, helps to provide lubrication to joints and keeps muscles supple. Consuming foods rich in minerals like magnesium, calcium, potassium, which are commonly found in fruits, green vegetables, nuts, seeds and beans can be beneficial.
For people experiencing other medical conditions like diabetes or high blood pressure, the risk of nerve damage is high. Hence, an appropairae diet plan that helps to manage diabetes, high blood pressure is important to reduce the risk of complications. A low sugar, low salt and low fat diet can help in addition to regular exercise or daily walks.
Massage - Gentle massage can help to relieve the stress in the muscles and relieve muscle spasm, which may be contributing to the symptoms of glossopharyngeal neuralgia.
Following certain tips can help to maintain a healthy lifestyle that can aid the treatment of glossopharyngeal neuralgia.
- Avoid intake of stimulants, caffeinated beverages, smoking or alcohol, as these can aggravate nerve irritation. It is better to avoid highly seasoned foods, heavy preservatives or high fatty foods. Healthy alternatives like milk, green tea, coconut water, fresh fruit and vegetable juices can be consumed instead. Increase liquid diet, so that chewing and difficulty in swallowing can be minimized.
- Practice relaxation and stress management techniques to keep mind and body relaxed. Regular exercises and physical activity is equally important. Involve in hobbies or activities that give pleasure to keep the mind off the complaints of glossopharyngeal neuralgia and help to cope with it.
- Avoid sitting late night, getting over stimulated or even overuse of electronic gadgets, as these too can irritate the nerve and aggravate symptoms of glossopharyngeal neuralgia. Make sure you remain relaxed and get good sleep during the night. Setting up a schedule for work and relaxation can help.
While most of the complementary therapies can help to relieve pain in glossopharyngeal neuralgia, they work best when applied in addition to the primary treatment of glossopharyngeal neuralgia. It is advisable to take medical opinion before undertaking any other treatment options and if there is worsening of symptoms, immediate medical care must be sought.