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The cause is often unknown but sometimes is an abnormally positioned artery that puts pressure on (compresses) the glossopharyngeal nerve.
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People have brief attacks of excruciating pain, affecting one side of the tongue or throat and sometimes an ear.
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Doctors diagnose the disorder based on what the pain is like and whether a local anesthetic applied to the back of the throat eliminates the pain.
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Certain antiseizure drugs or antidepressants, baclofen, or a local anesthetic may relieve the pain, but surgery is sometimes needed.
(See also Overview of the Cranial Nerves.)
Glossopharyngeal neuralgia, a rare disorder, usually begins after age 40 and occurs more often in men.
Occasionally, the vagus (10th cranial) nerve malfunctions at the same time because the vagus nerve and the glossopharyngeal (9th cranial) nerve exit the skull together. Thus, the problem affecting the glossopharyngeal nerve may also affect the vagus nerve. The vagus nerve helps control the heartbeat. When the vagus nerve malfunctions, the pulse may be abnormal, and abnormal heart rhythms (arrhythmias) may occur.
Causes
Often, the cause of glossopharyngeal neuralgia is unknown.
But sometimes glossopharyngeal neuralgia occurs when
Rarely, the cause is a tumor in the brain or neck, an abscess, a bulge (aneurysm) in an artery in the neck (carotid artery), or multiple sclerosis.
Symptoms
In glossopharyngeal neuralgia, attacks are brief and occur intermittently, but they cause excruciating pain. Attacks may be triggered by a particular action, such as chewing, swallowing, talking, yawning, coughing, or sneezing. The pain usually begins at the back of the tongue, back of the throat, or the area near the tonsils. Sometimes pain spreads to the ear or the area at the back of the jaw. The pain may last several seconds to a few minutes and usually affects only one side of the throat and tongue.
If the vagus nerve malfunctions, disturbing the heart rate, people may faint.
Diagnosis
Glossopharyngeal neuralgia is distinguished from trigeminal neuralgia (which causes similar pain) 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 pain results, the doctor applies a local anesthetic to the back of the throat. If the anesthetic eliminates the pain, glossopharyngeal neuralgia is likely.
Magnetic resonance imaging (MRI) is done to check for tumors. Computed tomography (CT) may be done to determine whether the styloid process is abnormally long.
A local anesthetic may be applied to back of the throat to help with diagnosis and to rule out other possible causes of the pain. Nerve blocks can also help doctors confirm the diagnosis. They can identify the affected nerve because they are used to disrupt a specific nerve pathway that transmits or enhances pain signals.
Treatment
The same drugs used to treat trigeminal neuralgia—antiseizure drugs (carbamazepine, oxcarbazepine, gabapentin, or phenytoin), baclofen, and tricyclic antidepressants may help.
If these drugs are ineffective, applying a local anesthetic (such as lidocaine) to the back of the throat may provide temporary relief (as well as confirm the diagnosis).
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 (called vascular decompression).
