Glossopharyngela neuralgia is a rare pain syndrome characterized by intermittent, severe shock-like pains that occur in the back of the throat, tongue or ear along the glossopharyngeal nerve. The glossopharyngeal nerve supplies sensation to the back of the throat and tongue and portions of the ear.
The syndrome is very similar to trigeminal neuralgia
in the electric shock-like nature of the pain. It is also triggered by stimulation of the area where the pain is felt
SymptomsMost patients experience pain in the back of the throat, tongue and ear. Occasionally, the pain is restricted to the ear.
The pain is sharp and sudden in onset and occurs for a short period of time during which the patient often must stop activities, including talking. The pain can be triggered by eating or swallowing.
In some patients, there is stimulation of related nerves that result in temporary slowing of heart beats, or bradycardia, or complete absence of heart beats, or asystole, that can lead to sudden temporary loss of consciousness or seizures in rare cases. The pain starts as brief episodes that may be absent for months or years, but tend to become more frequent through time.
CausesThe cause of most cases of glossopharyngela neuralgia is not known, or idiopathic, although these tend to be associated with compression of the glossopharyngeal nerve by a blood vessel.
In rare cases, the condition is associated with a lesion that compresses the nerve in its course outside the brain (secondary glossopharyngela neuralgia), such as a destructive tumor of the skull base.
Risk FactorsNo risk factor has been identified, but the condition is most common in patients between the ages of 40 and 60.
DiagnosisThe diagnosis is primarily based on the description of the location and pattern of the patient’s pain. When the pain is able to be stopped for several hours with the application of a local anesthetic to the back of the throat during a flare up, the diagnosis is further supported, but this test is rarely necessary.
MRI is routinely performed to ensure that there is not a tumor or other mass lesion associated with the pain that would require a different approach to treat the pain. The MRI also allows the identification of blood vessels that may be compressing the glossopharyngeal nerve, although this is not necessary to proceed with surgery.
ComplicationsThere are no long-term medical or neurologic complications from glossopharyngela neuralgia for most patients. Rarely, symptomatic heart rate changes during attacks of pain can occur. The major disability occurs from the significant impact the condition has on quality of life and psychological well-being.