Treatment for Glossopharyngeal Neuralgia

lossopharyngeal neuralgia is a condition that causes severe pain in the ear, nose, and throat areas. The Centers for Neurosurgery, Spine, and Orthopedics is equipped with the expertise to help patients alleviate glossopharyngeal neuralgia, among many other conditions. The award-winning team is comprised of elite board-certified neurosurgeons who specialize in every type of brain surgery, and collaborate with physicians specialized in non-surgical pain management, physical medicine, and rehabilitation physicians to ensure each patient receives the highest quality of care.

Overview

Glossopharyngeal neuralgia is a painful condition that causes sharp, stabbing, “shock-like” pain in the ears, nose, and throat areas. These areas are affected together because the ninth cranial nerve, known as the glossopharyngeal nerve, provides sensory input to these structures. Multiple attacks can occur within minutes of each other. The symptoms most commonly occur during the day but can disrupt sleep as well. Painful glossopharyngeal neuralgia symptoms are rare and can be misattributed to the wrong cause by providers unfamiliar with the disease.

In some cases, glossopharyngeal neuralgia is caused by an underlying condition, such as a tumor or nearby bone structure placing pressure on the ninth cranial nerve. Inflammatory conditions and autoimmune diseases may also cause glossopharyngeal neuralgia. In some cases, there is no identifiable attributing cause of the painful episodes. 

Preventing the symptoms and alleviating pain are the primary goals of glossopharyngeal neuralgia treatment. Anti-seizure and/or antidepressant medications are particularly effective for preventing and reducing glossopharyngeal neuralgia symptoms. However, if medication therapy is not effective and there is a structural abnormality or a tumor causing the pain, surgical treatment may be indicated.

Symptoms

In most cases of glossopharyngeal neuralgia, pain occurs along one side of the face. In rare cases, both sides of the face may be affected. The specific areas of the face that may experience pain or numbness secondary to the compression of the ninth cranial nerve include:

• Nasopharynx region (nose and throat)
• Tonsil area
• Larynx (voice box)
• Ears
• Back of the tongue

Glossopharyngeal neuralgia causes severe pain, which is described as “sharp,” “shooting,” “stabbing,” or even feeling like an “electric shock.” The duration of the episodes may vary, lasting anywhere from a few seconds to a few minutes. These pain attacks can occur continuously or may stop for days at a time before returning. Most patients don’t report feeling any pain between attacks, though some experience residual pain that lingers for a while after the initial “shock” feeling.

The pain from glossopharyngeal neuralgia can be severe enough to cause a patient to avoid eating or drinking. If left untreated, the condition can lead to unhealthy weight loss. Symptoms of glossopharyngeal neuralgia are typically triggered by everyday activities involving the mouth, throat, or nose, such as:

• Chewing, drinking, or swallowing
• Coughing or sneezing
• Speaking, laughing, or yawning

Symptoms of glossopharyngeal neuralgia may also be experienced if something touches the tonsils.

Causes & Risk Factors

Glossopharyngeal neuralgia primarily affects those in their mid-40s to mid-60s but may occur at any age. In some patients, the cause of glossopharyngeal neuralgia is linked to compression on the ninth cranial nerve by an anatomic structure such as a cervical malformation or a structural abnormality caused by a facial injury or lesion. It may also be linked to tumors, inflammatory or autoimmune diseases, or multiple sclerosis. But in some cases, none of these are present and the exact underlying cause of the patient’s glossopharyngeal neuralgia remains unknown.

Glossopharyngeal neuralgia itself is not a heritable condition. But if there’s an underlying genetic disorder causing glossopharyngeal neuralgia, there may be other family members experiencing the same symptoms.

Diagnosis

Diagnosing the cause of facial pain typically begins with the patient reaching out to a doctor. Depending on who they first contact will determine the course until the patient is properly diagnosed. Neurosurgeons and neurologists are experts at determining which nerve is causing the patient’s discomfort. Both begin with listening to what the patient is experiencing and then performing a neurological examination. If patients keep a log of the surrounding events when symptoms occur, it can be helpful for the physician to diagnose the condition and advise what provokes the symptoms and what to avoid.

Depending on the patient’s symptoms, the doctor may order further diagnostic tests to identify the root cause of the pain. The tests they order and the reasons why are:

• Blood tests — Will rule out any possible infections and/or indicate the possible presence of a tumor.
• CAT Scans — A CT (computerized tomography) scan uses rotating x-ray machines complied by a centralized computer to take cross-sectional images of the body. The ninth cranial nerve won’t appear on the CAT scan, but the CT images can reveal whether there is a tumor or nearby bone potentially causing pressure in the area of the glossopharyngeal nerve.
• X-rays — Prior to an MRI, the doctor must order a simple x-ray to identify any tumors or nearby bones that may be causing compression. Insurance companies require an x-ray to be completed before an MRI is authorized.
• MRIs — An MRI (magnetic resonance imaging) uses strong magnets and radio waves to create detailed images of tissues and organs inside of the body. An MRI is ordered either with or without contrast dye depending on what the doctor is attempting to visualize. Contrast can help the radiologist and doctor identify specific abnormalities in the nerves, blood vessels, or surrounding structures. The MRI is very effective in detecting any lesions or tumors near the ninth cranial nerve.

Treatment

The treatment plan for glossopharyngeal neuralgia will depend on the underlying cause directly linked to glossopharyngeal neuralgia. If there’s a tumor compressing the ninth cranial nerve then surgery, chemotherapy, or radiotherapy may be needed to remove or shrink the tumor. The only specialist trained on how to address a tumor in the head is a neurosurgeon. At CNSO, the neurosurgeons will determine the best course of treatment for a tumor affecting the glossopharyngeal nerve.

If a tumor is not the cause of facial pain, reducing and eliminating pain is the overarching goal of glossopharyngeal neuralgia treatment. Often, antiseizure or antidepressant medications are the most effective for targeting the symptoms of this condition. Such medications may include gabapentin, duloxetine, valproic acid, clonazepam, or topiramate. The neurosurgeon or pain management physician will first prescribe a low dose at first and will adjust for greater pain control as needed.

Other remedies that can work in tandem with medication is:

• Applying a cold and/or hot compress to the throat or ear on the side where the pain is experienced depending on which temperature improves the symptoms.
• Physical therapy exercises may alleviate symptoms.
• Psychological counseling to improve coping skills and distress caused by symptoms which may provoke additional symptoms.

If symptoms persist after attempting drug therapy, surgery may be needed to decompress the nerve which will alleviate the pressure. The soreness from the procedure will decrease within the first two weeks of the surgery and a full recovery can be expected within four to six weeks. 

Contact the Experts at CNSO

Glossopharyngeal neuralgia is just one type of the many conditions the team at the Centers for Neurosurgery, Spine, and Orthopedics is equipped to treat. The neurosurgeon-led multi-specialty teams across Bergen, Morris, Passaic, Hudson, and Essex counties in New Jersey provide patients with compassionate, comprehensive care. Make an appointment with the CNSO doctors today.