What is the glossopharyngeal nerve responsible for?
The glossopharyngeal nerve is the ninth pair of cranial nerves. It provides sensitivity to the posterior third of the tongue, tonsils, pharynx and part of the outer ear, and is involved in swallowing, taste perception and the functioning of the salivary gland. In addition, its fibers are involved in reflexes that regulate heart rate and blood pressure. That is why some patients experience a slow pulse, dizziness, and even fainting at the height of a painful attack - a rare but dangerous manifestation that requires the supervision of a cardiologist and neurologist.
- Sensitivity of the root of the tongue, pharynx and tonsils
- Participation in the act of swallowing
- Taste in the back third of the tongue
- Connection with heart rate reflexes
- Innervation of part of the outer ear - hence ear pain
Reasons
The most common mechanism is the same as in the more well-known trigeminal neuralgia: a vessel passing next to the nerve root near the brain stem pulsates and gradually damages its membrane, causing the nerve to begin to generate pain impulses. Secondary forms are associated with tumors of the nasopharynx and base of the skull, the effects of radiation therapy, infections, as well as with an elongated styloid process that injures the nerve. Multiple sclerosis is sometimes diagnosed in young patients.
- Compression of a nerve root by a vessel
- Tumors of the nasopharynx, tonsils, skull base
- Elongated styloid process
- Consequences of radiation therapy and surgery
- Chronic inflammatory processes in the pharynx
- Multiple sclerosis
Symptoms
The main symptom is a very intense but short pain, which is described as an electric shock or shooting. It begins at the root of the tongue, tonsil or deep in the pharynx and often extends to the ear and angle of the lower jaw, almost always on one side. The attacks are repeated dozens of times a day, between them the person feels normal. Typical triggers are: swallowing, especially cold water, coughing, yawning, talking, turning the head. Fear of triggering an attack causes people to avoid food and lose weight.
- Attacks of pain lasting seconds - 2 minutes
- Localization in the root of the tongue, tonsil, pharynx
- Recoil to the ear and jaw angle
- One-sided nature
- Provocation by swallowing, coughing, talking
- Sometimes - fainting and slowing of the pulse at the height of pain
How to make a diagnosis
The diagnosis is clinical: it is based on the nature and provocation of the attacks. The doctor excludes diseases that cause similar pain: chronic tonsillitis, tumors, pathology of the temporomandibular joint, dental diseases, trigeminal neuralgia. All patients undergo magnetic resonance imaging of the brain with vascular evaluation to look for vascular compression or mass. A test with a local anesthetic has diagnostic value: after irrigating the pharynx, the attacks temporarily stop. An examination by an ENT doctor is required.
- Detailed collection of complaints and description of triggers
- Examination by a neurologist with examination of cranial nerves
- Examination by an otolaryngologist
- MRI of the brain and blood vessels
- CT scan of the skull base for suspected elongated styloid process
- Test with local anesthesia of the pharynx
- ECG for fainting
Treatment
The basis of treatment is drugs from the anticonvulsant group, which reduce nerve excitability; They are prescribed and titrated by a neurologist; independent use is unacceptable due to side effects. Conventional painkillers for this neuralgia are ineffective. If the response is insufficient, local blockades and additional drugs are used. If medications do not help or are poorly tolerated, neurosurgical treatment is discussed: separation of the nerve and the vessel compressing it or other interventions. For secondary neuralgia, the underlying disease is treated.
- Anticonvulsants as prescribed by a neurologist
- Gradual dose selection with monitoring of tests
- Local anesthetics and blockades
- Neurosurgical decompression when medications are ineffective
- Treatment of tumor or inflammation in the secondary form
- Soft, warm food during an exacerbation
- Observation by a cardiologist for fainting