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What Is Glossopharyngeal Neuralgia & Can Radiotherapy Help?
There are several rare pain disorders that can be somewhat difficult to diagnose due to the intermittent nature of their symptoms, but due to the debilitating nature of said symptoms need to be addressed by neurological specialists.
One example of this that is particularly uncommon even amongst the relatively rare field of neuralgic pain conditions is glossopharyngeal neuralgia, which primarily causes pain in the mouth and the ear.
Thankfully, as with many rare pain disorders, there are specialist neurological treatments that can help, which means that a major component of treatment is spotting the signs and making a complete diagnosis.
If it is compressed, therefore, it will cause episodes of pain that can last between a few seconds to up to two minutes, particularly affecting the back of the mouth, the tonsils and the inner ear.
It can sometimes be confused with trigeminal neuralgia, which affects the fifth cranial nerve, as the symptoms are so similar, it is 100 times more common (albeit still very rare), and can affect a similar part of the face to glossopharyngeal neuralgia.
It is typically caused by a compression of the glossopharyngeal nerve (classical GPN), but it can also be caused by a tumour or other underlying condition (secondary GPN) or sometimes have a cause other than compression (idiopathic).
The criteria for diagnosing GPN include recurring severe episodes of pain that last up to two minutes and emerge suddenly. This pain will generally be described as shooting, stabbing or akin to an electric shock, and will occur when someone swallows, talks, yawns or coughs.
If all of these are the case and there is no alternative explanation for the pain, a neurologist will make a diagnosis of GPN and begin to arrange treatment.
It can also sometimes be confirmed by testing the affected area for pain, applying a local anaesthetic and then seeing if that causes the pain to stop. If it does, then it is a sign that the cause is GPN.
However, there is an even rarer variation of GPN which also affects the vagus nerve known as vagoglossopharyngeal neuralgia (VGPN), which can have potentially life-threatening complications.
The vagus nerve is the tenth cranial nerve and helps regulate several vital bodily functions such as breathing, heart rate, bodily reflexes and digestion. If the same compression that causes GPN also affects the vagus nerve, it can cause fainting, low blood pressure and potentially cardiac arrest.
Both versions are treatable, and depending on the specific nature and cause of the neuralgia, there is a wide range of potential treatment paths available.
Low doses can be very effective, so treatments tend to start with relatively small doses that are increased as and when necessary. If carbamazepine does not work or is not recommended for other reasons, there are nearly a dozen other medications that have proven to be effective for treating GPN.
Alternatively, if medication is not effective, then similar surgical procedures to trigeminal neuralgia may be recommended.
The first-line procedure for both is microvascular decompression, which uses various methods to relieve pressure on the nerve, typically by separating or placing a soft barrier between the ninth cranial nerve and nearby blood vessels.
Following the treatment, it is common for the pain to almost completely disappear, although in some cases it can take a few weeks for this to happen.
Alternatively, stereotactic radiosurgery is an alternative option to surgery, as it can help to provide relief from pain symptoms as well, although a neurologist will be best placed to determine if radiotherapy or surgery is the best option for you.
To learn more about our advanced radiotherapy and neurosurgical treatments for glossopharyngeal neuralgia and neuralgic pain conditions, take a look at the Queen Square website.
One example of this that is particularly uncommon even amongst the relatively rare field of neuralgic pain conditions is glossopharyngeal neuralgia, which primarily causes pain in the mouth and the ear.
Thankfully, as with many rare pain disorders, there are specialist neurological treatments that can help, which means that a major component of treatment is spotting the signs and making a complete diagnosis.
What Is Glossopharyngeal Neuralgia?
A condition that affects one in 100000 people each year, glossopharyngeal neuralgia (GPN) is caused by compression of the ninth cranial nerve, which affects the back part of your tongue, middle ear, and upper throat when you swallow.If it is compressed, therefore, it will cause episodes of pain that can last between a few seconds to up to two minutes, particularly affecting the back of the mouth, the tonsils and the inner ear.
It can sometimes be confused with trigeminal neuralgia, which affects the fifth cranial nerve, as the symptoms are so similar, it is 100 times more common (albeit still very rare), and can affect a similar part of the face to glossopharyngeal neuralgia.
It is typically caused by a compression of the glossopharyngeal nerve (classical GPN), but it can also be caused by a tumour or other underlying condition (secondary GPN) or sometimes have a cause other than compression (idiopathic).
How Is Glossopharyngeal Neuralgia Diagnosed?
A specialist neurologist will typically diagnose GPN through a detailed clinical examination, as medical imaging can typically only determine potential causes once a diagnosis is already confirmed.The criteria for diagnosing GPN include recurring severe episodes of pain that last up to two minutes and emerge suddenly. This pain will generally be described as shooting, stabbing or akin to an electric shock, and will occur when someone swallows, talks, yawns or coughs.
If all of these are the case and there is no alternative explanation for the pain, a neurologist will make a diagnosis of GPN and begin to arrange treatment.
It can also sometimes be confirmed by testing the affected area for pain, applying a local anaesthetic and then seeing if that causes the pain to stop. If it does, then it is a sign that the cause is GPN.
How Serious Is Glossopharyngeal Neuralgia?
As a pain disorder, in most cases the seriousness of GPN is directly related to the level of pain and how regularly pain episodes emerge. If it is seriously affecting your quality of life, it will need some kind of treatment to help manage it.However, there is an even rarer variation of GPN which also affects the vagus nerve known as vagoglossopharyngeal neuralgia (VGPN), which can have potentially life-threatening complications.
The vagus nerve is the tenth cranial nerve and helps regulate several vital bodily functions such as breathing, heart rate, bodily reflexes and digestion. If the same compression that causes GPN also affects the vagus nerve, it can cause fainting, low blood pressure and potentially cardiac arrest.
Both versions are treatable, and depending on the specific nature and cause of the neuralgia, there is a wide range of potential treatment paths available.
How Is Glossopharyngeal Neuralgia Treated?
The primary form of treatment for GPN is medication, as the condition tends to respond very well to anticonvulsant medication such as carbamazepine, which is also used to treat trigeminal neuralgia.Low doses can be very effective, so treatments tend to start with relatively small doses that are increased as and when necessary. If carbamazepine does not work or is not recommended for other reasons, there are nearly a dozen other medications that have proven to be effective for treating GPN.
Alternatively, if medication is not effective, then similar surgical procedures to trigeminal neuralgia may be recommended.
The first-line procedure for both is microvascular decompression, which uses various methods to relieve pressure on the nerve, typically by separating or placing a soft barrier between the ninth cranial nerve and nearby blood vessels.
Following the treatment, it is common for the pain to almost completely disappear, although in some cases it can take a few weeks for this to happen.
Alternatively, stereotactic radiosurgery is an alternative option to surgery, as it can help to provide relief from pain symptoms as well, although a neurologist will be best placed to determine if radiotherapy or surgery is the best option for you.
To learn more about our advanced radiotherapy and neurosurgical treatments for glossopharyngeal neuralgia and neuralgic pain conditions, take a look at the Queen Square website.
