Glossopharyngeal neuralgia is a condition with most cases having an unclear etiology. It can be categorized as either primary or secondary based on the underlying cause. Primary glossopharyngeal neuralgia stems from unknown factors leading to demyelination and nerve short-circuiting at the root of the glossopharyngeal nerve. Secondary glossopharyngeal neuralgia is often caused by irritation or compression of the glossopharyngeal nerve due to factors such as abnormal vascular loops, tumors, inflammation, elongated styloid process, or arteriosclerosis.
Clinical Manifestations
The hallmark symptom is episodic severe pain on one side, affecting areas such as the ipsilateral tonsil, tongue base, pharyngeal region, and deep ear. The pain is usually triggered by activities such as speaking, swallowing, or touching the pharyngeal wall or the angle of the mandible on the affected side. It is often described as sharp, stabbing pain lasting from a few seconds to several tens of seconds and is accompanied by increased salivation. The application of 1% dicaine for surface anesthesia to the pharyngeal area can alleviate or temporarily stop episodes.
Diagnosis
Serological and imaging examinations are needed to identify the underlying cause and to exclude pain caused by conditions such as local inflammation, elongated styloid process, pharyngeal or laryngeal tuberculosis, or malignant tumors of the pharynx and larynx. Differentiation from trigeminal neuralgia is also necessary.
Treatment
For primary glossopharyngeal neuralgia, treatment focuses on pain relief. For secondary cases, management targets the underlying cause. Analgesics, sedatives, or surface anesthetic sprays may help reduce pain and alleviate episodes. Oral medications such as carbamazepine or oxcarbazepine are also effective for pain management. When conservative treatment proves ineffective, interventions such as percutaneous radiofrequency ablation of the glossopharyngeal nerve, microvascular decompression via craniotomy, or nerve root sectioning of the glossopharyngeal nerve through oral or cervical approaches may be considered.