Glossopharyngeal nerve: neuralgia

Neuralgia of the glossopharyngeal nerve is a disease characterized by a one-sided lesion of the noninflammatory nature of the IX pair of cranial nerves. Its symptomatology is similar to manifestations of trigeminal neuralgia, in connection with which the probability of errors in the diagnosis is high. However, this pathology develops much less frequently than the latter: it causes 1 person per 200 thousand. of the population, for one case of neuralgia of the glossopharyngeal nerve, about 70-100 lesions of the trigeminal nerve occur. It affects people of mature and elderly, mostly men.

From our article you will learn about why this disease occurs, what are its clinical manifestations, and also about the principles of diagnosis and treatment of the neuralgia of the glossopharyngeal nerve. But first, for the reader to understand why these or other symptoms occur, we briefly consider the anatomy and functions of the IX pair of cranial nerves.

Anatomy and function of the nerve

As mentioned above, the term "glossopharyngeal nerve" (in Latin - nervus glossopharyngeus) denote IX a pair of cranial nerves. There are two, left and right. Each nerve consists of motor, sensory and parasympathetic fibers, which originate in the nuclei of the medulla oblongata.

• Its motor fibers provide movements of the shillopharyngeal muscle, which raises the pharynx.
• Sensitive fibers spread to the mucous membrane of the tonsils, pharynx, soft palate, drum cavity, auditory tube and tongue and provide sensitivity of these zones. Tastes of its fibers, being a kind of sensitive, are responsible for the taste sensations of the posterior third of the tongue and epiglottis.
• Together, the sensory and motor fibers of the glossopharyngeal nerve form the reflex arcs of the pharyngeal and palatine reflexes.
• Parasympathetic vegetative fibers of this nerve regulate the functions of the parotid gland (responsible for salivation).

It is important to know that the glossopharyngeal nerve passes in the immediate vicinity of the nerve of the wandering, in this connection, in many cases, their combined damage is determined.

Etiology (causes) of the neuralgia of the glossopharyngeal nerve

Depending on the causative factor, two forms of this pathology are distinguished: primary (or idiopathic, as its cause can not be reliably ascertained) and secondary (otherwise - symptomatic).

In most cases, the neuralgia of the glossopharyngeal nerve occurs in the following situations:

• lesions of the posterior cranial fossa (precisely where the oblong brain is localized) of infectious nature - arachnoiditis, encephalitis and others;
• ITC;
• diseases of the endocrine system (with thyrotoxicosis, diabetes mellitus, and so on);
• in the case of irritation or compression of the nerve itself in any part of it, more often in the region of the medulla oblongata (for tumors - meningioma, hemangioblastoma, cancer in the nasopharynx and others, hemorrhages in the brain tissue, an aneurysm of the carotid artery, hypertrophy of the styloid process and in a number of other situations);
• in the case of malignant tumors of the pharynx or larynx.

Also, risk factors for this disease are acute viral (in particular, influenza), acute and chronic bacterial (tonsillitis, pharyngitis, otitis, sinusitis and others) infections and atherosclerosis.

Clinical manifestations

This pathology occurs in the form of acute attacks of pain, which originates in the root of the tongue or one of the tonsils, and then spreads to the soft palate, pharynx and ear structure. In a number of cases, pain can be given to the eye area, the angle of the lower jaw and even the neck. Pain is always one-sided.

Such seizures last for 1-3 minutes, provoke their movements of the tongue (during meals, loud conversation), irritation of the tonsils or the root of the tongue.

Patients are often forced to sleep solely on a healthy side, because in the prone position on the side of the lesion occurs flowing saliva, and the patient is forced to swallow it in a dream, and this provokes nocturnal attacks of neuralgia.

In addition to the pain of a person, dry mouth is disturbed, and at the end of an attack, a large amount of saliva (hypersalivation) is released, which, however, is less on the side of the lesion than on the healthy side. In addition, the saliva secreted by the affected gland is characterized by increased viscosity.

In some patients, during a painful attack, such symptoms may occur:

• dizziness;
• darkening in the eyes;
• lowering blood pressure;
• loss of consciousness.

Most likely, such manifestations of the disease are associated with the irritation of one of the branches of the glossopharyngeal nerve, which leads to the depression of the vasomotor center in the brain, and consequently, to a drop in pressure.

There is neuralgia with an alternation of periods of exacerbations and remissions, and the duration of the latter in a number of cases is up to 12 months or more. However, over time, seizures occur more often, remissions become shorter, and also becomes more intense and painful. In some cases, the pain is so strong that the patient moans or screams, opens the mouth wide and actively rubs the neck under the angle of the lower jaw (under the soft tissues of this region is the pharynx, which, in fact, hurts).

Patients with experience often make complaints about pains that are not periodic but permanent, which become stronger when chewing, swallowing, or talking. Also, they can determine a violation (decrease) of sensitivity in areas innervated by the glossopharyngeal nerve: in the posterior third tongue, amygdala, pharynx, soft palate and ear, a taste disorder in the root of the tongue, a decrease in the amount of saliva. With symptomatic neuralgia, sensitivity disorders progress with time.

The consequence of disturbances of sensitivity in some cases is the difficulty of chewing food and swallowing it.

Principles of diagnostics

The primary diagnosis of the neuralgia of the glossopharyngeal nerve is based on the doctor's collection of patient complaints, the history of his life and the current disease. All matters: localization, the nature of pain, when it arises, how long it lasts and how the attack ends, how the patient feels between the attacks, other symptoms, disturbing the patient (they can point to pathology - a potential cause of neuralgia), concomitant diseases of a neurological, endocrine, infectious or other nature.

Then the doctor will conduct an objective examination of the patient, during which no significant changes in his condition will not reveal. Unless soreness can be detected by palpation of soft tissues over the angle of the lower jaw and in certain areas of the external auditory canal. Often such patients have reduced pharyngeal and palatine reflexes, impaired mobility of the soft palate, impaired sensitivity of the posterior third of the tongue (the patient feels all tastes as bitter). All the changes are not bilateral, but are found only on one side.

To determine the causes of secondary neuralgia, the doctor will refer the patient to a follow-up examination, which will include some of these methods:

• echoencephalography;
• electroencephalography;
• electroneuromyography;
• computer or magnetic resonance imaging of the brain;
• consultation of related specialists (in particular, the ophthalmologist, with obligatory examination of the fundus - ophthalmoscopy).

Differential diagnostics

Some diseases occur with symptoms similar to manifestations of the neuralgia of the glossopharyngeal nerve. In each case of treatment of a patient with such signs, the doctor conducts a thorough differential diagnosis, because the nature of these pathologies is different, which means that the treatment has its own peculiarities. So, painful attacks in the face are accompanied by such diseases:

• neuralgia of the trigeminal nerve (occurs much more often than others);
• ganglionitis (inflammation of the nervous ganglion) of the winged node;
• neuralgia of the ear;
• the different nature of glossalgia (pain in the area of ​​the tongue);
• Oppenheim's syndrome;
• neoplasms in the pharynx;
• retropharyngeal abscess.

Tactics of treatment

As a rule, the neuralgia of the glossopharyngeal nerve is treated conservatively, combining patients with medication and physiotherapy procedures. Sometimes you can not do without an operation.

Medication

The leading goal of treatment in this situation is to eliminate or at least significantly alleviate the pain that delivers the patient suffering. To do this, use:

• preparations of local anesthesia (dicaine, lidocaine) on the root of the tongue;
• injection preparations of local anesthesia (novocaine) - when topical agents do not have the desired effect; injection is carried out directly to the root of the tongue;
• non-narcotic analgesics (non-steroidal anti-inflammatory drugs) for oral or injection: ibuprofen, diclofenac and others.

The patient can also be assigned:

• vitamins of group B (milgamma, neurobion and others) in the form of tablets and solution for injections;
• anticonvulsants (finlepsin, diphenin, carbamazepine and so on) in tablets;
• Neuroleptics (in particular, aminazine) for injection;
• multivitamin complexes (Complivit and others);
• drugs that stimulate the body's defenses (ATP, FIBS, ginseng preparations and others).

Physiotherapy

In the complex treatment of neuralgia of the glossopharyngeal nerve, the physiological methods play an important role. They are conducted in order to:

• reduce the intensity of pain attacks and their frequency;
• improve blood flow in the affected area;
• improve nutrition of tissues in zones innervated by this nerve.

The patient is prescribed:

• Fluctuating currents on the upper sympathetic nodes (more precisely, on the area of ​​their projection); the first electrode is placed 2 cm from the angle of the lower jaw, the second - 2 cm above this anatomical formation; apply current by force to sensation to patients with moderate vibration; the duration of such an impact is, as a rule, from 5 to 8 minutes; procedures are conducted every day by a course of 8-10 sessions; the course of treatment is repeated 2-3 times in 2-3 weeks;
• sinusoidal modulated currents on the projection area of ​​the cervical sympathetic nodes (indifferent electrode is located on the back of the patient, and bifurcated - on the patient's neck; nodding muscles; the session lasts 8-10 minutes, the procedures are performed once a day, with a course of up to 10 exposures, repeated three times at intervals of 2-3 weeks);
• ultrasound therapy or ultraphoonophoresis of analgesics (in particular, analgin, anesthesin) drugs or euphyllin; work on the occipital region, on both sides of the spine; lasts a session of 10 minutes, spend them 1 time in 1-2 days in a course of 10 procedures;
• drug gangleron electrophoresis paravertebral to the cervical and upper thoracic vertebrae; duration of the session from 10 to 15 minutes, repeat them daily, with a course of 10-15 exposures;
• magnetotherapy with an alternating magnetic field; the Polyus-1 apparatus is used, it is acted upon by a rectangular inductor on the vertebrae of the cervical and the upper thoracic spine; the duration of the session is 15-25 minutes, they are administered once a day by a course of 10 to 20 procedures;
• decimeter wave therapy (acted by means of a rectangular radiator of the "Volna-2" apparatus on the collar area of ​​the patient; the air gap is 3-4 cm; the procedure lasts for up to 10 minutes, repeat them once every 1-2 days with a course of 12-15 sessions);
• laser puncture (affect the biological points of the IX pair of cranial nerves, the exposure is up to 5 minutes per point, procedures are performed every day with a course of 10 to 15 sessions);
• therapeutic massage of the neck-collar zone (spend it daily, the treatment course includes 10-12 procedures).

Surgery

In some situations, in particular, with hypertrophy of the styloid process, surgical intervention in the volume of resection of a part of this anatomical formation can not be avoided. The purpose of the operation is to eliminate the compression of the nerve from the outside or irritation with its surrounding tissues.

Conclusion

Neuralgia of the glossopharyngeal nerve, although it happens rarely, is capable of delivering real suffering to a person suffering from it. The disease is idiopathic (primary) and symptomatic (secondary). It is manifested by bouts of pain in the zones of innervation of the IX pair of cranial nerves, a preconditioned condition. It flows with alternation of exacerbation and remission, but over time, attacks occur more often, the pain becomes more intense, and remissions - shorter and shorter. It is important to correctly diagnose this pathology, because in some cases it is a manifestation of serious diseases requiring urgent treatment.

Treatment of the actual neuralgia may include the patient taking medication, physiotherapy, or surgery (fortunately, it is rarely necessary).

The prognosis for recovery in this pathology is usually favorable. Nevertheless, the treatment of her long, stubborn: lasts up to 2-3 years and even longer.

The first channel, the program "Live Healthily" with Elena Malysheva, heading "About medicine" on the topic "Neuralgia of the glossopharyngeal nerve": "

Neuralgia of the glossopharyngeal nerve. Why does it hurt to swallow

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