The disease to which this material will be devoted is not common. But at the same time, the symptoms of lesion of the glossopharyngeal nerve manifest themselves very clearly, delivering a lot of inconvenience to the patient. How to determine this disease, because of what it can occur, the article tells. She will also introduce the reader to the main diagnostic and therapeutic measures in this case.
What is it?
Symptoms of the lesion of the glossopharyngeal nerve will be considered further. First, determine what kind of disease. This is the name of a unilateral lesion of the ninth cranial nerve. Pain in the root of the tongue, pharynx, soft palate, tonsils is characteristic. Often she gives in the ear.
Such a pathology is known in medical circles under the name Sikar syndrome. This is due to the fact that the disease was first described by Sikar in 1920.
general information
Symptoms of the glossopharyngeal nerve are quite unpleasant in their manifestations, worsen the quality of life of the patient. This is a violation of the taste perception of the posterior third of the tongue, a decrease in the palatine and pharyngeal reflexes, and a violation of salivation.
Diagnosis of glossopharyngeal nerve neuralgia is carried out by narrow specialists - a neurologist, dentist, otolaryngologist. Basically, CT or MRI of the brain is performed. In some cases, echo-EG is indicated.
As for the treatment, in this case it is conservative. Anticonvulsant, analgesic drugs are prescribed. Additionally - sedatives and sleeping pills. As adjunctive therapy, physiotherapy, vitamin complexes, and general strengthening drugs can be used.
Statistics
If we turn to medical statistics, we find that neuralgia of the glossopharyngeal nerve (symptoms and treatment of the disease will be described later) is a rather rare pathology. After all, it occurs in 16 people out of 10 million.
The majority of patients are people over 40 years old. Mostly these are men.
Forms of the disease
Does it hurt to chew? This symptom can talk about problems with teeth and gums, as well as damage to the glossopharyngeal nerve. As for the latter case, it is further divided into two forms:
- Primary Or idiopathic.
- Secondary Another name is symptomatic. It can develop with injuries, infectious processes developing in the posterior cranial fossa. Or by squeezing a given nerve with tumors.
Causes of primary pathology
If the symptoms of glossopharyngeal nerve damage are similar in both forms of the disease, then their causes will be different.
In the primary form of Sikar's syndrome, neuralgia is idiopathic. Therefore, to establish its exact cause is not yet possible. However, it is believed that this form of lesion of the glossopharyngeal nerve can provoke the following:
- Atherosclerosis.
- Infections affecting the ENT organs. Somehow: tonsillitis, sinusitis, otitis media, chronic pharyngitis.
- Both acute and chronic intoxication of the body.
- Viral infectious diseases. A prime example is the flu.
Causes of secondary pathology
As for secondary neuralgia, then the causes can be established precisely. The most common are the following:
- Infectious pathology that affects the posterior cranial fossa. Arachnoiditis, encephalitis, etc.
- Various traumatic brain injuries.
- Metabolic disorder. In particular, hyperthyroidism, diabetes.
- Irritation or compression of the nerve in any of the areas of its passage. In particular, this is universally observed in intracerebral tumors of the cerebellar angle. That is, with meningioma, glioma, hemangioblastoma, medulloblastoma. The cause may be intracerebral hematomas, styloid process hypertrophy, nasopharyngeal tumors, carotid artery aneurysms, enlargement of osteophytes of the jugular openings, ossification of the stylohyal ligament.
- A number of experts believe that glossopharyngeal neuralgia is considered the first symptom of such dangerous conditions as pharyngeal cancer and laryngeal cancer.
Symptoms How to recognize
We determine the symptoms and treatment of glossopharyngeal neuralgia. The most common symptom is unilateral painful paroxysms, the duration of which can range from a few seconds to several minutes.
What does it mean? For example, a patient may feel that a soft palate hurts. If he follows his sensations, he will notice that the pain begins at the root of the tongue, after which he quickly gives into the soft palate, tonsils, pharynx, and sometimes in the ear. Pain may also pass to the lower jaw, neck, or eye.
Inflammation of the root of the tongue does not occur here. Although the symptoms are quite similar. Pain syndrome with neuralgia can provoke the following:
- Chewing.
- Swallowing.
- Yawn.
- Cough.
- Conversation.
- Too cold or too hot food.
What is noteworthy, during an attack, patients note dry mouth, and after it - already increased salivation. With the same inflammation of the root of the tongue, this does not happen. It should be noted that dry mouth will not be a characteristic sign of such neuralgia, since secretory insufficiency of the parotid salivary gland is often successfully compensated by the activity of neighboring glands.
As for swallowing disorders, which can be caused by paresis of the muscle that lifts the pharynx, they are not expressed. It is explained by the fact that the role of this muscle in the act of swallowing is insignificant. But still, the patient may experience difficulties with chewing and further swallowing food. In this case, they are associated with a violation of sensitivity. Including proprioceptive, which is responsible for sensing the position of the tongue in the mouth.
It is important to note that in some cases, symptoms of neuralgia are associated with the seasons. So, it is most noticeable in the spring and autumn.
Which specialist should I contact?
The glossopharyngeal nerve neuralgia is determined by a narrow specialist - a neurologist. But in order to exclude the possibility of diseases of the throat, nose, ear, and oral cavity, an examination by a dentist and otolaryngologist may additionally be required.
Neurological diagnosis
When examining a doctor, it is important to determine analgesia (that is, the absence of pain sensitivity) in such areas as the base of the tongue, soft palate, tonsils and upper part of the pharynx. The identification of taste sensitivity is also carried out. For this, various flavoring solutions are pipetted onto the symmetrical parts of the patient’s tongue.
In this case, it is of great importance to identify a unilateral isolated disorder of taste perception in the posterior third of the tongue. Indeed, a bilateral violation of taste sensitivity indicates another pathology - diseases of the oral mucosa (for example, with a chronic form of stomatitis).
Next, the specialist checks the pharyngeal reflex of the patient. Then the doctor touches the patient’s throat with a paper tube. In response to this, swallowing movements, and sometimes coughing, vomiting, should occur.
The palatine reflex is also tested. A healthy person touching the soft palate causes the palate and its tongue to rise.
If all the above reactions in a particular patient are absent, the specialist has a reason to suspect precisely neuralgia of the glossopharyngeal nerve. But the absence of such reflexes can also speak of pathologies of the vagus nerve.
If during the examination of the pharynx and pharynx of the patient rashes were detected, this may indicate ganglionitis of the nodes of the glossopharyngeal nerve. Symptoms of this condition are very similar to the neuralgia we are describing.
Instrumental diagnostics
In order to make a correct diagnosis, in addition to examination, a neurologist prescribes other diagnostic procedures to the patient. The most common today are magnetic resonance imaging and computed tomography of the brain.
If there is no possibility of their implementation, an echo-EG can be prescribed. What it is? So abbreviated as echoencephalography. This is an ultrasound diagnostic neurophysiological method. First of all, it is valuable in that it helps to assess the presence of volumetric pathological processes that occur in the substance of the brain. An EEG and an ophthalmologist consultation may also be prescribed. As part of the latter, an ophthalmoscopy is necessarily performed - an examination of the fundus.
A set of diagnostic procedures allows the specialist to verify the correctness of the diagnosis. And exclude the possibility of the development of the following pathologies in a patient:
- Ear neuralgia.
- Trigeminal neuralgia.
- Glossalgia of a different etiology.
- Pharyngeal abscess.
- Pterygopalatine ganglionitis.
- Oppenheim Syndrome.
- Tumors of the pharynx and larynx.
Directions of therapy
As we already mentioned, the treatment of inflammation of the glossopharyngeal nerve is purely conservative. The only exceptions are cases when it is squeezed. Here surgical intervention is necessary to eliminate the squeezing element. For example, resection of the enlarged styloid process.
To eliminate the pain-agonizing patient, they turn to lubricating the root of the tongue and throat with a 10% cocaine solution. This method helps to relieve pain for 6-7 hours. If the pain syndrome is persistent and intense, they turn to a more serious measure - the introduction of a 1-2% solution of novocaine. Moreover, the injection is made into the root of the tongue.
For oral administration, non-narcotic drugs can also be prescribed. In particular, ibuprofen, phenylbutazone, metamizole sodium, naproxen. In some cases, anticonvulsants are also indicated. Your doctor may prescribe drugs with carbamazepine or phenytoin.
In the case when the pain syndrome with such neuralgia is pronounced, tormenting the patient, the following medications will be shown:
- Sleeping pills.
- Antidepressant.
- Sedative.
- Antipsychotic.
In some cases of quickest recovery, physiotherapeutic procedures can be achieved:
- SMT on the areas of the larynx and tonsils.
- Diadynamic therapy.
- Galvanization.
Vitamin B1, multivitamin and general strengthening drugs are prescribed as adjunctive therapy.
The prognosis of recovery in the case of glossopharyngeal neuralgia is estimated by experts as favorable. In cases where its cause is correctly identified, and subsequently it is successfully removed or cured. But it should be noted that relief does not come here immediately. In some cases, several years of therapy are required.