What causes Glossopharanygeal neuritis.  What nerves are affected. 
What can relieve symptoms.

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Request for Question Clarification by easterangel-ga on 24 Apr 2005 17:57 PDT

Hi!

Do you mean Glossopharyngeal Neuralgia?

Thanks!

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Clarification of Question by georgie1942-ga on 26 Apr 2005 01:55 PDT

I am not sure. I was told this by a specialist.  It is a form of
trigeminal neurlagia, burt is more rare.  I think it involves the IX &
X cranial nerves, but I am not sure.

Hi georgie1942!!

According to your clarification your are asking about Glossopharyngeal Neuralgia:
Neuralgia is defined as an intense burning or stabbing pain caused by
irritation of or damage to a nerve. The pain is usually brief but may
be severe. It often feels as if it is shooting along the course of the
affected nerve.
"Glossopharyngeal Neuralgia is similar to Trigeminal Neuralgia but is
much less common. The shooting pain occurs in the throat, tonsil
region, and base of the tongue on one side. The pain may be
spontaneous or triggered by swallowing."
From "Glossopharyngeal Neuralgia":
http://www.neurosurgery.ucsd.edu/cnd/glossopharyngeal_neuralgia.htm


See "MedlinePlus Medical Encyclopedia: Glossopharyngeal neuralgia"
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9350.htm


- What causes Glossopharanygeal Neuralgia? and What nerves are affected?:

This condition is caused most frequently by an abnormal looping artery
impinging against the Glossopharyngeal nerve (cranial nerve 9) at the
root entry zone into the brain stem. It is often the result of
compression of the 9th nerve (glossopharyngeal) or 10th nerve (vagus),
but in some cases, no cause is evident.

"Glossopharyngeal neuralgia usually occurs without any obvious cause.
A thorough physical examination usually does not reveal any
abnormality other than the identification of trigger points.
Radiological examination including CT scans, MRIs, and angiograms will
be normal.
Why then does the nerve go into a state of hyperexcitability causing
?idiopathic glossopharyngeal neuralgia?? 
...it became apparent that most of these cases of ?idiopathic?
glossopharyngeal neuralgia could be caused by vascular compression of
the glossopharyngeal nerve at the nerve root entry zone, causing a
hyperactive rhizopathy. The implicating vessel is usually the
posterior inferior cerebellar artery (PICA) which frequently also
compresses on the rootlets of the vagus nerve. It is impossible to
image that radiologically...These syndromes are quite effectively
treated by a microvascular decompression procedure of the relevant
vessels...it is important to exclude secondary causes of
glossopharyngeal neuralgia. Any sort of compression or irritation to
the glossopharyngeal nerve can result in neural hyper-excitability and
neuralgia. The most common secondary cause of neuralgia is the Eagle?s
syndrome or styalgia. It is a glossopharyngeal nerve
hyper-excitability syndrome caused by compression of the nerve against
an elongated or fractured styloid process or a calcified stylo-hyoid
ligament.
Other causes of secondary glossopharyngeal neuralgia include:
cerebellopontine angle tumours, parapharyngeal space lesions,
metastasis to petrous temporal bone from breast carcinoma,
post-tonsillectomy, local infection, carcinoma of the parapharyngeal
space, carcinoma of the pharynx, nasopharyngeal carcinoma, posterior
fossa arterio-venous malformation."
Summed up from "The Glossopharyngeal Nerve, Glossopharyngeal Neuralgia and the
Eagle?s Syndrome - Current Concepts and Management":
You will be find this article very informative, it has enough
information to answer your question per se.
http://www.sma.org.sg/smj/4010/articles/4010ra1.htm


Regarding to the diagnosis several studies may be taken. These studies
includes physical examination, CAT Scan, X-Ray and MRI. None of these
is able to determine if glossopharyngeal neuralgia is caused by
vascular compression of the glossopharyngeal nerve at the nerve root
entry zone. Additional studies was developed to do this, and they are
having success diagnosing the vascular compression of the
glossopharyngeal nerve. One of the most effective techniques is the
MRI/MRA (MRI and Magnetic Resonance Angiography combined).

See also the Diagnosis section of the "The Glossopharyngeal Nerve,
Glossopharyngeal Neuralgia and the Eagle?s Syndrome - Current Concepts
and Management" article and the page:
"Glossopharyngeal Neuralgia: Diagnosis"
http://www.1uphealth.com/health/glossopharyngeal_neuralgia_diagnosis_tests.html


Regarding to the treatment, please read the following paragraphs:

"Treatment:
Initial treatment of Glossopharyngeal Neuralgia is medical with
carbamazepine (Tegretol®) and gabapentin (Neurontin®) being the
medications of choice. Unfortunately, these medications are not as
effective for Glossopharyngeal Neuralgia as they are for Trigeminal
Neuralgia. As a result, the majority of patients require Microvascular
Decompression (MVD) which is the only advisable surgical procedure.
 Microvascular Decompression:
This procedure involves entering the skull behind the ear and locating
a loop of blood vessel contacting the root entry zone of the 9th
cranial nerve.  The blood vessel is lifted away and padded a safe
distance off the nerve with a Teflon® felt sponge. The incision is
closed watertight. Most patients will experience immediate relief of
their pain after this procedure. The first night post-operatively is
spent in the intensive care unit for observation.  Most people will be
discharged home by the third post-operative day."
From the UCSD Division of Neurosurgery website:
http://www.neurosurgery.ucsd.edu/cnd/glossopharyngeal_neuralgia.htm

At the Department of Neurosurgery pages, from the University of
Pittsburgh website you can read:
"Glossopharyngeal Neuralgia":
"...We believe MVD for GN is the most effective treatment for this
disorder. Despite the rarity of GN, we have operated upon over 200
patients with throat pain over 80% of whom enjoy immediate excellent
relief."
http://www.neurosurgery.pitt.edu/cranialnerve/disorders/glossneuralgia.html

"Video of MVD Procedure":
http://videoserver.upmc.com/ramgen/neuro/lmimcs.rm


There is other procedure used to treat this condition: rhyzotomy; you
can read about it at:
"TREATMENTS FOR GPN" from the Centre for Cranial Nerve Disorders,
Winnipeg, University of Manitoba, Health Sciences Centre:
http://www.umanitoba.ca/centres/cranial_nerves/glossopharyngeal_neuralgia/treatments.html


Again the Treatment section of the "The Glossopharyngeal Nerve,
Glossopharyngeal Neuralgia and the Eagle?s Syndrome - Current Concepts
and Management" article will be helpful.


Additional references are:
"THE MERCK MANUAL--SECOND HOME EDITION, Glossopharyngeal Neuralgia in
Ch. 96, Cranial Nerve Disorders":
http://www.merck.com/mmhe/sec06/ch096/ch096g.html

"Glossopharyngeal Nerve":
http://medical.webends.com/kw/glossopharyngeal%20nerve

"Vagus Nerve":
http://medical.webends.com/kw/Vagus+Nerve


I hope that this helps you. Please do not consider this answer ended
until you feel satisfied with it, if you find something unclear or
incomplete do not hesitate to us ethe clarification feature to request
for further assistance, I will be glad to respond your requests before
you rate this answer.

Best regards.
livioflores-ga

Trigeminal neuralgia translates into plain English as:

  'Pain in the Trigeminal Nerve'

Since the Trigeminal is a 'motorway/autoroute' nerve that gathers up
loads of other nerves
- it is pretty much equivalent to saying 'a pain in the lower part of your head'

As for treatment, the first trick is Carbamapazine (trademark Tegretol)
- it is an anti-epileptic drug that turns you into a zombie
- another one is Gabapentin - a similar anti-epileptic offering
(the nice thing about those drugs is that zombies don't pester the doctor)

Having suffered from this nightmare for 13 years, I know a fair bit about it.
If you don't want to post here, then consider setting up a free Email account

What I will tell you is very depressing
- but with luck and cash you might get it sorted out.