Glossopharyngeal Neuralgia (GPN)
What is glossopharyngeal neuralgia (GPN)?
Glossopharyngeal neuralgia (GPN) is a rare condition that can cause sharp, stabbing, or shooting pain in the throat area near the tonsils, the back of the tongue or the middle ear.
The pain occurs along the pathway of the glossopharyngeal nerve, which is located deep in the neck. It serves the back of the tongue, throat and the parotid gland (one of the salivary glands), the middle ear and eustachian tube.
Painful episodes are usually intermittent, lasting from a few seconds to a few minutes. The pain might recur several times in a day. In other cases it might not come back for several weeks or months.
Certain activities may trigger painful episodes, including:
- Drinking cold liquids
- Sneezing or coughing
- Clearing the throat
- Touching the gums
Sometimes people with this condition may avoid eating, drinking or chewing because they fear that these activities may trigger a painful attack. Over time, this can result in weight loss.
Generally, only one side of the head is affected by GPN. The glossopharyngeal nerve has several branches, including the tympanic branch that receives sensations from the middle ear and mastoid.
Another important branch is the carotid sinus nerve that serves the carotid body and carotid sinus (widening of a carotid artery at the main branch point). Painful attacks may result in life-threatening symptoms, such as fainting (syncope), slow heartbeat (bradycardia) or arrhythmia (irregular heartbeat). In very rare cases, cardiac arrest may occur with no painful episodes.
How common is glossopharyngeal neuralgia (GPN)?
The disorder is rare, with less than 1 case reported per year among 100,000 people in the United States. It tends to occur more often in adults over age 40, but it may be present at any age. It appears to affect men more than women.
What causes glossopharyngeal neuralgia (GPN)?
Often there is no apparent cause for the condition. Compression of the glossopharyngeal nerve by a blood vessel near the brainstem may irritate the nerve and cause pain. In other cases, an elongated styloid process (a bone in the neck near the nerve) can cause pain. This condition is called Eagle syndrome.
Trauma due to an injury or a surgical procedure may also result in glossopharyngeal neuralgia. Other possible causes include infections, tumors and vascular abnormalities. Patients with multiple sclerosis may experience glossopharyngeal neuralgia as a result of the breakdown of the myelin sheath, the fatty membrane that surrounds and insulates the nerve.