Glossopharyngeal Neuralgia – Treated by Steroid Injection and Amitriptyline

I got a question on what could be done for Glossopharyngeal neuralgia and came across this article on repeated bilateral intraoral glossopharyngeal nerve injections and amitriptyline as an alternative.

Case Rep Neurol. 2011 Jan-Apr; 3(1): 27–31.
Treatment of a Patient with Glossopharyngeal Neuralgia by the Anterior Tonsillar Pillar Method
Cemil Ahmet Isbir  free article here

  • 65 year old with pain right ear area triggered with yawning, swallowing and cold food.
  • Should have had a sore throat spot anterior bottom of anterior tonsillar pillar.
  • Putting 10 lidocaine(the spray) on a swab and holding it at site should momentarily relieve pain.
  • Became unresonsive to carbemazepine 1200 mg/day
  • was started on amitriptyline 10 mg
  • New style glossopharyngeal nerve block was done BILATERALLY with 2 cc local and 20 mg depo-medrol.

Technique:

  • laryngoscope was used because it could sweep the tongue to opposite side.
  • Front tonsil pillar was visualized and base (bottom) end was injected “just lateral to the base of the anterior tonsillar pillar” at a depth of 0.5 cc usuing a 25 gauge needle –  author used a spinal needle but I bet a 2 ” would work as well. There should be no blood on aspiration (close to carotids) and injection should offer no resistance.

  •  First day shots were done with steroid, then shots were done daily with 2 mls local each side. Sounds like block could have continued for 2 weeks daily.
  • Right sided sore throat began to resolve and by 1 month pain had dropped from 9/10 to 1-2/10

Comment: – Have tried block once for only one go and got temporary respite. Is easier to to then looks – no gagging. I have 2 questions though – why do blocks need to be bilateral and could topical local blocks be used instead? Will have to see if can get author to respond… canada goose femme canada goose femme

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One Response to Glossopharyngeal Neuralgia – Treated by Steroid Injection and Amitriptyline

  1. Teri Tinker says:

    I was recently diagnosed with Glossopharyngeal Neuralgia. However, everything I find on the internet says that the ear and throat are involved and for me it literally just my tongue. Reading above talks about treating the tonsils and throat, can this just be done for my tongue? Have I been missed diagnosed? Also, I am looking for a support group to no avail, every that I have found is no longer active or I get the emails back saying not able to send.

    Any help or input would be greatly appreciated! I am desperate my life has been turned up side down!!!!
    Sincerely,
    Teri Tinker

    Teri,
    According to:
    Trigeminal and Glossopharyngeal Neuralgia
    Gaddum Duemani Reddy et al
    Neurol Clin 32 (2014) 539–552
    Criteria include:
    “paroxysmal attacks of facial pain lasting from fractions of a second to up to 2 minutes that are stereotyped in the individual patient. The attacks must be
    (1) characterized as sharp, stabbing, and severe;
    (2) precipitated by swallowing, chewing, talking, coughing, or yawning; and
    (3) within the posterior part of the tongue, tonsillar fossa, pharynx, or beneath the angle
    of the lower jaw and/or in the ear. – [hence ear does not have to be involved]
    Symptomatic GPN may also have an aching pain that persists between paroxysms and can be associated with sensory impairment within the distribution of the glossopharyngeal nerve that persists between paroxysms and can be associated with sensory impairment within the distribution of the glossopharyngeal nerve.”
    I’ve not had any luck with support groups though.
    -admin

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