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|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 702
In the Differential for Glossopharyngeal Neuralgia, do not Forget the Esophagus
Sylvain Redon, Anne Donnet
Department of Evaluation and Treatment of Pain, Clinical Neuroscience, Federation, La Timone Hospital, FHU INOVPAIN, Aix-Marseille Univ, Marseille, France
|Date of Web Publication||6-Jul-2020|
Dr. Sylvain Redon
Department of Evaluation and Treatment of Pain, Clinical Neuroscience Federation, La Timone Hospital, Marseille
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Redon S, Donnet A. In the Differential for Glossopharyngeal Neuralgia, do not Forget the Esophagus. Neurol India 2020;68:702
In the International Classification of Headache Disorders, glossopharyngeal neuralgia is the only swallowing-induced cranial neuralgia. In the typical description, brief paroxysms attacks of electric shock-like pain occur in the distribution of glossopharyngeal nerve territory: the throat, the tongue, or the angle of the jaw. The pain could radiate to the ear, eye, nose, chin, or shoulder. These attacks are precipitated by swallowing, coughing, talking, or yawning. Secondary causes must be excluded by careful imaging workup and thorough oropharyngeal examination. We report herein a rare case of periauricular neuralgia triggered by swallowing, outside the territory of glossopharyngeal nerve, secondary to esophageal candidiasis.
A 82-year-old man reported a 9-month history of severe right side pain behind his ear, the angle of his jaw, irradiating to the neck. The pain was described as paroxysmal shock-like attacks during several seconds, triggered by swallowing and in a lesser extent by mastication, associated with a continuous slight pain in the same territory. No trigger zone was found on clinical examination. No chest pain or heartburn was reported. A cerebral and cervical tomodensitometry was normal. A careful otorhinolaryngological examination with endoscopy was normal. The patient was partially improved with pregabalin (50 mg/day) but side effects required to stop this treatment. Seven months after the beginning of this pain, the patient reported dysphagia, with the sensation of food getting stuck in the throat. An upper gastrointenstinal endoscopy revealed gastric and esophageal candidiasis. The cranial and cervical pain quickly disappeared with amphotericin B (Fungizone®) and lanzoprazole. Eight months after this treatment, no painful or non-painful symptom was reported.
Otalgia, cervical pain, or buccal burning secondary to gastroesophageal reflux disease are well described in the literature. Irritation of the respiratory epithelium by gastric acid stimulates the glossopharyngeal and vagus nerves, producing ear pain. Throat cancer could be responsible for secondary glossopharyngeal neuralgia, but could also induce referred ear pain by irritation of the superior laryngeal branch of the vagus nerve. After otolaryngologic examination, the exploration of referred ear pain could include cervical MRI for the assessment of soft tissues of the neck. This case highlights the importance of esophageal affections in the assessment of periauricular neuralgia.
In conclusion, cranial paroxysmal shock-like pain triggered by swallowing are not reserved to glossopharyngeal neuralgia. In refractory cases of swallowing-induced cranial pain, esophageal or gastric pathologies should be considered as a possible etiology.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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