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Glossopharyngeal Neuralgia caused by tonsillectomy
Greetings!
My father had a tonsillectomy while he was attending elementary school. That operation wasn't 100% successful because left palatoglossal arch was damaged. There was no problem after operation. At the age of 30, he start to fill pain in his left ear every time he inhale cold air, or take a cold drink. Doctors concluded that he have chronic pharyngitis, and because of that mucous tissue in pharings was damaged, so neural endings of IX cranial nerve came to the surface. He managed to control the pain mostly with analgetics for last 25 years. (he have 55 years at this time)
Last week, he made inconvenient turn with his head while he was swallowing soda, and condition became worse. Now he feel intolerable pain in his left ear and small part of his left cheek, every time he swallow something - food, drink or just a saliva. He cant sleep, eat or do his every day duties without strong analgetics (he is using now diclofenac - Voltaren)
Is there any solution for his problem? May be some other less harmful types of drugs, or some kind of operation with transplantation of mucous tissue over naked nerve endings in his pharings or destroying them in some way.
(if it is better to post this question in some other forums such as Otorinolaringology or Maxillofacial Surgery, please let me know)
My father had a tonsillectomy while he was attending elementary school. That operation wasn't 100% successful because left palatoglossal arch was damaged. There was no problem after operation. At the age of 30, he start to fill pain in his left ear every time he inhale cold air, or take a cold drink. Doctors concluded that he have chronic pharyngitis, and because of that mucous tissue in pharings was damaged, so neural endings of IX cranial nerve came to the surface. He managed to control the pain mostly with analgetics for last 25 years. (he have 55 years at this time)
Last week, he made inconvenient turn with his head while he was swallowing soda, and condition became worse. Now he feel intolerable pain in his left ear and small part of his left cheek, every time he swallow something - food, drink or just a saliva. He cant sleep, eat or do his every day duties without strong analgetics (he is using now diclofenac - Voltaren)
Is there any solution for his problem? May be some other less harmful types of drugs, or some kind of operation with transplantation of mucous tissue over naked nerve endings in his pharings or destroying them in some way.
(if it is better to post this question in some other forums such as Otorinolaringology or Maxillofacial Surgery, please let me know)
Thank you for the information. I get my self familiar with Eagles syndrome and think about it and my fathers problems.
Hi, just read your story. Have you looked into Eagle's syndrome?
EAGLE'S SYNDROME - SYMPTOMS
Patients with vague head and neck pain symptoms can lead to an extensive differential diagnosis. One easily overlooked but important cause of chronic pain is Eagle’s syndrome (ES). Beginning in 1937, Dr. Watt Eagle published a series of articles describing a constellation of symptoms associated with an elongated styloid process. This syndrome that bears his name is associated with two classic presentations. The first, which the otolaryngologist is more familiar with, is throat pain radiating to the ear in a post-tonsillectomy patient. The second, and lesser-known presentation, is constant throbbing pain throughout either the internal or external carotid artery distributions.
A patient exhibiting the symptoms associated with Eagle’s syndrome, may consult their family physician or an otolaryngologist, a neurologist, a surgeon (neurosurgeon, maxillofacial or oral surgeon), a dentist or even a psychiatrist in order to be diagnosed. Persistent pain and other symptoms could aggravate the psychological state of a patient. By the time the syndrome is actually diagnosed, many patients have already visited some of these doctors, who have unsuccessfully tried to treat their symptoms.
Symptoms depend on a variety of factors, including the length and width of the styloid process, the angle and direction of its deviation and the degree of ossification. The pathogenesis of the syndrome was described by Eagle, who discussed types.
The first type, ‘‘classic Eagle’s syndrome,’’ typically occurs in patients after tonsillectomy, although it can also occur after any other type of pharyngeal surgery. A palatable mass may be observed in the tonsillar fossa, its palpation sometimes exacerbating the patient’s symptoms. Symptoms include ear pain, neck pain extending to the oral cavity and the maxilla, dysphonia, dysphagia, odynophagia, persistent sore throat, the sensation of a foreign body in the pharynx, painful trismus <25 mm, vertigo and tinnitus. Pain is also observed when turning the head or extending the tongue. Apart from turning the head, yawning can also trigger symptoms, particularly those resembling migraine. Other symptoms may include tongue pain in general, a sensation of increased salivation, alterations in taste, vocal changes, pain in the upper limbs, chest, and temporomandibular joint, facial paresthesia, pharyngeal spasm, pain triggered by the movement of the mandible, cough, dizziness, or sinusitis. Eagle’s syndrome has also been reported as the most important cause of secondary glossopharyngeal neuralgia or atypical craniocervical pain. All of these symptoms are attributed to the irritation of cranial nerves V, VII, IX or X, all of which are situated very close to the styloid process. The observation of symptoms after tonsillectomy generates the hypothesis that these nerves are entrapped in the locally formed granular tissue. Trauma to the soft tissues during tonsillectomy may cause bone formation, leading to an elongated styloid process or ossified stylohyoid ligament. Ossification typically appears from 2 to 12 months after the trauma.
In the stylo-carotid artery syndrome, an elongated styloid process deviating slightly from its normal direction can impinge the internal or external carotid artery, stimulating the sympathetic nerve plexus accompanying the artery and causing pain during artery’s palpation. Stimulation of the internal carotid artery causes pain along the artery that is sometimes accompanied by pain in the eye and parietal cephalalgia. These symptoms can result in wrong diagnoses, such as cluster headache or migraine. Symptoms may also include aphasia, sight disturbances, weakness or even syncope episodes. Stimulation of the external carotid artery causes facial pain, mainly in the area under the eyes. Histological examination of the vessel wall in such cases may reveal arteriosclerosis. Stylo-carotid artery syndrome might also result in arterial variation.
DIAGNOSIS
The diagnosis of Eagle’s syndrome is based on four different parameters:
(1) clinical manifestations
(2) digital palpation of the process in the tonsillar fossa
(3) radiological findings and
(4) lidocaine infiltration test. During the lidocaine infiltration test, lidocaine anesthetic is administered to the area where the styloid process is palpable in the tonsillar fossa. If the patient’s symptoms and local sensitivity subside the test result is considered positive and Eagle’s syndrome is diagnosed.
A patient exhibiting the symptoms associated with Eagle’s syndrome, may consult their family physician or an otolaryngologist, a neurologist, a surgeon (neurosurgeon, maxillofacial or oral surgeon), a dentist or even a psychiatrist in order to be diagnosed. Persistent pain and other symptoms could aggravate the psychological state of a patient. By the time the syndrome is actually diagnosed, many patients have already visited some of these doctors, who have unsuccessfully tried to treat their symptoms. This is quite understandable considering that the clinical manifestations of Eagle’s syndrome resemble those of many other diseases. Consequently, it is quite difficult to make a correct diagnosis based solely on clinical manifestations. However, it is very important for physicians and dentists to include Eagle’s syndrome in their differential diagnosis when treating patients experiencing pain in the cervicofacial and cervicopharyngeal regions.
A 3D-CT scan is considered the gold standard in the radiological diagnosis of Eagle's Syndrome. It provides an accurate measurement of the length and angulation of the styloid process and is considered to be the best supplement to the plain x-ray.
It is important to note that an elongated styloid process does not necessarily signify Eagle’s syndrome, as the majority of individuals exhibiting this anatomical anomaly experience no symptoms. Additionally, although an elongated process is found bilaterally in most cases, patients typically display unilateral symptoms. Also it is noteworthy that the occurrence of the syndrome correlates with the length of the styloid process, its width and its angulation. In fact a number of mechanisms can result in the onset of the syndrome and are responsible for the variety of symptoms. Consequently, patients may experience any number of symptoms, which often mislead physicians and necessitate the use of other data such as radiological findings to confirm the diagnosis. Both physicians (head and neck, oral and maxillofacial surgeons) and dentists must have a high index of suspicion for this clinical entity. Eagle’s syndrome should be included in the differential diagnosis of cervicofacial and pharyngeal pain. The fact that it is often excluded in such cases results in underdiagnosis and, consequently, an underestimation of the incidence of this syndrome.
EAGLE'S SYNDROME - SYMPTOMS
Patients with vague head and neck pain symptoms can lead to an extensive differential diagnosis. One easily overlooked but important cause of chronic pain is Eagle’s syndrome (ES). Beginning in 1937, Dr. Watt Eagle published a series of articles describing a constellation of symptoms associated with an elongated styloid process. This syndrome that bears his name is associated with two classic presentations. The first, which the otolaryngologist is more familiar with, is throat pain radiating to the ear in a post-tonsillectomy patient. The second, and lesser-known presentation, is constant throbbing pain throughout either the internal or external carotid artery distributions.
A patient exhibiting the symptoms associated with Eagle’s syndrome, may consult their family physician or an otolaryngologist, a neurologist, a surgeon (neurosurgeon, maxillofacial or oral surgeon), a dentist or even a psychiatrist in order to be diagnosed. Persistent pain and other symptoms could aggravate the psychological state of a patient. By the time the syndrome is actually diagnosed, many patients have already visited some of these doctors, who have unsuccessfully tried to treat their symptoms.
Symptoms depend on a variety of factors, including the length and width of the styloid process, the angle and direction of its deviation and the degree of ossification. The pathogenesis of the syndrome was described by Eagle, who discussed types.
The first type, ‘‘classic Eagle’s syndrome,’’ typically occurs in patients after tonsillectomy, although it can also occur after any other type of pharyngeal surgery. A palatable mass may be observed in the tonsillar fossa, its palpation sometimes exacerbating the patient’s symptoms. Symptoms include ear pain, neck pain extending to the oral cavity and the maxilla, dysphonia, dysphagia, odynophagia, persistent sore throat, the sensation of a foreign body in the pharynx, painful trismus <25 mm, vertigo and tinnitus. Pain is also observed when turning the head or extending the tongue. Apart from turning the head, yawning can also trigger symptoms, particularly those resembling migraine. Other symptoms may include tongue pain in general, a sensation of increased salivation, alterations in taste, vocal changes, pain in the upper limbs, chest, and temporomandibular joint, facial paresthesia, pharyngeal spasm, pain triggered by the movement of the mandible, cough, dizziness, or sinusitis. Eagle’s syndrome has also been reported as the most important cause of secondary glossopharyngeal neuralgia or atypical craniocervical pain. All of these symptoms are attributed to the irritation of cranial nerves V, VII, IX or X, all of which are situated very close to the styloid process. The observation of symptoms after tonsillectomy generates the hypothesis that these nerves are entrapped in the locally formed granular tissue. Trauma to the soft tissues during tonsillectomy may cause bone formation, leading to an elongated styloid process or ossified stylohyoid ligament. Ossification typically appears from 2 to 12 months after the trauma.
In the stylo-carotid artery syndrome, an elongated styloid process deviating slightly from its normal direction can impinge the internal or external carotid artery, stimulating the sympathetic nerve plexus accompanying the artery and causing pain during artery’s palpation. Stimulation of the internal carotid artery causes pain along the artery that is sometimes accompanied by pain in the eye and parietal cephalalgia. These symptoms can result in wrong diagnoses, such as cluster headache or migraine. Symptoms may also include aphasia, sight disturbances, weakness or even syncope episodes. Stimulation of the external carotid artery causes facial pain, mainly in the area under the eyes. Histological examination of the vessel wall in such cases may reveal arteriosclerosis. Stylo-carotid artery syndrome might also result in arterial variation.
DIAGNOSIS
The diagnosis of Eagle’s syndrome is based on four different parameters:
(1) clinical manifestations
(2) digital palpation of the process in the tonsillar fossa
(3) radiological findings and
(4) lidocaine infiltration test. During the lidocaine infiltration test, lidocaine anesthetic is administered to the area where the styloid process is palpable in the tonsillar fossa. If the patient’s symptoms and local sensitivity subside the test result is considered positive and Eagle’s syndrome is diagnosed.
A patient exhibiting the symptoms associated with Eagle’s syndrome, may consult their family physician or an otolaryngologist, a neurologist, a surgeon (neurosurgeon, maxillofacial or oral surgeon), a dentist or even a psychiatrist in order to be diagnosed. Persistent pain and other symptoms could aggravate the psychological state of a patient. By the time the syndrome is actually diagnosed, many patients have already visited some of these doctors, who have unsuccessfully tried to treat their symptoms. This is quite understandable considering that the clinical manifestations of Eagle’s syndrome resemble those of many other diseases. Consequently, it is quite difficult to make a correct diagnosis based solely on clinical manifestations. However, it is very important for physicians and dentists to include Eagle’s syndrome in their differential diagnosis when treating patients experiencing pain in the cervicofacial and cervicopharyngeal regions.
A 3D-CT scan is considered the gold standard in the radiological diagnosis of Eagle's Syndrome. It provides an accurate measurement of the length and angulation of the styloid process and is considered to be the best supplement to the plain x-ray.
It is important to note that an elongated styloid process does not necessarily signify Eagle’s syndrome, as the majority of individuals exhibiting this anatomical anomaly experience no symptoms. Additionally, although an elongated process is found bilaterally in most cases, patients typically display unilateral symptoms. Also it is noteworthy that the occurrence of the syndrome correlates with the length of the styloid process, its width and its angulation. In fact a number of mechanisms can result in the onset of the syndrome and are responsible for the variety of symptoms. Consequently, patients may experience any number of symptoms, which often mislead physicians and necessitate the use of other data such as radiological findings to confirm the diagnosis. Both physicians (head and neck, oral and maxillofacial surgeons) and dentists must have a high index of suspicion for this clinical entity. Eagle’s syndrome should be included in the differential diagnosis of cervicofacial and pharyngeal pain. The fact that it is often excluded in such cases results in underdiagnosis and, consequently, an underestimation of the incidence of this syndrome.
Hi I to have GN caused by a tonsillectomy, your dad will or should see an ENT once an ENT diagnoses it he can't give medication as a nerve is involved so then he will be referred to a neurologist for medication. I currently take high amounts of ms contin and gabapentin (neurontin) and nortriptyline (small dose) it doesnt really help me with the pain but i sleep alot more which for me is a real addition as the days go by faster. Hope your dad can find a good pain med ther is also a support group in yahoo groups and there a few of us there with all different med suggestions and surgery ideas. Generally if it caused by a tonsillectomy dependant on the spot where the nerve was damaged they dont like to operate as this could give rise to more complications after rather than less.....
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