Glossopharyngeal neuralgia is a condition characterized by paroxysmal, recurrent, and severe pain localized within the distribution of the glossopharyngeal nerve and the auricular and pharyngeal branches of the vagus nerve. Its nature is similar to that of trigeminal neuralgia, but it is less common.
The etiology remains unclear; it may be caused by nerve demyelination, and can also be observed in conditions such as cerebellopontine angle tumors, jugular foramen region tumors, skull base tumors, nasopharyngeal and tonsillar tumors, arachnoiditis, compression by arterial tumors, etc., which involve the glossopharyngeal nerve and trigger pain.
Diagnostic Key Points
Most patients develop the condition after age 40, and it can affect both men and women. The pain is located in the root of the tongue or the pharyngeal wall near the tonsil area, and may radiate to the nasopharynx or deep ear. It can be triggered by swallowing, speaking, coughing, yawning, or tongue movement. Trigger points may be present on the posterior pharyngeal wall, tongue root, and tonsillar fossa. Episodes last from a few seconds to 1–2 minutes. Occasionally, the pain may be accompanied by paroxysmal cough, a sensation of laryngeal spasm, cardiac arrhythmia, and hypotensive syncope.
Treatment
I. Acupoints and Needling Techniques
1. LI4 (Hegu) (bilateral): Located on the dorsum of the hand, between the 1st and 2nd metacarpal bones, near the midpoint of the radial side of the 2nd metacarpal bone. Take two 30-gauge 2-cun filiform needles, perform routine local disinfection, and insert posteriorly.
Insert about 1.8 cun in the direction of SI3 (Houxi); needling sensation: distension and pain in the palm.
2. PC6 (Neiguan) (bilateral): Located on the palmar aspect of the forearm, 2 cun proximal to the wrist crease, between the tendons of the palmaris longus and flexor carpi radialis. Use two 30-gauge, 1.5 cun filiform needles. After routine local disinfection, insert perpendicularly toward TE5 (Waiguan) to a depth of approximately 1.3 cun. Needle sensation: Local distension and pain, or a radiating sensation toward the elbow.
3. **ST9 (Renying)** (bilateral): Located in the neck, level with the laryngeal prominence, on the anterior border of the common carotid artery. Use two 30-gauge, 1.5 cun filiform needles. Perform routine local disinfection. When inserting, avoid the carotid artery and direct the needle toward the spine to a depth of approximately 1.2 cun. Needling sensation: Local or neck-throat area distension and pain.
4. CV23 (Lianquan): Located in the anterior neck region, on the anterior midline, superior to the laryngeal prominence, in the depression at the superior border of the hyoid bone. To locate, have the patient tilt the head backward. Use a 30-gauge, 1.5-cun filiform needle. After routine local disinfection, insert the needle about 1.3 cun toward the root of the tongue. Needle sensation: distention and heaviness at the root of the tongue.
## 2. Methods
The patient assumes a semi-reclining seated position. Needles are inserted into the aforementioned acupoints according to the method, retained for 40 minutes, then withdrawn. The needles are twirled once during retention. Treatment is administered once daily, with 10 sessions constituting one course. If no effect is observed, the treatment is discontinued; if improvement is noted but not complete recovery, a 5-day break is taken before resuming needling.
Appendix: Block Therapy (Acupoint Injection Therapy)
The patient is placed in a lateral decubitus position with the affected side facing upward. The puncture point is located at the depression behind the ipsilateral earlobe and the mandibular angle, approximately at the level of the mastoid tip. After routine local disinfection, a 6-gauge, 10 cm local anesthesia needle attached to a 5 ml sterile syringe is inserted perpendicularly or slightly anteriorly to a depth of about 4–5 cm. If the patient experiences a paresthesia sensation (numbness) in the ipsilateral corner of the mouth, root of the tongue, lower lip, mandible, pharynx, or temporal region, the syringe is aspirated to check for blood return. If no blood is aspirated, 0.3 ml of 2% procaine is injected. Shortly afterward, varying degrees of ipsilateral pharyngeal wall paralysis, sensory disturbance, dysphagia, or hoarseness indicate successful puncture. Then, 000 micrograms of vitamin (2 ml) is slowly injected. If the puncture is not accurately placed, the procedure may be repeated on another day. Treatments are administered once every 3 days, with 6 sessions constituting one course. If no effect is observed, the treatment is discontinued.
**Comment**
Glossopharyngeal neuralgia is relatively rare in clinical practice, and acupuncture is considered a good therapeutic approach for it. For cases that are more refractory and recurrent, with poor response to acupuncture, block therapy can be employed. The key to block therapy lies in precision—accurate localization, technique, and manipulation are essential.
The manipulations and needling are performed accurately without error, consistently achieving satisfactory results.