Glossopharyngeal nerve paralysis is caused by various injuries to the glossopharyngeal nerve, leading to reduced or loss of sensory function within the area it innervates. Isolated glossopharyngeal nerve paralysis is extremely rare and usually occurs together with damage to other cranial nerves. The main causes of glossopharyngeal nerve paralysis include glossopharyngeal nerve transection, tonsillectomy, and, in some cases, compression due to inflammation or tumors in the throat, mouth floor, or surrounding areas. However, these cases are typically accompanied by symptoms of injury to other cranial nerves.
1. Diagnostic Criteria
Clinical sensory disturbances associated with glossopharyngeal nerve lesions include reduced or loss of taste perception on the posterior one-third of the tongue. General sensation in the upper pharynx may also be diminished or absent, often accompanied by decreased or absent gag reflex and soft palate reflex. Unilateral loss of the gag and soft palate reflexes has pathological significance, whereas bilateral reduction or absence—if no other symptoms are present (e.g., choking or coughing)—is clinically insignificant, as this can occur in normal individuals. Damage to the glossopharyngeal nerve results in paralysis of the stylopharyngeus and palatopharyngeus muscles, leading to soft palate ptosis (drooping).
Examination: Unilateral glossopharyngeal nerve paralysis. Main manifestations include the palatal arch on the affected side being lower than that on the healthy side, and the uvula deviating toward the healthy side. Repeated phonation and repeated gag reflex fatigue testing can be performed. After fatigue, the gag reflex on the paralyzed side disappears.
Bilateral glossopharyngeal nerve paralysis presents with the following symptoms: ① Difficulty swallowing (dysphagia), with nasal regurgitation of liquids during drinking, and accumulation of food and saliva in the pharyngeal cavity. ② Difficulty phonating (dysphonia), particularly with laryngeal sounds, resulting in a nasal voice. ③ Weakness in elevating both sides of the soft palate; the soft palate appears flaccid at rest, and the gag reflex is absent.
The following methods can be used for examination: ① Drinking water leads to choking cough. ② When pressing the base of the tongue and instructing the patient to say “ah,” the palatine arch fails to lift. This is because the muscle fibers from the base of the tongue that normally assist in elevating the anterior palatine arch are unable to do so, thereby revealing a drooping soft palate. ③ Continuous laryngeal phonation results in unclear articulation. ④ The patient can only puff out the cheeks when the nostrils are manually occluded.
Treatment (Zhiliaofa)
I. Acupoints and Acupuncture Techniques
1. **ST9 (Renying) on the affected side**: Located in the neck, level with the laryngeal prominence, at the anterior border of the common carotid artery. Use a 30-gauge, 1.5-cun filiform needle. After routine local disinfection, insert approximately 1.3 cun toward the spine, carefully avoiding the common carotid artery. Needling sensation: distending pain in the neck and pharynx.
**2. CV23 (Lianquan):** Located on the anterior midline of the neck, in the depression superior to the hyoid bone, above the laryngeal prominence. To locate, tilt the head backward. Use a 30-gauge, 1.5-cun filiform needle. After routine local disinfection, insert obliquely toward the root of the tongue to a depth of approximately 1 cun. Sensation: Local distension and pain.
3. **PC6 (Neiguan) (affected side)**: Located on the palmar aspect of the forearm, 2 cun proximal to the palmar wrist crease, between the tendons of the palmaris longus and flexor carpi radialis. A 30-gauge, 1.5 cun filiform needle is used. After routine local disinfection, insert perpendicularly toward TE5 (Waiguan) approximately 1.3 cun deep. Needling sensation: local distension and pain, or radiation toward the elbow.
4. **LI4 (Hegu) (affected side)**: 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. Use a 30-gauge, 1.5 cun filiform needle. After routine local disinfection, insert obliquely toward LU10 (Yuji) to a depth of approximately 1 cun. Needling sensation: local distension and pain.
2. Methods
Acupuncture is applied on the affected side or bilaterally. The patient is placed in a sitting position. The above acupoints are inserted according to the standard method with electrical stimulation. The needles are retained for 40 minutes and then removed. The treatment is given once daily, with 6 sessions constituting one course. A 5-day rest is taken before the next course.
3. Commentary
Unilateral glossopharyngeal nerve palsy responds well to electroacupuncture therapy, with most cases recovering within approximately two courses of treatment. Bilateral glossopharyngeal nerve palsy also shows some response to electroacupuncture, but it is often accompanied by infections of the nasopharynx or the trachea and lungs. In such cases, electroacupuncture should be administered on the basis of treating these concurrent conditions, and satisfactory results can still be achieved.