Gradual aggravation of idiopathic glossopharyngeal neuralgia
Medicine: April 2019 - Volume 98 - Issue 17 - p e15234 describes a case of gradual aggravation of idiopathic GPN due to chronic tonsillitis in a 74-year-old female patient. She has provided informed consent for publication of this case. The patient was diagnosed with idiopathic GPN 8 years ago. Her pain had been controlled well by taking 200 mg doses of ibuprofen irregularly. The usual visual analog scale (VAS) score had been 1–2/10, but the pain began to increase gradually starting 5 months ago and the VAS scores increased to 4–5/10. She began to take 600 mg/day of pregabalin and 1200 mg/day of ibuprofen, but the pain was not alleviated.

She complained of pain-induced sleep disturbance and swallowing difficulties and was admitted for pain control as a neurology outpatient. There were no specific results for brain magnetic resonance imaging (MRI), laboratory tests, and physical examination except increased erythrocyte sedimentation rate. Meanwhile, her medication was increased to 1500 mg/day of gabapentin, 30 mg/day of duloxetine, and 20 mg/day of oxycodone. Nevertheless, her pain was not relieved, and she was referred to the pain clinic for nerve block. A percutaneous glossopharyngeal nerve block was performed, neurolysis and pulsed radiofrequency neuromodulation of the glossopharyngeal nerve by the peristyloid technique. The effect of the treatment lasted only 2 days.

An intraoral approach was planned, but while inspecting the oral cavity we found a mass in her left tonsil. We referred her to the department of the otolaryngology, where she underwent neck computed tomography (CT) and tonsillar biopsy. Fortunately, the biopsy showed only chronic inflammation and she was treated for chronic tonsillitis with 300 mg/day of cefditoren for 2 weeks. Her pain was alleviated, and in a follow-up neck CT 2 weeks later the chronic inflammation and enlarged lymph nodes were diminished.

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