Glossopharengeal & Vagus Disorder

Question 1

What is it

Answer 1

Dysfunction of the glossopharyngeal nerve (CN IX) and/or vagus nerve (CN X), affecting swallowing, speech, and autonomic functions.

Question 2

Clinical features

Answer 2

🔹 Glossopharyngeal Nerve (CN IX) Dysfunction
Dysphagia (difficulty swallowing) 🥄❌
Loss of gag reflex (afferent limb) 🤢❌
Loss of taste on the posterior 1/3 of the tongue 👅
Pain in the throat & ear (glossopharyngeal neuralgia) ⚡🎵

🔹 Vagus Nerve (CN X) Dysfunction
Dysphonia (hoarseness due to vocal cord paralysis) 🎤😖
Dysphagia & choking on liquids 🥤❌
Loss of gag reflex (efferent limb)
Uvular deviation to the unaffected side 👅➡️
Autonomic dysfunction (irregular heart rate, BP changes, GI issues) ❤️📉

Question 3

Epidemiology

Answer 3

Rare overall but can occur due to stroke, tumors, infections, or trauma
Glossopharyngeal neuralgia (CN IX irritation) is less common than trigeminal neuralgia
Vagus nerve dysfunction is more common in stroke & surgical complications

Question 4

Age Groups Affected

Answer 4

Any age: Trauma, tumors, or infections
Middle-aged to older adults: Stroke, degenerative diseases (ALS, MS)
Surgical patients (thyroid, neck, cardiac surgeries): Risk of vagus nerve injury

Question 5

Risk Factors

Answer 5

✅ Modifiable:
Smoking & alcohol (increases stroke & cancer risk) 🚬🍷
Hypertension & atherosclerosis (stroke risk) 🩸
Neck trauma or surgery (thyroid, carotid, heart surgery)
Infections (e.g., Guillain-Barré syndrome, syphilis, Lyme disease)

🚫 Non-Modifiable:
Stroke & neurodegenerative diseases (ALS, MS, Parkinson’s)
Head & neck tumors (e.g., skull base tumors, laryngeal cancer)
Congenital conditions affecting CN IX/X

Question 6

Clinical Presentation

Answer 6

🔹 Glossopharyngeal Palsy (CN IX):
Pain in throat & ear (glossopharyngeal neuralgia) ⚡
Loss of taste on posterior 1/3 of tongue
Difficulty swallowing 🥄❌

🔹 Vagus Palsy (CN X):
Hoarseness, weak voice (vocal cord paralysis) 🎤❌
Difficulty swallowing & aspiration risk 🥤😖
Uvula deviates AWAY from the lesion 👅➡️
Autonomic dysfunction (BP instability, slow HR in severe cases) ❤️📉

🔹 Bilateral CN IX/X Lesions (Severe Cases – Rare):
Severe swallowing & speech impairment
Increased risk of aspiration pneumonia

Question 7

Prognosis

Answer 7

🔹 Depends on the cause:
Stroke-related: Partial recovery with speech/swallow therapy
Trauma or surgical injury: Recovery varies, may need rehab
Neurodegenerative diseases (ALS, MS): Progressive decline
Glossopharyngeal neuralgia: Treatable with medications or nerve blocks

🔹 Prevention:
Control stroke risk factors (BP, diabetes, smoking)
Proper surgical technique in neck & cardiac surgeries
Early treatment of infections & autoimmune conditions

Question 8

Test

Answer 8

Ask patient to cough - bovine cough or hoarse voice

Swelling test - cup of water

Test for uvula deviation (‘Ahh’)
Would move away from palsied lesion

Can mention in OSPE -
Gag reflex (loss of)
Blood pressure (disphagia)