Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The Xth cranial nerve is one of twelve pairs of nerves connected with the brain which provides sensation to the ear, tongue, pharynx and larynx, and moves muscles of speech and swallowing. The nerve also sends impulses to the heart, lungs, esophagus, stomach, and smooth muscles of visceral organs.

Causes of paralysis may include: tumors or lesions of the nerve or nerve root; brainstem lesions or injury; vascular lesions; surgery; infections; inflammatory processes such as herpes zoster; or trauma.

Manifestations may include: dysphagia; hoarseness or spasms of the vocal chords; dysarthria; deviated uvula; drooping of the soft palate; absent gag reflex; regurgitation of liquids through the nose when swallowing; dyspnea; respiratory stridor; alteration in the heart rate; or sensory loss in the external ear.

Diagnostic measures may include: a complete history; physical and neurological examinations; sensory and motor tests; blood studies; spinal tap; computed tomography (CT) scan; magnetic resonance imaging (MRI); electrocardiogram (EKG); and electromyography (EMG).

Treatment may be directed to the specific underlying cause and symptoms. Treatment measures may include surgery and medications to treat underlying disease, e.g., infection, respiratory, or cardiac conditions. Vocal chord spasms may be treated with botox. Nutritional intervention, and physical or speech therapies may be needed. Other treatments for symptoms of affected neighboring nerves may be indicated.

Regeneration of the nerve may depend on the degree and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. The nutritional status may decline, and a feeding tube may be necessary. There may also be injury to neighboring nerves.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease

 Notes

• Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach, and heart.

• Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor.