Neuralgia refers to a severe sharp pain, which occurs along the course of a nerve. The IXth cranial nerve is one of twelve pairs of nerves connected with the brain which provides sensory input from the pharynx, tonsils, posterior third of the tongue, and carotid arteries. It also moves the swallowing and salivary gland muscles.

In some cases, the cause of neuralgia may be unknown. Identified causes of the condition include: injury or irritation to the nerve; nerve root compression by a blood vessel or tumor; viral infections; multiple sclerosis; or toxins.

Signs and symptoms are similar to those of trigeminal neuralgia (see Diagnostic Code: 8405 Fifth [trigeminal] cranial nerve-Neuralgia), and may be characterized by attacks of unilateral, sharp, stabbing, burning pain in the tonsils or posterior pharynx. There may be hypersensitivity to swallowing, talking or touching which provoke new attacks. Symptoms may occur at irregular intervals.

Diagnostic measures include: physical and neurological examinations; sensory and motor tests; and electromyography (EMG). Local anesthesia to the affected area may be used to differentiate neuralgia of the Vth cranial nerve (see Diagnostic Code: 8405 Fifth [trigeminal] cranial nerve-Neuralgia).

Anticonvulsant medications may be used. Peripheral nerve blocks may be done if pain medication fails. Surgical resection of the nerve may be necessary when medical therapy fails.

Frequency of attacks may vary with periods of long remissions. Continuous bouts may be incapacitating. In the event of surgery, there may be permanent anesthesia of the mucous membrane, loss of taste on the back third of the tongue, and loss of a gag reflex on the affected side. However, swallowing and other motor functions may not be affected. Nutritional status may decline during periods of attacks. Medications may warrant ongoing liver and blood studies.

• 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 loss of motor function of tongue.