So this ear pain business

So folks,

I've been reading and re reading this little piece on here

http://www.sma.org.sg/smj/4010/articles/4010ra1.htm

and all of a sudden I'm begining to question if I'm taking the wrong course of action, now I'm waiting to have a styloidectomy for glosso, which is being caused by eagles and from what I've already heard the styloidectomies tend to help folk who are having them for eagles symptoms but not so much for glosso.

But this article here makes out that the ear pain isn't necessarily likely to be helped by a tuskectomy, maybe I'm reading it wrong, but it seems to indicate that procedures through the throat/ decompressions and neurectomies aren't too successful for the ear pain as thas is due to the nerve being affected further up and closer to the brainstem, so the nerve needs to be dealt with elsewhere or in some kind of dual approach or something.

Anyone know anything about this? My surgeon did say she wasn't sure or indeed to hopeful about how successful it would be, but it's ENT I'm seeing not neurosurgery, so I'm not sure how to progress, is it worth putting the anchors on and finding out if it should actually be neurosurgery I should be visiting because it's the ear portion of the nerve rather than the throat, or do I just throw caution to the wind and hope for the best?

Any ideas or info would be really really appreciated guys.

Much love

Gracie x x x

Right, so let me run this by you all. If you could cast your eyes over my email to the doc before I send it off and tell me if it’s okay without sounding like a nut I’d really appreciate it:

Dear Dr

Please forgive my emailing you, but I have a couple of questions that I’d like to ask before surgery that I hadn’t considered/been aware of when we spoke last. I’ve been busy of late helping to set up an online support community for people with Glossopharyngeal Neuralgia, as no such thing was in existence, and have found that it’s been really really isolating anyway during the course of this I have come across an article and was wondering if you could clarify some details for me.

The article in full is here: http://www.sma.org.sg/smj/4010/articles/4010ra1.htm

Now it’s raised some queries and concerns and I’m hoping that you may be able to help answer them for me. From what I believe in general terms the styloidectomy can be very successful for people who suffer from the symptoms of eagles syndrome, and when we spoke you did advise there was a possibility it could make the neuralgia worse, that is a possibility that I am willing to risk from surgery if there is also the possibility of relief, and getting off all of the medication. But reading this article I have to wonder if the styloidectomy in and of it’s own is what I need to be doing

The portion of this that interested me is as follows:

The next step will be surgical treatment. If an elongated styloid process is present, then resection of the process will give good results. The styloid process can be approached either externally through the neck or through the tonsillar fossa after a preliminary tonsillectomy has been done. The preferred approach is through the tonsil fossa as it will not leave any scars on the neck and is a simple procedure. The parapharyngeal space is entered when the superior constrictors are separated to access the styloid process. The patient should therefore be on prophylactic antibiotics during the procedure to prevent contamination of the parapharyngeal space by intra-oral contents.

If the styloid is not elongated, and the symptoms predominantly oro-pharyngeal in distribution, serious consideration should be given to avulsing the glossopharyngeal nerve low in its course through the neck. The glossopharyngeal nerve can be approached through an external neck incision or the pharyngeal trans-tonsillar approach. The external approach is difficult(44) as the glossopharyngeal nerve is small and lies deep within the neck. The pharyngeal approach as proposed by Wilson and McAlpine(10) is a much simpler approach as the glossopharyngeal nerve can be found just lateral to the superior constrictor muscle which forms the bed of the tonsil fossa. Avulsion of the nerve at the level of the tonsils have been reported to give good results in patients with the oropharyngeal type of glossopharyngeal neuralgia(10,45).

The only caution with the pharyngeal approach is that symptom control is inadequate if the distribution of pain is in the ear. In the tympanic type of neuralgia, the hypersensitivity and irritability of the Jacobson’s nerve is a major contributor to symptomatology. The pharyngeal approach to resection of the glossopharyngeal nerve, by itself, is likely to fail. It should be combined with a tympanotomy and avulsion of the nerves of the tympanic plexus to deal with the contribution by the Jacobson’s nerve.

Alternatively, the glossopharyngeal nerve has to be divided proximal to where the Jacobson’s nerve branch out from the petrous ganglion at the level of the jugular foramen. This would require either a high cervical approach or a retrosigmoid posterior fossa approach to the glossopharyngeal nerve. The high cervical approach is a hazardous procedure with a high risk of inadvertent damage to the sympathetic chain, vagus and accessory nerves as they exit from the jugular foramen. Adson(46) describes the high cervical approach as a “highly formidable procedure”, that he recommends intracranial division of the glossopharyngeal nerve. Thus, in the presence of significant tympanic neuralgia, the posterior cranial fossa approach should be used.

Glossopharyngeal nerve resection through the posterior fossa approach was first used by Dandy(23) in 1927. He reported very good results from the procedure. However, there was a subset of patients who failed to improve with the Dandy procedure. This group responded very well with a second procedure to resect the upper vagal rootlets through the posterior fossa approach. The resection of the upper vagal rootlets was based on the assumption that patients who did not respond well to isolated glossopharyngeal resection probably has a contributory vagal neuralgia. Based on the experience of several authors(8,47,48), it was recommended that the upper vagal rootlets as well as the glossopharyngeal nerve should be divided at the nerve root entry zone in patients with symptoms of glossopharyngeal neuralgia.

My concern is neuralgia that I suffer from is deep in my ears,( the element that affects my throat seems not to affect me much when I take the tegretol,which, in part with a family history of TN, and side effects from various medications led to the initial diagnosis of Trigeminal Neuralgia.) I’m sorry to keep bombarding you with questions, but after dealing with this for so long I feel it’s irresponsible to not be informed and understand what I’m going into. Neither do I want to sound like some crazy interned hypochondriach, but the article advises that the styloidectomy can give good relief if the element of the pain is oropharyngeal, which is great, but it also details that the success rate is low if performed on it’s own if the pain is within the ears, which is what I’m trying to escape.

It goes on to talk about options to alleviate that portion of the pain, and I wont pretend to understand that portion of the article, but given the distribution of the my pain, that implies that I could be better served to see about adding an avulsion of the other portion of the nerve too? I just don’t want to go through one surgical procedure and deal with the recovery to discover it’s a two part procedure and need to have a second procedure thereafter.

I’d really appreciate it if you could offer any thoughts or insights on it. Thanks in advance

Kind regards

Grace Stephen