Diagnosis and Treatment of Glossopharyngeal and Vagal Neuropathies in a Patient with Laryngopharyngeal Reflux

Abstract

In this case report, we describe the case of a patient with glossopharyngeal and vagal neuropathy masked by laryngopharyngeal reflux (LPR). LPR is a common disorder in persons older than 40 yr and is characterized by acid reflux into the upper esophagus and pharynx. Classic symptoms include mucus production, cough, wheezing, hoarseness, throat irritation, and globus sensation.1–5 LPR is clinically differentiated from gastroesophageal reflux disease by the absence of heartburn and presence of prominent laryngopharyngeal symptoms, with laryngoscopy typically showing vocal cord edema and erythema.6 LPR is usually confirmed via pH studies demonstrating prolonged acidic pH in the upper esophagus and/or pharynx.2,7 Vagal and/or glossopharyngeal neuropathies, however, are relatively rare conditions that may present together.8 Glossopharyngeal neuropathy is characterized by paroxysms of lancinating or burning pain in the oropharynx, whereas vagal neuropathy presents similarly but can also include symptoms of vocal cord dysfunction, such as hoarseness. Electromyography can be performed to confirm the diagnosis9 but is uncomfortable to the point of requiring deep sedation and is thus rarely done. Both conditions share some symptoms with LPR, notably inspiratory stridor, hoarseness, and throat pain.10 In our case, the patient’s neuropathy was first diagnosed at the chronic pain center and successfully treated with pregabalin almost a year after its onset.