Background: Superior laryngeal nerve neuralgia is a very rare disease typically associated with paroxysmal and lancinating pain mostly localised on one side of the laryngeal region and sometimes radiating into the homolateral jaw or ear. The condition is usually idiopathic and treated successfully with carbamazepine. Even if the symptoms are unusual or not typical for superior laryngeal nerve neuralgia, the condition should be considered as a possible diagnosis if there are no other pathological findings.
Case report: In October 1999, a 44-year old man presented a progressive dysphagia. Complaining about increasing problems in swallowing, he started refusing solid food and lost about 50 kg in two and a half years. In addition, he complained about persistent pain in the right laryngeal region, intensified by chewing or swallowing. Extensive investigations produced no pathological findings, especially no neoplastic process or other consuming diseases. After an injection of local anaesthetic near to the right hypothyroid membrane, the symptoms improved dramatically for a few hours and the diagnosis of superior laryngeal neuralgia was made. To confirm the diagnosis we injected sodium chloride as a placebo without any effect. The condition was successfully treated with 200 mg of carbamazepine three times daily without any major side effects.
Conclusions: Even if the symptoms are not typical and dysphagia and weight loss are the outstanding symptoms, superior laryngeal nerve neuralgia should be considered as the possible diagnosis, especially if no other pathological findings are revealed. Injection of local anesthetic is a valuable tool for diagnosing the disease.