114 THE PHARYNX AND NASOPHARYNX helped by astringent gargles or paints. Removal of the hypertrophied tissue may be necessary. SENSORY NEUROSES Anaesthesia may be found in diseases of the central nervous system, such as syringomyelia, bulbar paralysis and intracranial tumours. There is usually an associated paralysis of the soft palate. Hyperaesthesia is a common condition, especially in those who over- indulge in tobacco or alcohol, and it is usually associated with a pharyngitis. Examination of the pharynx produces violent gagging and choking fits. Paraesthesia is often met with in women at the menopause. The complaint is of a feeling of a lump behind the tongue, and a constant desire to clear the throat. There is no true dysphagia. A careful examination must be made to exclude any malignancy or other organic disease. Enlargement of the lingual tonsil is not uncommonly found. Treatment is symptomatic, and the use of an astringent gargle or paint, reinforced by a dogmatic assurance that there is no malignancy, is usually sufficient. Spontaneous cure often results. Secretory neurosis is the name which might be applied to those patients who have a constant desire to expectorate. The sputum is usually frothy, with little mucus content, and is produced by the action of clearing the throat. , The patient should be assured that there is no disease, and advised to refrain from the clearing and spitting. NEURALGIA OF THE PHARYNX Glossopharyngeal neuralgia is uncommon. Severe shooting pain radiates from the tonsillar region to the ear. It may be stimulated by swallowing or may occur after tonsillectomy. If relief is not obtained by carbamazepine neuro- surgical destruction of the nerve may be required. MOTOR NEUROSES Rhythmic movement of the soft palate is a rare condition. The movements may be accompanied by a clicking sound which can be heard by both patient and doctor. In some cases this condition is associated with trigeminal neuralgia. There is no specific treatment. Paralysis of the soft palate used to be seen after diphtheria and polio- myelitis, and occasionally after influenza. Diseases of the central nervous system such as syringomyelia, embolism, tumours and meningitis may produce a palatal paralysis along with other manifestations of the diseases. The paralysis is usually unilateral but may be bilateral. When unilateral the palate is drawn to the healthy side on phonation, but when bilateral the palate hangs loosely and does not respond to stimulation. The voice has a nasal quality, and fluid or food may escape into the nose.