Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal

IX Glossopharyngeal and X Vagus
The 9th and 10th nerves are tested together. They are responsible for swallowing, phonation, guttural and palatal articulation (the 7th nerve has a component for labial articulation). The glossopharyngeal nerve also subserves taste to the posterior one-third of the tongue but this is rarely tested.


Examination Technique:

  • check palatial elevation by having the patient sustain an "ah." When observing palatal movement, look at the palate rather than the uvula.

  • assess the gag reflex by gentling stroking the soft palate on each side.

  • swallowing can be assessed by giving the patient a sip of water and observing them swallow.

  • listen to the patient’s speech. Is there a nasal quality?

  • assess palatal articulation with a "KA" sound, guttural with a "GO" sound and labial with a "PA" sound.


Normal Response:

  • the palate should elevate symmetrically, both when sustaining an "AH" and in response to stimulation on either side. Some patients however do not have a gag response and this can be normal if it is absent bilaterally. Patients should also be asked if they feel the stimulus.


Abnormal Response:

  • with unilateral palatal weakness, the palate fails to elevate on the weak side and the gag reflex will be absent on that side.