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.
- 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 patients speech. Is there a
- assess palatal articulation with a "KA"
sound, guttural with a "GO"
sound and labial with a "PA" sound.
- 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.
- with unilateral palatal weakness, the palate fails
to elevate on the weak side and the gag reflex will
be absent on that side.