Isolated Deep Ear Canal Pain: Possible Role of Auricular Branch of Vagus Nerve-Case Illustrations with Cadaveric Correlation.
Glossopharyngeal, nervus intermedius, and vagus neuralgias can all present with ear pain. However, to our knowledge, there have been no reports of otalgia as the only symptom of vagus neuralgia. The seventh, ninth, and tenth cranial nerves have many interneural connections, and the exact anatomy and pathophysiology of these neuralgias are often not clear. Moreover, symptoms due to involvement of any of these nerves can be difficult to attribute solely to 1 of them. The overlapping sensory innervation of the external auditory canal can lead to misdiagnosis in patients suffering from otalgia. This report presents a case of pure otalgia due to vascular compression of the vagus nerve (VN) and considers the microanatomic differences between glossopharyngeal and nervus intermedius neuralgia via cadaveric dissections. We report 2 cases of external auditory canal pain that continued following microvascular treatment of trigeminal neuralgia. Intraoperatively and at secondary operation, the posterior inferior cerebellar artery was found to be adherent and to penetrate between the fibers of the VN. Following microvascular treatment of the VN, the pain resolved.


CONCLUSIONS
This is the first report of vagus neuralgia presenting solely with ear pain. Surgeons should be aware that primary external auditory canal pain can be due to vagus neuralgia via its auricular branch and that such patients can be misdiagnosed with glossopharyngeal or nervus intermedius neuralgias.
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Neurosurgery, Lariboisière Hôpital, Paris VII-Diderot University, Paris, France.
Kentaro
K
Watanabe
Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Seattle Science Foundation, Seattle, Washington, USA.
R Shane
RS
Tubbs
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Shunsuke
S
Satoh
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Ali R
AR
Zomorodi
Department of Medicine/Neurology and Neurobiology, Duke University, Durham, North Carolina, USA.
Wolfgang
W
Liedtke
Department of Neurosurgery, Lariboisière Hôpital, Paris VII-Diderot University, Paris, France.
Moujahed
M
Labidi
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Allan H
AH
Friedman
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: fukushima@carolinaneuroscience.com.
Takanori
T
Fukushima
D004424:Ear Canal / Q000294:innervation* / Q000503:physiopathology; D004433:Earache / Q000150:complications*; D005154:Facial Nerve / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D014630:Vagus Nerve / Q000473:pathology*
Auricular branch of the vagus nerve; External auditory canal pain; Glossopharyngeal neuralgia; Microvascular decompression; Nervus intermedius neuralgia; Vagus neuralgia