Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign.
BACKGROUND
A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve.


RESULTS
In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed.


CONCLUSIONS
Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.
Department of Otorhinolaryngology,Head and Neck Surgery,Luzerner Kantonsspital,Luzern,Switzerland.
S
S
Mulazimoglu
Department of Pathology,Winterthur Kantonsspital,Switzerland.
R
R
Flury
Sydney City ENT,Australia.
S
S
Kapila
Department of Otorhinolaryngology,Head and Neck Surgery,Luzerner Kantonsspital,Luzern,Switzerland.
T
T
Linder
D000368:Aged; D003371:Cough / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D054644:Ear Auricle / Q000294:innervation / Q000601:surgery; D004424:Ear Canal / Q000294:innervation* / Q000601:surgery; D004433:Earache / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005930:Glossopharyngeal Nerve / Q000503:physiopathology / Q000601:surgery; D016697:Herpes Zoster Oticus / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery
Cough; Earache; External Auditory Canal; Facial Nerve; Facial Nerve Sensory Disorders; Neuralgia; Temporal Bone