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Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign

Published online by Cambridge University Press:  08 February 2017

S Mulazimoglu ,
R Flury ,
S Kapila  and
T Linder
S Mulazimoglu
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland
R Flury
Affiliation:
Department of Pathology, Winterthur Kantonsspital, Switzerland
S Kapila
Affiliation:
Sydney City ENT, Australia
T Linder*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland
*
Address for correspondence: Dr Thomas Linder, Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse, CH-6000 Luzern, Switzerland Fax: +41 41 205 49 95 E-mail: Thomas.Linder@luks.ch
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Abstract

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.

Methods and 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.

Conclusion:

Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.

Keywords

Facial NerveFacial Nerve Sensory DisordersExternal Auditory CanalTemporal BoneEaracheNeuralgiaCough
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 329 - 333
Copyright
Copyright © JLO (1984) Limited 2017 

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References

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