Watanabe K, Tubbs RS, Satoh S, Zomorodi AR, Liedtke W, Labidi M, Friedman AH, Fukushima T.Isolated Deep Ear Canal Pain: Possible Role of the Auricular branch of the Vagus Nerve. Case Illustrations with Cadaveric Correlation.World Neurosurg. 2016 Sep 1. pii: S1878-8750(16)30786-0. doi: 10.1016/j.wneu.2016.08.102.
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 is often not clear. Moreover, symptoms due to involvement of any of these nerves can be difficult to attribute solely to one 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 and considers the microanatomical differences between glossopharyngeal and nervus intermedius neuralgia via cadaveric dissections. We report two 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 vagus nerve. Following microvascular treatment of the vagus nerve, the pain resolved.
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.