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Auricular syncope

  • A Thakar (a1), K K Deepak (a2) and S Shyam Kumar (a1)

To describe a previously unreported syndrome of recurrent syncopal attacks provoked by light stimulation of the external auditory canal.

Case report:

A 13-year-old girl had been receiving treatment for presumed absence seizures, with inadequate treatment response. Imaging was normal. Careful history taking indicated that the recurrent syncopal attacks were precipitated by external auditory canal stimulation. Targeted autonomic function tests confirmed a hyperactive vagal response, with documented significant bradycardia and lightheadedness, provoked by mild stimulation of the posterior wall of the left external auditory canal. Abstinence from ear scratching led to complete alleviation of symptoms without any pharmacological treatment.


Reflex syncope consequent to stimulation of the auricular branch of the vagus nerve is proposed as the pathophysiological mechanism for this previously undocumented syndrome.

Corresponding author
Address for correspondence: Dr A Thakar, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Fax: 00 91 11 26588663 E-mail:
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1 Brignole M. Neurally-mediated syncope. Ital Heart J 2005;6:249–55
2 Ballantyne J. Anatomy of the ear. In: Ballantyne J, Groves J, eds. Scott-Brown's Diseases of the Ear, Nose and Throat, 4th edn. London: Butterworths, 1979;1:165
3 Feldman JI, Woodworth WF. Cause for intractable chronic cough: Arnold's nerve. Arch Otolaryngol Head Neck Surg 1993;119:1042
4 Tekdemir I, Aslan A, Elhan A. A clinico-anatomic study of the auricular branch of the vagus nerve and Arnold's ear-cough reflex. Surg Radiol Anat 1998;20:253–7
5 Rush AJ, Marangell LB, Sackeim HA, George MS, Brannan SK, Davis SM et al. Vagus nerve stimulation for treatment-resistant depression: a randomised, controlled acute phase trial. Biol Psychiatry 2005;58:347–54
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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