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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

  • S Mulazimoglu (a1), R Flury (a2), S Kapila (a3) and T Linder (a1)
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.


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

Corresponding author
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:
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2 Grey P. The clinical significance of the communicating branches of the somatic sensory supply of the middle and external ear. J Laryngol Otol 1995;109:1141–5
3 Ulubil SA, Eshraghi AA, Telischi FF. Sectioning the sensory auricular branch of the facial nerve to treat recalcitrant otalgia. Otol Neurotol 2009;30:522–4
4 Hunt JR. The sensory field of the facial nerve: a further contribution to the symptomatology of the geniculate ganglion. Brain 1915;38:418–46
5 Schuknecht HF. Pathology of the Ear. Cambridge, MA: Harvard University Press, 1974
6 Lang J. Clinical Anatomy of the Head. Berlin: Springer-Verlag, 1983
7 Eshraghi AA, Buchman CA, Telischi FF. Sensory auricular branch of the facial nerve. Otol Neurotol 2002;23:393–6
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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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Supplementary Materials

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