Learning Objectives: To show delegates a novel way of treating neuralgic external ear otalgia.

Introduction: Steroids are used in other specialities such as orthopaedics and anaesthetics for pain relief. It is felt that corticosteroids reduce pain by inhibiting prostaglandin synthesis which reduced inflammation and tissue oedema by stopping the reduction in tissue vascular permeability. They have also been shown to reduce spontaneous discharge in an injured nerve with reduced neuropathic pain. Steroids are in all ENT department as we use them regularly to help with other symptoms such as hearing loss and vertigo. We present five cases where steroids were used for neuralgic otalgia of the external ear over a year period in an ENT Clinic in a UK district general hospital.

Method: Usual causes of otalgia which can be varied and sinister had to ruled out with full history taking, examination including otoscopy and flexible nasendoscopy. Any further imaging needed was decided on a case by case basis. Patients were examined by the consultant under the microscope. The location of pain on the pinna or external auditory canal was tested by pressing the areas with the speculum or wax hook. Patients were verbally consented and subcutaneous Methylprednisolone Acetate in the form of Depo-Medrone 40 mg/ml was injected into the area. The patient's notes were reviewed and symptoms pre-procedure and post-procedure reviewed and assessed.

Results: Patients all had an improvement on their pain score. Most needed repeated treatment, but were grateful for the temporary relief.

Conclusion: To our knowledge this treatment has not been used in ENT before for managing otalgia. We have had great success with it with small patient numbers and over a short time period. It is easy, safe and practical in perform in the clinic room. We would conclude that large patient numbers and research is needed to assess the reliability, cost analysis and predictability of this procedure in the short and long term.