13.3.1 Nervus intermedius neuralgia

Previously used term:

Geniculate neuralgia.

Description:

A rare disorder characterized by brief paroxysms of pain felt deeply in the auditory canal, sometimes radiating to the parieto-occipital region. In the vast majority of cases, vascular compression is found at operation, occasionally with a thickened arachnoidea, but it may develop without apparent cause or as a complication of herpes zoster or, very rarely, multiple sclerosis or tumour. It is provoked by stimulation of a trigger area in the posterior wall of the auditory canal and/or periauricular region.

Diagnostic criteria:
  1. Paroxysmal attacks of unilateral pain in the distribution of nervus intermedius1 and fulfilling criterion B
  2. Pain has all of the following characteristics:
    1. lasting from a few seconds to minutes
    2. severe in intensity
    3. shooting, stabbing or sharp in quality
    4. precipitated by stimulation of a trigger area in the posterior wall of the auditory canal and/or periauricular region
  3. Not better accounted for by another ICHD-3 diagnosis2.
Notes:
  1. Pain is located in the auditory canal, auricle, in the region of the mastoid process and occasionally the soft palate, and may sometimes radiate to the temporal region or the angle of the mandible.
  2. In view of the complex and overlapping innervation of the external ear, deriving from trigeminal (auriculotemporal), facial (nervus intermedius), glossopharyngeal, vagus and second cranial nerves, attribution of neuralgias to a single nerve may not be easy in this body region when a specific neurovascular contact cannot be visualized.
Comment:

Disorders of lacrimation, salivation and/or taste sometimes accompany the pain of 13.3.1 Nervus intermedius neuralgia.