Sensory Innervation of the Ear

  • The innervation to the ear is one of the most complex in the body:
    • There are four cranial nerves and two upper cervical nerves that contribute to sensory innervation of the ear:
      • Cranial nerves:
        • V
        • VII
        • IX
        • X
      • Upper cervical nerves:
        • C2
        • C3
          • Though the sensory innervation to the ear may appear fairly well defined:
            • There is considerable overlap and ambiguity in the sensory distribution of these nerves

Essentially any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3 can potentially cause pain referred to the ear
  • The mandibular division of CN V (V3):
    • Supplies the:
      • Tragus
      • Helical crus
      • Anterosuperior wall of the external auditory canal
      • Adjacent tympanic membrane
      • Temporomandibular joint
    • The auriculotemporal branch but also has sensory nerve fibers via the lingual, buccal, and inferior alveolar nerves:
      • Which serve to innervate the:
        • Oral cavity:
          • Floor of mouth, lower teeth, palate, mandible including the temporomandibular joint (TMJ)
        • The three mayor salivary glands

Primary and referred otalgia pathways of the mandibular nerve (V3). Cranial nerve V is the most frequent pathway for referred otalgia via the auriculotemporal branch (Nerve of Arnold) of the trigeminal nerve.
  • The facial nerve (VII) supplies the:
    • Posterior-inferior portion of the external ear canal
    • Adjacent tympanic membrane
      • The sensory distribution of the facial nerve is variable:
        • With an overlapping sensory distribution with the trigeminal nerve
      •  The seventh cranial nerve:
        • The posterior auricular nerve:
          • Serves to innervate the ear directly
        • The greater superficial petrosal nerve and the vidian nerve serve to supply the:
          • Nasal mucosa
          • Posterior ethmoid
          • Sphenoid sinuses
          • Soft palate

Primary and referred otalgia pathways of the facial nerve (VII). Cranial nerve VII produces referred otalgia via the auricular branch of the facial nerve. Bell palsy can present as ear pain, antecedent to facial paralysis.
  • The glossopharyngeal nerve (IX) supplies the:
    • Inner ear
    • Inner tympanic membrane
      • The tympanic nerve (Jacobson nerve, a branch of cranial nerve IX):
        • Directly innervates the ear but also has:
          • Pharyngeal, lingual, and tonsillar branches to supply the:
            • Posterior one-third portion of the tongue
            • Tonsillar fossa / pillars
            • Pharynx:
              • Inferior nasopharynx
            • Parapharyngeal space
            • Retropharyngeal space
            • Eustachian tube

Cranial nerve IX mediates otalgia via the tympanic nerve of Jacobson
  • The vagus nerve (X) supplies:
    • A similar distribution to CN IX:
      • But also innervates the concha
    • The vagus nerve supplies the:
      • Valleculae
      • Lingual, and laryngeal surfaces of the epiglottis
      • Supraglottic larynx
      • Pyriform sinuses
      • Thyroid gland
      • More distant sites within the thorax:
        • Including the tracheobronchial tree and esophagus
    • The Arnold nerve:
      • Directly innervates the ear
    • The internal branch of the superior laryngeal nerve:
      • Innervate the larynx
    • The pharyngeal branch of the vagus nerve:
      • Innervate the lower pharynx

Primary and referred otalgia pathways of the vagus nerve (X). Cranial nerve X is involved with otalgia via the auricular nerve of Arnold.
  • The upper cervical nerves (C2 and C3) innervate:
    • The skin in front of and behind the ear
    • The medial and lateral aspect of the auricle
    • Temporomadibular joint
      • The upper cervical nerves (C2 and C3) innervate a significant portion of the external ear, including the auricle, lobule, and the skin in front of and behind the external ear via the:
        • Great auricular nerve
        • Lesser occipital nerves

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

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  • Rodrigo Arrangoiz MS, MD, FACS:
    • Is a member of the American Head and Neck Society

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    • He is a member of the American Thyroid Association:

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Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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