The auricular branch of the vagus nerve is often termed the Alderman's nerve or Arnold's nerve. The latter name is an eponym for Friedrich Arnold.[1] The auricular branch of the vagus nerve supplies sensory innervation to the skin of the ear canal, tragus, and auricle.
The nerve reaches the surface by passing through the tympanomastoid fissure between the mastoid process and the tympanic part of the temporal bone, and divides into two branches:
Laryngeal cancer can present with pain behind the ear and in the ear - this is a referred pain through the vagus nerve to the nerve of Arnold.
In a small portion of individuals, the auricular nerve is the afferent limb of the Ear-Cough or Arnold Reflex.[2] Physical stimulation of the external acoustic meatus innervated by the auricular nerve elicits a cough, much like the other cough reflexes associated with the vagus nerve. Rarely, on introduction of speculum in the external ear, patients have experienced syncope due to the stimulation of the auricular branch of the vagus nerve.
Clinical application
This nerve may be stimulated as a diagnostic or therapeutic technique
Transcutaneous vagus nerve stimulation (tVNS) was proposed by Ventureya (2000) for seizures.[3] In 2003 Fallgatter et al. published "Far field potentials from the brain stem after transcutaneous vagus nerve stimulation"[4] and in 2007 Kraus et al. did the first tVNS-fMRI study.[5] In Europe, a device was approved for seizure treatment (NEMOS by CerboMed). Although the transcutaneous method has not been specifically approved in the United States (i.e. off-label) it is legal and being investigated (and found to be effective and safe) for many conditions including:
^Yu L, Scherlag BJ, Li S, Fan Y, Dyer J, Male S, Varma V, Sha Y, Stavrakis S, Po SS (March 2013). "Low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve: a noninvasive approach to treat the initial phase of atrial fibrillation". Heart Rhythm. 10 (3): 428–35. doi:10.1016/j.hrthm.2012.11.019. PMID23183191.
^Hein E, Nowak M, Kiess O, Biermann T, Bayerlein K, Kornhuber J, Kraus T (May 2013). "Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study". J Neural Transm (Vienna). 120 (5): 821–7. doi:10.1007/s00702-012-0908-6. PMID23117749. S2CID25011526.
^Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, Moreno FA, Dunner DL, Lesem MD, Thompson PM, Husain M, Vine CJ, Banov MD, Bernstein LP, Lehman RB, Brannon GE, Keepers GA, O'Reardon JP, Rudolph RL, Bunker M (July 2013). "Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects". Brain Stimul. 6 (4): 631–40. doi:10.1016/j.brs.2012.09.013. PMID23122916. S2CID15939572.
^Huston JM, Gallowitsch-Puerta M, Ochani M, Ochani K, Yuan R, Rosas-Ballina M, Ashok M, Goldstein RS, Chavan S, Pavlov VA, Metz CN, Yang H, Czura CJ, Wang H, Tracey KJ (December 2007). "Transcutaneous vagus nerve stimulation reduces serum high mobility group box 1 levels and improves survival in murine sepsis". Crit. Care Med. 35 (12): 2762–8. doi:10.1097/01.CCM.0000288102.15975.BA. PMID17901837. S2CID24608542.
^Wang Z, Zhou X, Sheng X, Yu L, Jiang H (2015). "Unilateral low-level transcutaneous electrical vagus nerve stimulation: A novel noninvasive treatment for myocardial infarction". Int J Cardiol. 190: 9–10. doi:10.1016/j.ijcard.2015.04.087. PMID25912108.
^Kreuzer PM, Landgrebe M, Resch M, Husser O, Schecklmann M, Geisreiter F, Poeppl TB, Prasser SJ, Hajak G, Rupprecht R, Langguth B (September 2014). "Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study". Brain Stimul. 7 (5): 740–7. doi:10.1016/j.brs.2014.05.003. PMID24996510. S2CID22539797.
