A 42-year-old man with unilateral sensorineural hearing loss and tinnitus reports diminished sensation when his ear is touched behind and deep in the external auditory canal. In the context of an early acoustic neuroma, this finding represents:

• A Frey syndrome, due to aberrant auriculotemporal regeneration
• B Gradenigo syndrome, due to petrous apicitis involving the trigeminal ganglion
• C Hutchinson sign, due to nasociliary nerve infiltration
• D Hitzelberger sign, due to involvement of sensory fibres in the posterior meatal wall ✓

Explanation

The skin of the posterior half of the external auditory canal and adjacent concha receives sensory supply from fibres travelling with the facial nerve through the internal auditory canal (nervus intermedius component, nerve of Wrisberg). An enlarging intracanalicular schwannoma can compress these fibres early, producing hypoesthesia called the Hitzelberger sign. Gradenigo syndrome involves otorrhoea with retro-orbital pain from petrous apicitis, and the other eponyms are unrelated to the ear.

Reference: Diseases of Ear, Nose and Throat (Dhingra), 8th ed.

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Written and medically reviewed by the StethoPrep medical team.