A 50-year-old smoker presents with progressive dysphonia, dysphagia, and right-sided otalgia with a normal ear examination. The otalgia is most likely referred via which nerve?

• A Greater auricular nerve (C2, C3)
• B Arnold's nerve (auricular branch of vagus, CN X) ✓
• C Jacobson's nerve (tympanic branch of glossopharyngeal, CN IX)
• D Chorda tympani (branch of facial nerve)

Explanation

Referred otalgia from a laryngeal or hypopharyngeal malignancy is mediated by the auricular branch of the vagus nerve (Arnold's nerve), which supplies the posterior EAC and concha. Since the vagus also supplies laryngeal and pharyngeal sensory fibres, pain from a laryngeal tumour is referred to the ear via Arnold's nerve. Jacobson's nerve (CN IX) mediates referred otalgia from the tongue base, tonsil, and nasopharynx. The greater auricular nerve is a cervical plexus branch.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.