A 42-year-old chronic smoker and alcoholic presents with progressive dysphagia to solids, a 3-week history of unilateral otalgia, and a 3 cm hard irregular mass at the base of tongue on examination. Biopsy confirms squamous cell carcinoma. The referred otalgia in this patient is most likely mediated through which nerve?

• A Auriculotemporal nerve (branch of V3)
• B Arnold's nerve (auricular branch of vagus X) ✓
• C Jacobson's nerve (tympanic branch of IX)
• D Great auricular nerve (C2, C3)

Explanation

Referred otalgia from the larynx, hypopharynx, and base of tongue is mediated through Arnold's nerve (the auricular branch of the vagus nerve, CN X), which supplies the posterior external auditory canal and auricle. Tumours of the larynx and piriform sinus most commonly cause referred otalgia through this pathway. Jacobson's nerve (IX) mediates referred pain from the tonsil and pharynx but not the larynx. Unexplained unilateral otalgia in a smoker must prompt thorough endoscopic examination of the pharynx and larynx.

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.