Neuralgia n. intermedii – case report of a rare differential diagnosis of otalgia
23 April 2019 (online)
Neuralgia of nervus intermedius is rare disorder, with about 150 reported patients. We present a long-term case of a 79-year-old male patient with recurrent neuralgia of the right nervus intermedius.
Methods and Results:
The first attack took place at the age of 43 years. Family and medical history was uneventful. Until the age of 68 years, 20 further events occurred with intervals of months to years. Pain was described as shooting, burning and piercing at the external acoustic meatus and retroauricular area radiating to the outer ear. After exclusion of any other disorder, the diagnosis was made according to the International Classification of Headache Disorders (ICHD). The length of the episodes increased over the time from minutes to > 4 hours. In parallel, the intensity of pain advanced from 5/10 to 7/10. No consistent trigger was found. The patient never presented herpetic eruptions or other concurrent symptoms. A causative vascular malformation was ruled out by MR angiography. The otherwise healthy patient refused systemic therapy of acute events as well as medical prophylaxis of recurrences. An attempted treatment with acupuncture had no effect. All attacks were treated successfully by a single infiltration of the retroauricular region and posterior wall of the external acustic meatus using local anaesthetics. Immediate termination of pain was accompanied by local warmth and hyperalgesia of the affected area persisting for several days. No events occurred within the last 11 years.
Neuralgia of n. intermedius is a diagnosis of exclusion. After diagnostic evaluation, attacks can be successfully relieved by local anaesthesia.