Auricular branch of vagus nerve explained

Auricular branch of vagus nerve
Latin:ramus auricularis nervi vagi
Branchfrom:Vagus nerve

The auricular branch of the vagus nerve is often termed the Alderman's nerve ("a reference to the old Aldermen of the City of London and their practice of using rosewater bowls at ceremonial banquets, where attendees were encouraged to place a napkin moistened with rosewater behind their ears in the belief that this would aid digestion") or Arnold's nerve (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.

Path

It arises from the superior ganglion of the vagus nerve, and is joined soon after its origin by a filament from the petrous ganglion of the glossopharyngeal; it passes behind the internal jugular vein, and enters the mastoid canaliculus on the lateral wall of the jugular fossa.

Traversing the substance of the temporal bone, it crosses the facial canal about 4mm above the stylomastoid foramen, and here it gives off an ascending branch which joins the facial nerve.

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:

Clinical significance

This nerve may be involved by the glomus jugulare tumour.

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:

References

  1. [Mohsin F. Butt|Butt, M. F.]
  2. Brendan J. Canning . Anatomy and Neurophysiology of the Cough Reflex . Chest . January 2006 . 129 . 1 Suppl . 33S–47S . 10.1378/chest.129.1_suppl.33S. 16428690 . free .
  3. Ventureyra EC. . Transcutaneous vagus nerve stimulation for partial onset seizure therapy. A new concept . Childs Nerv Syst. . February 2000 . 10663816 . 10.1007/s003810050021 . 16 . 2 . 101–2. 37581541 .
  4. Fallgatter AJ, Neuhauser B, Herrmann MJ, Ehlis AC, Wagener A, Scheuerpflug P, Reiners K, Riederer P . Far field potentials from the brain stem after transcutaneous vagus nerve stimulation . Childs Nerv Syst. . December 2003 . 14666414 . 10.1007/s00702-003-0087-6 . 110 . 12 . 1437–43. 19386258 .
  5. Kraus T, Hösl K, Kiess O, Schanze A, Kornhuber J, Forster C . BOLD fMRI deactivation of limbic and temporal brain structures and mood enhancing effect by transcutaneous vagus nerve stimulation . J Neural Transm (Vienna) . 2007 . 17564758 . 10.1007/s00702-007-0755-z . 114 . 11 . 1485–93. 22936816 .
  6. Stavrakis S, Humphrey MB, Scherlag BJ, Hu Y, Jackman WM, Nakagawa H, Lockwood D, Lazzara R, Po SS . Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation . J Am Coll Cardiol . Mar 2015 . 25744003 . 10.1016/j.jacc.2014.12.026 . 65 . 9 . 4352201 . 867–75.
  7. Yu L, Scherlag BJ, Li S, Fan Y, Dyer J, Male S, Varma V, Sha Y, Stavrakis S, Po SS . 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 . March 2013 . 23183191 . 10.1016/j.hrthm.2012.11.019 . 10 . 3 . 428–35.
  8. Hein E, Nowak M, Kiess O, Biermann T, Bayerlein K, Kornhuber J, Kraus T . Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study . J Neural Transm (Vienna) . May 2013 . 23117749 . 10.1007/s00702-012-0908-6 . 120 . 5 . 821–7. 25011526 .
  9. 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 . Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects . Brain Stimul. . July 2013 . 23122916 . 10.1016/j.brs.2012.09.013 . 6 . 4 . 631–40. 15939572 .
  10. Huang F, Dong J, Kong J, Wang H, Meng H, Spaeth RB, Camhi S, Liao X, Li X, Zhai X, Li S, Zhu B, Rong P . Effect of transcutaneous auricular vagus nerve stimulation on impaired glucose tolerance: a pilot randomized study. . BMC Complement Altern Med . June 2014 . 24968966 . 10.1186/1472-6882-14-203 . 14 . 4227038 . 203 . free .
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  12. Jacobs HI, Riphagen JM, Razat CM, Wiese S, Sack AT . Transcutaneous vagus nerve stimulation boosts associative memory in older individuals . Neurobiol Aging . May 2015 . 25805212 . 10.1016/j.neurobiolaging.2015.02.023 . 36 . 5 . 1860–7. 20404433 .
  13. Wang Z, Zhou X, Sheng X, Yu L, Jiang H . Unilateral low-level transcutaneous electrical vagus nerve stimulation: A novel noninvasive treatment for myocardial infarction. . Int J Cardiol . 2015 . 25912108 . 10.1016/j.ijcard.2015.04.087 . 190 . 9–10.
  14. Kreuzer PM, Landgrebe M, Resch M, Husser O, Schecklmann M, Geisreiter F, Poeppl TB, Prasser SJ, Hajak G, Rupprecht R, Langguth B . Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study . Brain Stimul. . September 2014 . 24996510 . 10.1016/j.brs.2014.05.003 . 7 . 5 . 740–7. 22539797 .
  15. Cai PY, Bodhit A, Derequito R, Ansari S, Abukhalil F, Thenkabail S, Ganji S, Saravanapavan P, Shekar CC, Bidari S, Waters MF, Hedna VS . Vagus nerve stimulation in ischemic stroke: old wine in a new bottle. . Front. Neurol. . June 2014 . 25009531 . 10.3389/fneur.2014.00107 . 5 . 4067569 . 107. free .

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