Objective:

The nervus intermedius is a small branch of the facial nerve that carries general visceral efferent fibers and special visceral afferent fibers involved in taste, as well as general somatic afferent fibers. The international Classification of Headache Disorders, 3rd edition defines nervus intermedius neuralgia as pain within distribution of intermedius nerve, which innervates the auditory canal, auricle, and part of the mastoid process. It is characterized by brief paroxysms of intense, sharp pain in the ear lasting for seconds to minutes. Treatment options include analgesics, anticonvulsants, and surgery. We present a case of a patient with an atypical presentation of nervus intermedius neuralgia.

Background:

A 55 year old female presents with 4 years of recurrent deep right inner ear pain. Attacks of pain are described as severe, sharp, stabbing pain, like “an ice pick jamming” into her inner ear, lasting all day. Interestingly, episodes last 3-4 weeks and occur once yearly, typically in the late winter months. In between these periods, she is pain-free. She has had negative evaluations by ENT, neurosurgery, audiology, and dentistry. Imaging, including MRI brain, MRA head/neck, and CT temporal bone were normal. She received mixed diagnoses, including trigeminal neuralgia, glossopharyngeal neuralgia, cervicogenic otalgia and TMJ dysfunction. Eventually, she responded well to oxcarbazepine and was diagnosed with nervus intermedius neuralgia.

Design/Methods:

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Results:

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Conclusions:

The diagnosis of nervus intermedius neuralgia is rare and a challenging diagnosis to make. Our patient presents with recurrent, yearly episodes of this disease, a pattern only seen with cluster headache, making her diagnosis and management even more challenging. To our knowledge, this is the first case of recurrent annual nervus intermedius neuralgia.