The auricular branch of the vagus nerve is often termed the Alderman's nerve ("a reference to the old

Aldermen An alderman is a member of a municipal assembly or council in many jurisdictions founded upon English law with similar officials existing in the Netherlands (wethouder) and Belgium (schepen). The term may be titular, denoting a high-ranking membe ...

of the

City of London The City of London, also known as ''the City'', is a Ceremonial counties of England, ceremonial county and Districts of England, local government district with City status in the United Kingdom, city status in England. It is the Old town, his ...

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). The auricular branch of the

vagus nerve The vagus nerve, also known as the tenth cranial nerve (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibe ...

supplies sensory innervation to the skin of the

ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the auricle to the eardrum and is about in length and in diameter. S ...

, tragus,

tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit changes in pressur ...

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 The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posteri ...

, and enters the mastoid canaliculus on the lateral wall of the jugular fossa. Traversing the substance of the

temporal bone The temporal bone is a paired bone situated at the sides and base of the skull, lateral to the temporal lobe of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples where four of the cranial bone ...

, it crosses the

facial canal The facial canal (also known as the Fallopian canal) is a Z-shaped canal in the temporal bone of the skull. It extends between the internal acoustic meatus and stylomastoid foramen. It transmits the facial nerve (CN VII) (after which it is nam ...

about above the

stylomastoid foramen The stylomastoid foramen is a foramen between the styloid and mastoid processes of the temporal bone of the skull. It is the termination of the facial canal, and transmits the facial nerve, and stylomastoid artery. Facial nerve inflammation in th ...

, and here it gives off an ascending branch which joins the

facial nerve The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of ta ...

. 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: * one joins the posterior auricular nerve. * the other is distributed to the skin of the back of the ear (auricle) and to the posterior part of the

Clinical significance

This nerve may be involved by the glomus jugulare tumour.

Laryngeal cancer Laryngeal cancer is a kind of cancer that can develop in any part of the larynx (voice box). It is typically a squamous-cell carcinoma, reflecting its origin from the epithelium of the larynx. The prognosis is affected by the location of the tumo ...

can present with pain behind the ear and in the ear - this is a

referred pain Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in t ...

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. 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. In 2003 Fallgatter et al. published "Far field potentials from the brain stem after transcutaneous vagus nerve stimulation" and in 2007 Kraus et al. did the first tVNS-fMRI study. 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: *

Atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...

* Depression *

Diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

* Endotoxemia *

Memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembe ...

Myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...

Tinnitus Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely ...

Stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

References

External links

Diagram
{{Authority control Vagus nerve Nerves of the head and neck Human head and neck Nervous system Autonomic nervous system