Neuralgia of the ear node is a disease of the ear vegetative ganglion, manifested by paroxysms of vegetalgia that engulfs the parotid region and the ear. During an attack, pain can radiate to the back of the head, lower jaw, neck, shoulder girdle, arm and upper chest. Paroxysm is accompanied by hypersalivation, sometimes — clicks in the ear and its congestion. Hearing is not impaired. Diagnosis is carried out by a neurologist, but includes consultation with an otolaryngologist, dentist and other specialists, depending on the clinical situation. The treatment plan consists of means for relieving pain paroxysms, vascular, decongestant, metabolic drugs, physiotherapy procedures and reflexotherapy. An important point is to eliminate the root cause of neuralgia.
General information
The auricular vegetative node (ganglion) is a cluster of intermediate neurons of the sympathetic and parasympathetic nerve pathways. The node receives sympathetic preganglionic fibers through the plexus of the middle meningeal artery, parasympathetic fibers — from the branch of the lingopharyngeal nerve. The postganglionic fibers of the ear node are part of the ear-temporal nerve, which is a branch of the trigeminal nerve. They go to the ear gland and vessels of the temporal region, providing their vegetative innervation.
Neuralgia of the ear node is included in the group of vegetative ganglionitis of the head, which also includes neuralgia of the submandibular and sublingual nodes, ganglionitis of the ciliary node, ganglionitis of the pterygoid node and the upper sympathetic node, cervical truncitis. Specialists in the field of neurology have collected statistical data indicating that neuralgia of the ear ganglion is most common in middle-aged and young women.
Causes
Etiopathogenetically, neuralgia of the ear node is an irritative disease that develops reflexively in the presence of pathological vegetative impulses coming from chronic infectious foci or with chronic processes in somatic organs. The pathology that is localized in the same region with the ear node and has an infectious and inflammatory character is of the greatest importance. These include diseases of the parotid gland (mumps, sialadenitis, stones), chronic purulent otitis, chronic tonsillitis, sinusitis (frontitis, sinusitis, ethmoiditis), dental diseases (chronic periodontitis, stomatitis, gingivitis, periodontitis).
Less common is neuralgia of the ear node due to the presence of a distant focus of infection (pyelonephritis, urethritis, cystitis), a general infectious process (tuberculosis, syphilis, chronic sepsis), metabolic disorders due to endocrine pathology (hyperthyroidism, diabetes mellitus) or somatic disease (cirrhosis of the liver, cholecystitis, CRF, chronic gastritis, gastroduodenitis, adnexite).
Symptoms
Neuralgia of the ear node is manifested by attacks of vegetalgia that occur in front of the opening of the external auditory canal, in the parotid region and in the ear on the side of the lesion. Intense burning or throbbing pain radiates to the lower jaw, behind the ear, to the back of the head, neck and upper arm of the corresponding side. The reflex mechanism of pain irradiation leads to its spread to the upper parts of the chest and arm. Taking hot food or drinks, hypothermia of the face, psycho-emotional overstrain, excessive physical exertion can provoke a painful paroxysm. The duration of an attack of vegetalgia, as a rule, is several minutes, but it can be an hour or more.
The dependence of the functioning of the autonomic nervous system on external factors (lighting, barometric pressure, temperature changes, air humidity, etc.) causes the characteristic rhythmicity of vegetalgia — its occurrence mainly in the evening and at night, exacerbation in autumn and spring.
In some cases of neuralgia, paroxysm of pain is accompanied by ear congestion or sensations of clicks in it. The latter is caused by periodic reflex spasm of the muscles of the auditory tube. Often, during an attack, patients note a noticeable increase in salivation, whereas in the intercalative period hypersalivation is not observed. The auditory function does not suffer.
Diagnostics
Often patients seek help from a dentist or an otolaryngologist, and already from them they receive a referral to a neurologist’s consultation. The latter establishes a diagnosis based on typical complaints, the presence of sharp soreness during palpation of the sclerotomic points of the auricular, chin and mandibular nerves, the Richet point is the place where the ear node anastomoses with the mandibular nerve. The detection of hyperalgesia in the parotid region also speaks in favor of neuralgia. In a difficult diagnostic situation, diagnostic novocaine or lidocaine blockade of the ear ganglion is resorted to.
In the process of diagnosis, an important role is played by determining the etiology of the occurrence of neuralgia. For this purpose, dental examination and ultrasound of the parotid salivary gland, otolaryngological examination (audiometry, otoscopy, rhinoscopy, pharyngoscopy, radiography of the paranasal sinuses) are performed. If necessary, consultations of narrow specialists (urologist, gastroenterologist, gynecologist, endocrinologist, etc.) and additional studies of somatic organs (gastroscopy, ultrasound of the abdominal cavity, ultrasound of the kidneys, thyroid hormone levels, etc.) are prescribed.
Differential diagnosis is performed with otitis media, eustachiitis, trigeminal neuralgia, mumps, tumors, cysts and stones of the parotid gland.
Treatment
Emergency care aimed at relieving paroxysms of vegetalgia includes the use of anti-inflammatory and analgesic agents: sodium metamizole, acetylsalicylic acid, aminophenazone, therapeutic novocaine blockades. They are combined with ganglioblockers (benzohexonium, pachycarpine), antispasmodics (drotaverine, ganglefen), sedatives (motherwort, valerian, bromine preparations) and hypnotics (phenobarbital, barbamil, zopiclone). An additional analgesic effect is provided by electrophoresis with novocaine or ultraphonophoresis with hydrocortisone on the area of the ear node.
Metabolic and vascular therapy is indicated: vitamins g. B, pentoxifylline, nicotinic acid. Antiallergic drugs (promethazine, chloropyramine, loratadine, desloratadine) are used to reduce puffiness. With the predominance of signs of irritation of parasympathetic fibers in the clinic of neuralgia, cholinolytic agents are prescribed: platyphylline, diphenyltropine, etc.
Intolerance to pharmacotherapeutic methods of treatment is an indication for reflexotherapy using acupuncture, magnetic acupuncture, laser acupuncture. During the convalescence period, DDT, amplipulstherapy, electrophoresis with hyaluronidase are recommended.
Of fundamental importance in the treatment is the elimination of the root cause of the disease: oral sanitation, treatment of otolaryngological diseases and pathology of the oral cavity, correction of endocrine disorders, therapy of chronic diseases of the somatic organs. According to the indications, surgical interventions are carried out: removal of tumors and stones of the parotid gland, dissection of adhesions, sanitizing surgery on the middle ear, ethmoidotomy, maxillofacial surgery, frontotomy, etc.
