Auricular branch of vagus nerve

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 4 mm 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:

• 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 ear canal.

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. 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
• Depression
• Diabetes
• Endotoxemia
• Exercise capacity
• Memory
• Myocardial infarction
• Tinnitus
• Stroke

References

References

1. [[Mohsin F. Butt. Butt, M. F.]], [[Ahmed Albusoda. Albusoda, A.]], [[Adam D. Farmer. Farmer, A. D.]], [[Qasim Aziz. Aziz, Q.]] (2019). The anatomical basis for transcutaneous auricular vagus nerve stimulation. ''Journal of Anatomy'', Nov 19 [https://onlinelibrary.wiley.com/doi/full/10.1111/joa.13122]
2. {{WhoNamedIt. synd. 258
3. Brendan J. Canning. (January 2006). "Anatomy and Neurophysiology of the Cough Reflex". Chest.
4. Ventureyra EC.. (February 2000). "Transcutaneous vagus nerve stimulation for partial onset seizure therapy. A new concept". Childs Nerv Syst..
5. (December 2003). "Far field potentials from the brain stem after transcutaneous vagus nerve stimulation". Childs Nerv Syst..
6. (2007). "BOLD fMRI deactivation of limbic and temporal brain structures and mood enhancing effect by transcutaneous vagus nerve stimulation". J Neural Transm (Vienna).
7. (Mar 2015). "Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation". J Am Coll Cardiol.
8. (March 2013). "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.
9. (May 2013). "Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study". J Neural Transm (Vienna).
10. (July 2013). "Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects". Brain Stimul..
11. (June 2014). "Effect of transcutaneous auricular vagus nerve stimulation on impaired glucose tolerance: a pilot randomized study.". BMC Complement Altern Med.
12. (December 2007). "Transcutaneous vagus nerve stimulation reduces serum high mobility group box 1 levels and improves survival in murine sepsis". Crit. Care Med..
13. Ackland, Gareth L. (2025-05-01). "Non-invasive vagus nerve stimulation and exercise capacity in healthy volunteers: a randomized trial". European Heart Journal.
14. (May 2015). "Transcutaneous vagus nerve stimulation boosts associative memory in older individuals". Neurobiol Aging.
15. (2015). "Unilateral low-level transcutaneous electrical vagus nerve stimulation: A novel noninvasive treatment for myocardial infarction.". Int J Cardiol.
16. (September 2014). "Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study". Brain Stimul..
17. (June 2014). "Vagus nerve stimulation in ischemic stroke: old wine in a new bottle.". Front. Neurol..