Sectioning the sensory auricular branch of the facial nerve to treat recalcitrant otalgia

OBJECTIVE: To present a new surgical approach to treat idiopathic neuralgia of the sensory auricular branch of the facial nerve. PATIENTS: Three patients with chronic ear pain resistant to medical therapy. INTERVENTION: Sectioning of the sensory auricular branch of the facial nerve along its course at the posterior wall of the external auditory canal by a retroauricular mastoidectomy approach. MAIN OUTCOME MEASURES: Resolution of otalgia. RESULTS: All the patients were relieved of their pain at their first follow-up visit, and they have remained symptom-free. The patients were followed at least for 1 year. CONCLUSION: The surgical treatment of idiopathic otalgia should be reserved for patients in whom medical treatment has failed. Finding the exact location of the ear pain is of utmost importance for a favorable outcome after surgery. If the origin of the otalgia is found to be the sensory auricular branch of the facial nerve, the section of this nerve offers favorable outcomes with no morbidity.