What is the anatomy of the ear relative to the administration of ear anesthesia?

Updated: Jun 14, 2018
  • Author: Daniel J Hutchens, MD, MS; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

The ear is composed of 3 compartments: the external ear, the middle ear, and the inner ear. For the purpose of local anesthesia, this article focuses on the external ear which comprises the auricle, or pinna, and the ear canal. The auricle (visible part of ear) is composed mainly of cartilage covered by skin and consists of the helix, antihelix, lobule, tragus, and concha.

Anatomy of the ear is shown below.

Anatomy of the ear. Anatomy of the ear.

Four sensory nerves supply the external ear: (1) greater auricular nerve, (2) lesser occipital nerve, (3) auricular branch of the vagus nerve, and (4) auriculotemporal nerve. Knowledge of the nerve anatomy is critical in understanding anesthesia of the ear. For more information about the relevant anatomy, see Trigeminal Nerve Anatomy, Facial Nerve Anatomy, and Vagus Nerve Anatomy.

Anatomy of the sensory nerves of the external ear are shown in the image below.

Anatomy of sensory nerves in the external ear. Anatomy of sensory nerves in the external ear.

See the list below:

  • The greater auricular nerve is a branch of the cervical plexus. It innervates the posteromedial, posterolateral, and inferior auricle (lower two-thirds both anteriorly and posteriorly).

  • The lesser occipital nerve innervates a small portion of the helix.

  • The auricular branch of the vagus nerve innervates the concha and most of the area around the auditory meatus.

  • The auriculotemporal nerve originates from the mandibular branch of the trigeminal nerve. It innervates the anterosuperior and anteromedial aspects of the auricle.

  • The external auditory canal and tympanic membrane have separate innervation. Indications for anesthetizing these areas are distinct from those for performing an auricular block.

For more information about the relevant anatomy, see Ear Anatomy.


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