Geniculate Neuralgia

Geniculate neuralgia is a rare syndrome of episodic, lancinating pain located within the ear canal. There may be a trigger point within the canal and associated with disorders of tearing, taste, and salivation. It is important to distinguish geniculate neuralgia from other causes of inner ear pain, including structural lesions and glossopharyngeal or trigeminal neuralgia. MRI may show vascular conflict with CN VII/VIII complex. Typical treatment is with carbamazepine. Surgery is reserved for those patients who have an incomplete response to medication. Surgery is directed at microvascular decompression of the CN VII/VIII complex with or without sectioning of the nervus intermedius. The entry zones of CN IX and X may also be explored. Complications and management are discussed.