Auricular branch of vagus nerve

The auricular branch of the vagus nerve is often termed the Alderman's nerve or Arnold's nerve. The latter name is an eponym for Friedrich Arnold.[1] The auricular branch of the vagus nerve supplies sensory innervation to the skin of the ear canal, tragus, and auricle.

Auricular branch of vagus nerve
Plan of upper portions of glossopharyngeal, vagus, and accessory nerves (auricular labeled at top center)
Fromvagus nerve
LatinRamus auricularis nervi vagi
Anatomical terms of neuroanatomy


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 (0.16 in) 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:

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.[2] 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.[3] In 2003 Fallgatter et al. published "Far field potentials from the brain stem after transcutaneous vagus nerve stimulation"[4] and in 2007 Kraus et al. did the first tVNS-fMRI study.[5] 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:


This article incorporates text in the public domain from page 911 of the 20th edition of Gray's Anatomy (1918)

  1. synd/258 at Who Named It?
  2. Brendan J. Canning, PhD (January 2006). "Anatomy and Neurophysiology of the Cough Reflex". CHEST. Retrieved 2009-03-09.
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  4. Fallgatter AJ, Neuhauser B, Herrmann MJ, Ehlis AC, Wagener A, Scheuerpflug P, Reiners K, Riederer P (December 2003). "Far field potentials from the brain stem after transcutaneous vagus nerve stimulation". Childs Nerv Syst. 110 (12): 1437–43. doi:10.1007/s00702-003-0087-6. PMID 14666414.
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  8. Hein E, Nowak M, Kiess O, Biermann T, Bayerlein K, Kornhuber J, Kraus T (May 2013). "Auricular transcutaneous electrical nerve stimulation in depressed patients: a randomized controlled pilot study". J Neural Transm (Vienna). 120 (5): 821–7. doi:10.1007/s00702-012-0908-6. PMID 23117749.
  9. Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, Moreno FA, Dunner DL, Lesem MD, Thompson PM, Husain M, Vine CJ, Banov MD, Bernstein LP, Lehman RB, Brannon GE, Keepers GA, O'Reardon JP, Rudolph RL, Bunker M (July 2013). "Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects". Brain Stimul. 6 (4): 631–40. doi:10.1016/j.brs.2012.09.013. PMID 23122916.
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