The auricular branch of the vagus nerve (Arnold nerve) arises from the superior (jugular) ganglion of the vagus nerve and supplies the skin of the posterior external auditory canal, the adjacent auricle (concha and posterior helix), and part of the mastoid skin. It is the only sensory branch of the vagus nerve supplying the body surface and creates a reflex arc between the ear canal and the vagus nerve nuclei.
Arnold nerve mediates several clinically important reflexes: the ear-cough reflex (Arnolds reflex) in which touching the posterior ear canal triggers coughing in approximately 2% of individuals; the vagal ear reflex causing bradycardia and syncope during ear syringing or otoscopy; and potentially the trigger for vagal-mediated vomiting from middle ear stimulation. Arnold nerve is stimulated in transcutaneous auricular vagal nerve stimulation (taVNS), which is used therapeutically to modulate cardiac arrhythmias and inflammatory conditions.
The auricular branch of the vagus nerve in the posterior external auditory canal triggers the Arnold ear-cough reflex when stimulated during otoscopy, ear syringing, or cerumen removal in susceptible individuals; rarely, excessive vagal stimulation from this reflex produces bradycardia and syncope requiring cessation of the procedure.
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