13.3.1 Classical nervus intermedius neuralgia

Nervus intermedius neuralgia developing without apparent cause.

Diagnostic criteria:
A. At least three attacks of unilateral pain fulfilling criteria B and C
B. Pain is located in the auditory canal, sometimes radiating to the parieto-occipital region
C. Pain has at least three of the following four characteristics:

    1. recurring in paroxysmal attacks lasting from a few seconds to minutes
    2. severe intensity
    3. shooting, stabbing or sharp in quality
    4. precipitated by stimulation of a trigger area in the posterior wall of the auditory canal and/or periauricular region

D. No clinically evident neurological deficit
E. Not better accounted for by another ICHD-3 diagnosis.

Disorders of lacrimation, salivation and/or taste sometimes accompany the pain of 13.3.1 Classical nervus intermedius neuralgia. In view of the complex and overlapping innervation of the external ear, deriving from the trigeminal (auriculotemporal nerve), facial (nervus intermedius), glossopharyngeal, vagus and second cranial nerves, attribution of neuralgias to a single nerve may not be easy in this body region if a specific neurovascular contact cannot be visualized.

The pain of 13.3.1 Classical nervus intermedius neuralgia can result in psychological effects and significantly impair quality of life.