A technique for studying sensory nerve conduction velocity of the

greater auricular nerve according to one of the conventional methods

is described. Latency and conduction velocities obtained from 35
nerves in 20 healthy adults were 1.7 ? 0.2 msec (SD) and 46.8 ? 6.6 m/
sec (SD), respectively. This technique is easy to perform and is useful in
documenting traumatic and other neuropathies involving the greater
auricular nerve, as illustrated in the case report in this article.
MUSCLE & NERVE 7~232-234 1984

A TECHNIQUE FOR STUDYING THE GREATER

AURICULAR NERVE CONDUCTION VELOCITY
SARALA K. PALLIYATH, MD

Electrophysiological techniques to study the up- and the back of the lower part of the auricle
per cervical nerves are scarce. Some of these (Fig. 1). This nerve has been reported to be pal-
nerves are superficial and easily accessible for pable and visible in some normal adults.'32
nerve conduction studies. The greater auricular
nerve in the neck is easily susceptible to injury and METHOD
is affected in leprosy and hereditary hypertrophic Greater auricular nerve conduction velocity stud-
neuropathies. Nerve conduction velocity studies of ies, according to conventional method^,^ were ob-
the greater auricular nerve in such instances would tained in 20 healthy volunteers (13 males and 7
be helpful. A simple technique for recording the females). Their ages ranged from 21 to 66 years.
nerve conduction velocity of the greater auricular Both sides were tested in 15 subjects. Median and
nerve is described. peroneal motor, sural, and median sensory con-
duction velocity studies were performed to exclude
ANATOMY subjects with subclinical peripheral neuropathy.
T h e greater auricular nerve (C2, C3), a purely sen- One patient with greater auricular nerve neuroma
sory nerve, is the largest ascending branch of the was also studied. T h e equipment used was DISA
cervical plexus. From the base of the neck and 1500 Digital EMG System (DISA Electronics,
deep to the sternomastoid, it winds around the Franklin Lakes, Nj). T w o surface disc electrodes, 9
posterior border and ascends cephalad on the sur- mm in diameter, were placed 2 cm apart on the
face of that muscle. It divides into an anterior back of the ear lobe (active electrode proximal).
branch, which supplies the skin over the mastoid T h e ground electrode was placed over the back of
the neck (Fig. 2). T h e nerve was stimulated with a
bipolar surface stimulating electrode held firmly
against the lateral border of the sternomastoid
muscle (cathode distal), at a point 8 cm proximal to
From the Department of Neurology, Veterans Administration Medical the active electrode. A square wave pulse of 0.1-
Center and Tulane Medical Center, New Orleans, LA. msec duration was applied, and stimulus intensity
This paper was presented as a poster presentation in the 5th Interna- was gradually increased until the onset of a clear
tional Neuromuscular Conference in Marseille, France, September, 1982.
nerve action potential. The current required
Acknowledgment: The author wishes to thank Dr. Barry Schwartz for his ranged from 10-12 mamp. The sweep speed was
aid in the statistical analysis.
set at 1 msecldivision and the gain was set at 20 p.V/
Address reprint requests to Dr. Palliyath at the Department of Neurology,
VA Medical Center, New Orleans, LA 70146. division. A clear, well-defined nerve action poten-
tial was obtained without using the averager (Fig.
Received for publication June 14, 1983, revised manuscript accepted for
publication October 7, 1983. 3). T h e latency was measured from the stimulus
0148-639WO70310232 $04.0010
onset to the negative peak of the potential and the
0 1984 John Wiley & Sons, Inc. amplitude was measured from the take-off to the

232 The Greater Auricular Nerve MUSCLE & NERVE MarIAor 1984
 1 msec
FIGURE 3. Greater auricular nerve action potential.
Great Auricular

peak of the negative peak. Skin temperature was

maintained between 33-35°C.

RESULTS
One-way analysis of' variance was performed for
four dependent measures: latency (msec), conduc-
tion velocity (misec), amplitude (pV), and duration
(msec). Each analysis contained only those subjects
FIGURE 1. Anatomy of the greater auricular nerve. ( n = 15) who had bilateral recordings.
The analysis revealed no significant differences
between the right and left recordings ( P > 0.1) for
any measure. The means and standard deviation
for the total number of subjects for right or left
recordings on each measure can be seen in Table
1 , which is composed of 15 subjects with right and
left recordings, 4 with left recordings, and 1 sub-
ject with right only recordings.
The average of right and left combined record-
ings was I.? -t 0.2 msec for latency, 46.8 & 6.6 mi
sec for conduction velocity, 12.7 t 4.1 pV for am-
plitude, and 0.8 * 0.2 msec for duration.

CASE REPORT
A 65-year-old man developed pain in the distribu-
tion of the left greater auricular nerve following
gastrectomy 2 years earlier. A central venous line
was inserted on the left side of the neck at the
time of the surgery. Shock-like paresthesia could
be triggered by palpitating the lateral border of
the sternomastoid. Injury to the greater auricu-
lar nerve was diagnosed and latency studies of
the greater auricular nerve were done as already
described. On the affected side, the nerve action
potential could be obtained only on averaging 32
responses; the latency was 2.2 msec and the am-
plitude was 2 FV. On the opposite side, a nerve ac-
FIGURE 2. Stimulation and recording technique. tion potential of 10-pV amplitude and 2-msec la-

The Greater Auricular Nerve MUSCLE & NERVE MarlApr 1984 233
 Table 1. Electrophysiological data of greater auricular nerve on normal subjects.
Latency (rnsec) Conduction velocity (rnlsec) Amplitude (FV) Duration (rnsec)
Right 1.8 5 0.2 45.8 2 7.5 12.7 2 4.2 0.9 2 0.2
n = 16
Left 1.7 f 0.2 47.8 * 5.6 12.6 5 4.0 0.8 5 0.2
n = 19
Left and right
combined 1.7 ? 0.2 46.8 2 6.6 12.7 2 4.1 0.8 5 0.2
n = 35
Values are mean t SD
n = Number of nerves.

tency was obtained, without averaging. The nerve About 63% of normal adult population from a n
was explored and a 3-mm neuroma was excised. endemic area is reported to have a palpable
greater auricular nerve. The greater auricular
COMMENT nerve conduction velocity studies will be helpful in
Greater auricular nerve response is relatively easy identifying the early involvement of the nerve in
to record except for the occasional difficulty en- these diseases. Lynch and Johnston' reported that
countered in heavy-set people with short necks. 87% of nonleprous British soldiers had a palpable
The recording can be done from the mastoid pro- greater auricular nerve and in 39% it was visible.'
cess if the ear lobe is defective. The stimulus cur- It would be interesting to study the conduction ve-
rent required to obtain the nerve action potential is locity of the greater auricular nerve in such indi-
minimal and produces no discomfort. The nerve viduals.
action potential is obtained without the use of an
averager.
Greater auricular nerve conduction velocity REFERENCES
studies are useful in documenting the neuropathy, 1. Lynch P: Greater auricular nerve in diagnosis of leprosy. B r
as in the illustrated case report. The nerve is re- M e d J II:1340, 1978.
ported to be very vulnerable during rhytidectomy 2. Lynch P, Johnston JH: The greater auricular nerve in pre-
sumably non-leprous British soldiers. Trans R Sac Trop Med
producing either transient or permanent numb- Hyg 76:136, 1980.
ness around the ear. Painful neuroma results when 3. McKinney P, Katrana DJ: Prevention of injury to the greater
the main trunk of the nerve is injured.3 Thicken- auricular nerve during rhytidectomy. Plast Reconrtr Surg
66:675-679, 1980.
ing of the greater auricular nerve is common in 4. Oh SJ: Electrodiagnostic studies in neuromuscular disease.
leprosy and hereditary hypertrophic neuropathies. A h ] Med Sci 17:300-307, 1980.

234 The Greater Auricular Nerve MUSCLE 8, NERVE MariApr 1984