A 70-year-old man with severe deep paroxysmal ear pain

摘要

A 70 year-old man was admitted to the orofacial pain clinic with a6 months history of severe, paroxysmal episodes of stabbing pain inthe depth of the left ear canal. According to the patient's self-report,a previous neurological examination had not found abnormalities.Also, three months before, he had been successfully treated for aleft external otitis. Nonetheless, the pain persisted. Upon the clinicalexamination, no signs of peripheral lesions (face and oral mucosa) orscar tissues were identified. However, several attacks of very intensepain (10/10 on the visual analogue scale) on the left ear canal and radiating to the ipsilateral temporal region were observed. The painwas either spontaneous or elicited by light tactile stimulation ofthe ipsilateral concha but not by pressure stimuli or mandibularmovements. Cranial nerve examination was normal, except for aleft anacusis, right hypoacusis and a discrete paresis of the leftorbicularis. Past medical history included type II diabetes mellitusand a left otosurgery several years later. A head MRI was obtained(Fig. 1) and laboratorial tests were requested.