It is the usual cattle prod at my office this week, with a couple back-to-back cases leading me to finally whelp a long-awaited blog on a subject.
I've had 2 patients asked me the same question this week, which basically could be summarized as following: can a neck problem cause pain and abnormal sensation in the ear? And the answer to that is actually a resounding yes. The 1st patient who asked had had a slightly frustrating encounter with an ENT who found nothing wrong with the ear in spite of some continued sensation of prickling and tingling affecting the entire external ear area. The 2nd patient had more of an inkling of the correlation, since the ear pain and the neck symptoms seemed to come hand-in-hand.
The anatomical correlation between the cervical spine and the ear is multifaceted. The upper cervical spine, especially the facet joints of C1 and C2 articulation, can radiate to the area just below the ear, the pointy bone called the mastoid. That's probably where we're going to find more than half of the referred ear pain. The other half of the problem is often going to come from an area a little more remote, but still within the cervical area, just behind the SCM muscle: the auricular nerve. The auricular nerve has a sensory branch that travels up from the lateral side of the neck into the external part of the ear. It's a sensory nerve, meaning that they will primarily give abnormal sensation. Some of it is painful but it's often mostly described as a sensation of burning, tingling, pricking that comes and goes and is often triggered with rapid motion of the cervical spine and head away from the shoulder. The auricular nerve exits superficially posterior to the SCM muscle, which is a large superficial muscle that controls head rotation. It's a muscle that's often injured in injuries combining rotation and extension, such as whiplash type forces.
Resolution of the ear pain associated with the neck pain obviously depends on the offending structure. Cervical adjustments will resolve about half of them, but specific myofascial release of the posterior part of the SCM at the auricular nerve is a little more tricky and often overlooked as a source of continued superficial ear symptoms.
