In peritonsillar abscess, pain is referred to ear due to:
Ans: (b) Glossopharyngeal nerveRef: Gray's Anatomy, The Anatomical Basis of Clinical Practice, Susan Standring, 41st edition, 2016, Page 576 & 577Tonsils and tonsillar fossa are supplied by the glossopharyngeal nerve*.The tympanic branch of the glossopharyngeal (Jacobson's) nerve* supplies the mucous membrane lining the tympanic cavity.Infection, malignancy and postoperative inflammation of the tonsil and tonsillar fossa may therefore be accompanied by pain referred to the ear.Structures related to the tonsillar fossa/tonsillar bedMuscles - Superior constrictor, sometimes by the anterior fibres of palatopharyngeus and styloglossus.Arteries - Tonsillar artery branch of the facial artery, ascending palatine artery and occasionally facial artery.Veins - Paratonsillar vein and venae comitantes accompanying tonsillar artery.Nerve - Glossopharyngeal nerve.The internal carotid artery lies approximately 25 mm behind and lateral to the tonsil, o In some individuals, the styloid process may be elongated and deviate towards the tonsillar bed. o The glossopharyngeal nerve lies immediately lateral to the muscular wall of the tonsillar fossa and is commonly temporarily affected by oedema following tonsillectomy.Points to Remember:Because of the nature of the ear's sensory innervations, a wide variety of disorders can produce referred otalgia.The ear receives an extensive sensory innervation via four cranial nerves (Trigeminal, Facial, Glossopharyngeal and Vagus) and two spinal segments (C2 and C3).The other causes of referred otalgia (most common causes) are: o Temporomandibular joint syndromePharyngitisDental diseaseCervical spine arthritis
Trigeminal nerve
Glossopharyngeal nerve
Mandibular nerve
Auriculotemporal nerve
Head & Neck