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Clinical Procedures > Anesthetic and Analgesic Techniques
Anesthesia of the Ear
Article Last Updated: Jan 18, 2006
AUTHOR AND EDITOR INFORMATION
Section 1 of 14  
Author: Elizabeth Tillem, MD, Assistant Attending, Department of Emergency Medicine, Bronx Lebanon Hospital Center
Coauthor(s):
Michael Lawrence Hochberg, MD, Clinical Instructor, Emergency Medicine, Albert Einstein College of Medicine; Attending, Emergency Medicine, Montefiore Medical Center
Editors: Andrew K Chang, MD, Department of Emergency Medicine, Albert Einstein College of Medicine, Assistant Professor, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, Pharmacy Editor, University of Nebraska Medical Center College of Pharmacy, eMedicine.com, Inc; Luis M. Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA, Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Emergency Medicine Center, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Author and Editor Disclosure
Synonyms and related keywords:
anesthesia of ear, anesthesia, regional block, nerves of ear, auricular nerve, vagus nerve, auricular branch, auriculotemporal nerve, external auditory canal, tympanic membrane, auricular block, ring block, tragus
The regional block can provide anesthesia for lacerations and other painful procedures of the ear.
Anatomy
Four sensory nerve branches supply the external ear.
Anatomy of sensory nerves in the external ear. - The greater auricular nerve is a branch of the cervical plexus. It innervates the inferior ear and the posterior aspects of the medial and lateral ear. Branches of the lesser occipital nerve may also innervate these areas.
- The auricular branch of the vagus nerve innervates the concha and most of the area around the auditory meatus.
- The auriculotemporal nerve is a branch of the mandibular branch of the trigeminal nerve. It innervates the superior and medial part of the anterior ear.
- The external auditory canal and tympanic membrane have separate innervation. Indications for anesthetizing these areas are distinct from those for performing an auricular block.
- Suture of a large laceration of the ear or the skin surrounding the ear
- Painful procedures of the ear, such as incision and drainage of an abscess or hematoma
- Cellulitic periauricular skin
- Severe allergy to the chosen anesthetic
Local anesthetic agents (eg, lidocaine 1% [Xylocaine], bupivacaine 0.25% [Marcaine]) may be used. If a regional block is to be performed, lidocaine with epinephrine may be used; however, epinephrine is contraindicated for direct infiltration of the ear itself.
For more information, see Local Anesthetic Agents, Infiltrative Administration.
- Syringe, 5-10 mL
- Needle, 25 or 27 gauge
- Parenteral anesthetic agent
- Light source
Position the patient so that both physician and patient are comfortable and so that the ear to be anesthetized is easily accessible. Supine is usually the optimal position.
The choice of technique depends on the area of the ear that requires anesthesia.
This technique, called ring block, provides anesthesia to the entire ear, excluding the concha and external auditory canal.
Ring block technique.
- Disinfect skin with alcohol swab.
- Insert the needle into the skin inferior to the attachment of the earlobe to the head. Do not insert the needle into the earlobe itself. Direct the needle toward the tragus.
- Aspirate and then inject 3-4 mL of anesthetic while advancing the needle toward the tragus.
- Withdraw the needle but do not remove it. Redirect the needle posteriorly along the inferior posterior auricular sulcus.
- Aspirate and inject anesthetic while advancing the needle.
- Remove the needle and reinsert it just superior to the attachment of the helix to the scalp. Direct the needle anteriorly, toward the tragus, and aspirate before injecting anesthetic. Advance the needle while injecting. Inject the subcutaneous tissue, not the ear cartilage.
- Withdraw the needle but do not remove it. Redirect the needle posteriorly; aim toward the mid-ear. Aspirate and inject anesthetic while advancing the needle.
- Be aware that the superficial temporal artery, located medial to the ear, crosses over the zygomatic arch. If the artery is cannulated, maintain firm pressure with gauze for at least 20-30 minutes.
This technique provides anesthesia to the earlobe and lateral helix (greater auricular and less occipital nerves).
Technique to anesthetize the earlobe and lateral helix.
- Disinfect the skin with an alcohol swab.
- Insert the needle behind the inferior aspect of the earlobe. Aspirate and inject 3-4 mL of anesthetic while advancing the needle superiorly, following the curve of the posterior sulcus.
This technique provides anesthesia to the helix and tragus (auriculotemporal nerve).
Technique to anesthetize the helix and tragus.
- Disinfect the skin with an alcohol swab.
- Insert the needle superiorly and anteriorly to the tragus.
- Aspirate and inject 2-4 mL of anesthetic.
- Since adequate anesthesia of the auditory canal and tympanic membrane is difficult to obtain, consult an ENT specialist for painful procedures involving these areas.
- Do not inject cellulitic skin.
- Do not inject any anesthetic containing epinephrine directly into the ear itself.
- Infection
- Inadequate anesthesia
- Cannulation of the superficial facial artery
American Society of Regional Anesthesia and Pain Medicine
520 N Northwest Highway
Park Ridge IL 60068
847-825-7246
American Academy of Otolaryngology – Head and Neck Surgery
1 Prince St
Alexandria VA 22314-3357
703-836-4444
eMedicine.com, Inc: Local Anesthesia and Regional Nerve Block Anesthesia
eMedicine.com, Inc: Ear, Reconstruction and Salvage
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Anatomy of sensory nerves in the external ear. |
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Technique to anesthetize the earlobe and lateral helix. |
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| Media file 4:
Technique to anesthetize the helix and tragus. |
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- Gmyrek R. Local Anesthesia and Regional Nerve Block Anesthesia. eMedicine.com Journal [serial online]. 2004;Available at www.emedicine.com/derm/topic824.htm.
- Riviello RJ. Otolaryngologic Procedures. In: James R. Roberts, MD, Jerris R. Hedges, MD, MS. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia: Saunders; 2004:1287-1289.
Anesthesia of the Ear excerpt Article Last Updated: Jan 18, 2006
Topic originally published: Jan 5, 2006
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