The Journal of Laryngology & Otology

Clinical Records

Auricular syncope

A Thakara1 c1, K K Deepaka2 and S Shyam Kumara1

a1 Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India

a2 Department of Physiology, All India Institute of Medical Sciences, New Delhi, India

Abstract

Objective: To describe a previously unreported syndrome of recurrent syncopal attacks provoked by light stimulation of the external auditory canal.

Case report: A 13-year-old girl had been receiving treatment for presumed absence seizures, with inadequate treatment response. Imaging was normal. Careful history taking indicated that the recurrent syncopal attacks were precipitated by external auditory canal stimulation. Targeted autonomic function tests confirmed a hyperactive vagal response, with documented significant bradycardia and lightheadedness, provoked by mild stimulation of the posterior wall of the left external auditory canal. Abstinence from ear scratching led to complete alleviation of symptoms without any pharmacological treatment.

Conclusions: Reflex syncope consequent to stimulation of the auricular branch of the vagus nerve is proposed as the pathophysiological mechanism for this previously undocumented syndrome.

(Accepted June 11 2007)

(Online publication October 12 2007)

Correspondence:

c1 Address for correspondence: Dr A Thakar, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Fax: 00 91 11 26588663 E-mail: meenaal@vsnl.com

Footnotes

Dr A Thakar takes responsibility for the integrity of the content of the paper.

Competing interests: None declared