A technique for studying sensory nerve conduction velocity of the
greater auricular nerve according to one of the conventional methods
is described. Latency and conduction velocities obtained from 35
nerves in 20 healthy adults were 1.7 ? 0.2 msec (SD) and 46.8 ? 6.6 m/
sec (SD), respectively. This technique is easy to perform and is useful in
documenting traumatic and other neuropathies involving the greater
auricular nerve, as illustrated in the case report in this article.
A TECHNIQUE FOR STUDYING THE GREATER
AURICULAR NERVE CONDUCTION VELOCITY
SARALA K. PALLIYATH, MD
Electrophysiological techniques to study the up-
per cervical nerves are scarce. Some of these
nerves are superficial and easily accessible for
nerve conduction studies. The greater auricular
nerve in the neck is easily susceptible to injury and
is affected in leprosy and hereditary hypertrophic
neuropathies. Nerve conduction velocity studies of
the greater auricular nerve in such instances would
be helpful. A simple technique for recording the
nerve conduction velocity of the greater auricular
nerve is described.
ANATOMY
T h e greater auricular nerve (C2, C3), a purely sen-
sory nerve, is the largest ascending branch of the
cervical plexus. From the base of the neck and
deep to the sternomastoid, it winds around the
posterior border and ascends cephalad on the sur-
face of that muscle. It divides into an anterior
branch, which supplies the skin over the mastoid
From the Department of Neurology, Veterans Administration Medical
Center and Tulane Medical Center, New Orleans, LA.
This paper was presented as a poster presentation in the 5th Interna-
tional Neuromuscular Conference in Marseille, France, September, 1982.
Acknowledgment: The author wishes to thank Dr. Barry Schwartz for his
aid in the statistical analysis.
Address reprint requests to Dr. Palliyath at the Department of Neurology,
VA Medical Center, New Orleans, LA 70146.
Received for publication June 14, 1983, revised manuscript accepted for
publication October 7, 1983.
0148-639WO70310232 $04.0010
0 1984 John Wiley & Sons, Inc.
232 The Greater Auricular Nerve
MUSCLE & NERVE 7~232-234 1984
and the back of the lower part of the auricle
(Fig. 1). This nerve has been reported to be pal-
pable and visible in some normal adults.'32
METHOD
Greater auricular nerve conduction velocity stud-
ies, according to conventional method^,^ were ob-
tained in 20 healthy volunteers (13 males and 7
females). Their ages ranged from 21 to 66 years.
Both sides were tested in 15 subjects. Median and
peroneal motor, sural, and median sensory con-
duction velocity studies were performed to exclude
subjects with subclinical peripheral neuropathy.
One patient with greater auricular nerve neuroma
was also studied. T h e equipment used was DISA
1500 Digital EMG System (DISA Electronics,
Franklin Lakes, Nj). T w o surface disc electrodes, 9
mm in diameter, were placed 2 cm apart on the
back of the ear lobe (active electrode proximal).
T h e ground electrode was placed over the back of
the neck (Fig. 2). T h e nerve was stimulated with a
bipolar surface stimulating electrode held firmly
against the lateral border of the sternomastoid
muscle (cathode distal), at a point 8 cm proximal to
the active electrode. A square wave pulse of 0.1-
msec duration was applied, and stimulus intensity
was gradually increased until the onset of a clear
nerve action potential. The current required
ranged from 10-12 mamp. The sweep speed was
set at 1 msecldivision and the gain was set at 20 p.V/
division. A clear, well-defined nerve action poten-
tial was obtained without using the averager (Fig.
3). T h e latency was measured from the stimulus
onset to the negative peak of the potential and the
amplitude was measured from the take-off to the
MUSCLE & NERVE MarIAor 1984

Great Auricular
FIGURE 1. Anatomy of the greater auricular nerve.
FIGURE 2. Stimulation and recording technique.
The Greater Auricular Nerve
1 msec
FIGURE 3. Greater auricular nerve action potential.
peak of the negative peak. Skin temperature was
maintained between 33-35°C.
RESULTS
One-way analysis of' variance was performed for
four dependent measures: latency (msec), conduc-
tion velocity (misec), amplitude (pV), and duration
(msec). Each analysis contained only those subjects
( n = 15) who had bilateral recordings.
The analysis revealed no significant differences
between the right and left recordings ( P > 0.1) for
any measure. The means and standard deviation
for the total number of subjects for right or left
recordings on each measure can be seen in Table
1 , which is composed of 15 subjects with right and
left recordings, 4 with left recordings, and 1 sub-
ject with right only recordings.
The average of right and left combined record-
ings was I.? -t 0.2 msec for latency, 46.8 & 6.6 mi
sec for conduction velocity, 12.7 t 4.1 pV for am-
plitude, and 0.8 * 0.2 msec for duration.
CASE REPORT
A 65-year-old man developed pain in the distribu-
tion of the left greater auricular nerve following
gastrectomy 2 years earlier. A central venous line
was inserted on the left side of the neck at the
time of the surgery. Shock-like paresthesia could
be triggered by palpitating the lateral border of
the sternomastoid. Injury to the greater auricu-
lar nerve was diagnosed and latency studies of
the greater auricular nerve were done as already
described. On the affected side, the nerve action
potential could be obtained only on averaging 32
responses; the latency was 2.2 msec and the am-
plitude was 2 FV. On the opposite side, a nerve ac-
tion potential of 10-pV amplitude and 2-msec la-
MUSCLE & NERVE MarlApr 1984 233
 Table 1. Electrophysiological data of greater auricular nerve on normal subjects.
Latency (rnsec) Conduction velocity (rnlsec) Amplitude (FV) Duration (rnsec)
Right 1.8 5 0.2 45.8 2 7.5 12.7 2 4.2 0.9 2 0.2
n = 16
Left 1.7 f 0.2 47.8 * 5.6 12.6 5 4.0 0.8 5 0.2
n = 19
Left and right
combined 1.7 ? 0.2 46.8 2 6.6 12.7 2 4.1 0.8 5 0.2
n = 35
Values are mean t SD
n = Number of nerves.

tency was obtained, without averaging. The nerve
was explored and a 3-mm neuroma was excised.
COMMENT
Greater auricular nerve response is relatively easy
to record except for the occasional difficulty en-
countered in heavy-set people with short necks.
The recording can be done from the mastoid pro-
cess if the ear lobe is defective. The stimulus cur-
rent required to obtain the nerve action potential is
minimal and produces no discomfort. The nerve
action potential is obtained without the use of an
averager.
Greater auricular nerve conduction velocity
studies are useful in documenting the neuropathy,
as in the illustrated case report. The nerve is re-
ported to be very vulnerable during rhytidectomy
producing either transient or permanent numb-
ness around the ear. Painful neuroma results when
the main trunk of the nerve is injured.3 Thicken-
ing of the greater auricular nerve is common in
leprosy and hereditary hypertrophic neuropathies.
About 63% of normal adult population from a n
endemic area is reported to have a palpable
greater auricular nerve. The greater auricular
nerve conduction velocity studies will be helpful in
identifying the early involvement of the nerve in
these diseases. Lynch and Johnston' reported that
87% of nonleprous British soldiers had a palpable
greater auricular nerve and in 39% it was visible.'
It would be interesting to study the conduction ve-
locity of the greater auricular nerve in such indi-
viduals.
REFERENCES
1. Lynch P: Greater auricular nerve in diagnosis of leprosy. B r
M e d J II:1340, 1978.
2. Lynch P, Johnston JH: The greater auricular nerve in pre-
sumably non-leprous British soldiers. Trans R Sac Trop Med
Hyg 76:136, 1980.
3. McKinney P, Katrana DJ: Prevention of injury to the greater
auricular nerve during rhytidectomy. Plast Reconrtr Surg
66:675-679, 1980.
4. Oh SJ: Electrodiagnostic studies in neuromuscular disease.
A h ] Med Sci 17:300-307, 1980.

234 The Greater Auricular Nerve MUSCLE 8, NERVE MariApr 1984