Tympanic membrane sensation.

Sensation from the tympanic membrane is generally believed to be mediated via at least four cranial nerves, some authors describing discrete territories for each of these nerves. The lack of critical evidence for independent sensory areas prompted a clinical study of tympanic membrane sensation in 32 patients having known cranial nerve deficits. Tympanic membrane sensation was tested in four quadrants using a 300 mg bristle under a Zeiss operating microscope. The findings were highly suggestive of a predominantly nociceptive system. Any change relative to the opposite tympanum was usually anaesthesia. No complete trigeminal deficit retained perception in all tympanic quadrants. Facial, glossopharyngeal and vagal deficits alone never affected tympanic sensation. These findings support the trigeminal nerve as the principal sensory nerve to the tympanic membrane, supplemented only inconstantly and incompletely by the other cranial nerves.