Peripheral nerve field stimulation for otalgia: A novel therapy for refractory deep ear pain

• Refractory deep ear pain is a complex clinical problem.
• PFNS can be an option in patients who have exhausted all other treatment modalities.
• PFNS can provide hope and benefit to patients with refractory otalgia.
• Randomized controlled studies are required to establish the efficacy of PFNS.

Refractory otalgia or deep ear pain is a complex clinical problem that poses significant challenges to the physicians. Here we report a case of a 39 year old female who presented to us with deep right ear pain which started following cholesteatoma excision 11 years ago. Since onset of right ear pain, she had multiple ear surgeries including microvascular decompression and excision of right temporal bone before presentation. Following neuropsychological assessment and excluding underlying depression/anxiety, she underwent peripheral nerve field stimulation (PFNS) trial. She had a successful PFNS trial and underwent permanent implantation of PFNS and pulse generator. She had > 50% reduction in her pain intensity on VAS and pain medications. She required explantation due to superficial infection; however she was satisfied with her therapy and looking forward for reimplantation. We report the first case of successful management of refractory deep ear pain using PFNS with a review of pertinent literature.