Nervus intermedius neuralgia is an extremely rare craniofacial neuralgia characterized by intermittent episodes of pain located deep in the ear that last for seconds or minutes and are often triggered by sensory or mechanical stimuli at the posterior wall of the auditory canal without any underlying pathology. Pain can be associated with disorders of lacrimation, salivation, and taste. Despite the fact that the majority of cases is idiopathic, reports can be found in the literature, where this neuralgia is secondary to a neurovascular conflict between the seventh cranial nerve and anterior-inferior cerebellar artery, posterior-inferior cerebellar artery, and vertebral artery or their branches. For these cases a microvascular decompression procedure can be considered a valid therapeutic approach. In a video, we describe microsurgical decompression of the nervus intermedius in a 40-year-old lady who described a 19-year history of short-lasting paroxystic pain felt in the deep external acoustic meatus on the left side, refractory to medical treatment, with no disturbances of lacrimation, salivation, or taste.
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