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S. S. MOORTHY, MD; GOPAL KRISHNA, MD; C. L. ELLIOTT, MD
Indianapolis

Arch Otolaryngol. 1985;111(9):631.

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To the Editor.—We observed slowing of the heart rate and cardiac dysrhythmias in pediatric patients undergoing myringotomy and ear tube insertion during halothane and nitrous oxide and oxygen administration by mask. These patients did not receive any premedication. Cardiac dysrhythmias (slowing of heart rate, Fig 1, sinus bradycardia, premature ventricular beats, Fig 2) occurred during insertion of the ear speculum and

Fig 1.—Electrocardiogram showing slowing of heart rate during introduction of ear speculum (arrow) in 4-year-old girl for myringotomy and ear tube insertion.

Fig 2.—Electrocardiogram showing unifocal premature ventricular beats during introduction of ear speculum (arrow) in 4-year-old boy undergoing myringotomy and ear tube insertion. initial manipulation of the ear. We speculate this response represents a vagal reflex.

The auricular branch of the vagus nerve (Arnold's nerve, Alderman's nerve) arises from the superior vagal ganglion, joins a branch from the glossopharyngeal nerve, enters the temporal bone at the level . . . [Full Text PDF of this Article]

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