“…In our series, in the 11 patients with otalgia, 5 (45%) had perineural invasion confirmed pathologically, whereas in the 16 patients with confirmed perineural invasion, only 5 (31%) complained of otalgia. In addition, our study demonstrated that no more patients with ACC of the external auditory canal complained of otalgia than those with squamous cell carcinoma of the external auditory canal in our previous study (38% vs 59%), in which the rate of facial nerve invasion was 43% . Given that otalgia can be caused not only by perineural invasion, but also by otitis externa, we assume that otalgia may be more related to local inflammation than perineural invasion.…”