PONOS Clinic · Procedures · Neuromodulation

Pulsed radiofrequency of the auriculotemporal nerve

PRF following clinical assessment and an ultrasound-guided diagnostic block

A treatment targeting the auriculotemporal nerve, which may be considered for selected patients within an individual diagnostic pathway.

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Dr Evangelos Panagiotakos MD · PONOS Clinic · Turin

Temporomandibular pain and chewing muscles · Illustrative representation. Click to enlarge.

A pulsed technique for neuromodulation

Pulsed radiofrequency (PRF) delivers pulses of energy close to the nerve, aiming to modify its activity in signal transmission. It is not intended to create the continuous thermal lesion associated with ablative radiofrequency.

The procedure described uses PRF. The distinction from thermal radiofrequency concerns the method and purpose of treatment; it does not mean that adverse effects are impossible.

Why target the auriculotemporal nerve?

This is a branch of the mandibular nerve (V3 of the trigeminal nerve), involved in sensation in the temporal and preauricular regions and the temporomandibular joint. Selecting this target requires consistency between symptoms, clinical examination and the response to testing.

Auriculotemporal pain

PRF may be discussed in selected cases of persistent pain involving this nerve, after reviewing previous treatments and alternatives.

The somatosensory component of tinnitus

Within the PONOS pathway, the nerve may be assessed as a potential target when the presentation suggests somatosensory involvement. This assessment does not replace an ENT and audiological evaluation.

Indications: TMJ pain and painful bruxism

Temporomandibular joint pain

Persistent TMJ pain with suspected auriculotemporal involvement, in cases selected following clinical assessment and an ultrasound-guided diagnostic block.

Pain associated with bruxism

Bruxism or clenching accompanied by temporomandibular pain with an identified auriculotemporal component. PRF targets this painful component and is not a direct treatment for grinding or clenching.

The indication is considered alongside dental, jaw-function and rehabilitation care. The response to the block contributes to target selection without guaranteeing the outcome of treatment.

The pathway: an ultrasound-guided diagnostic block first

Specialist assessment. Symptoms, their distribution, modifying factors, previous investigations and earlier treatments are reviewed.

Ultrasound-guided diagnostic block. In the PONOS clinical pathway, the target is assessed using a selective injection of local anaesthetic under ultrasound guidance.

Interpreting the response. The extent and duration of symptom changes are recorded and compared with the baseline and the expected anatomical distribution.

A shared decision about PRF. The test result is considered alongside the diagnosis, alternatives and the individual balance of benefits and risks.

A positive test does not guarantee success. It provides clinical information that helps with selection; on its own, it cannot establish a certain likelihood of response or the duration of any benefit.

Its role in the somatic tinnitus pathway

In the PONOS somatic tinnitus pathway, both the auriculotemporal nerve and the third occipital nerve are assessed with targeted tests when clinically relevant. These are distinct targets: this page describes only PRF of the auriculotemporal nerve.

Jaw or cervical involvement needs to be assessed within the overall clinical picture. Tinnitus does not always have the same origin, and not every patient is a candidate for a procedure.

Available evidence. A single-centre retrospective study involving 67 patients reported a reduction in tinnitus intensity in 23 patients at the seven-week follow-up after auriculotemporal PRF. The uncontrolled design limits the conclusions: this finding is neither an individual prediction nor proof of effectiveness for every type of tinnitus.^[1]

For the general clinical context, see the page about somatic tinnitus (Italian). The relationship between jaw pain and bruxism is described on the page about temporomandibular disorders.

How the procedure is performed

Following the preliminary assessment and informed consent, the clinician identifies the target using ultrasound and positions a dedicated needle close to the nerve. Radiofrequency is then delivered in pulsed mode. The settings, duration and supportive care are determined by the clinical circumstances.

Afterwards, individual advice is provided about observation, daily activities and follow-up. Monitoring focuses on the symptom for which treatment was indicated, distinguishing improvement in pain from improvement in tinnitus.

Expected benefits, limitations and risks

The aim is to reduce the selected symptom and its impact on daily life. The response may be partial, temporary or absent. Case reports are also available for auriculotemporal neuralgia, but they do not establish a reliable success rate.^[2]

Possible adverse effects include pain at the needle insertion site, bruising, swelling, altered sensation and nerve irritation. Infection, bleeding, drug reactions or injury to nearby structures may occur. Ultrasound guidance and sterile technique reduce risks without eliminating them.

Before treatment, tell your clinician about medication, allergies, anticoagulant therapy, infections and other relevant conditions. Any changes to medication must be agreed with your treating clinicians.

The PONOS specialist pathway

The decision to use PRF follows an individual assessment and discussion of the ultrasound-guided test result.

Request an assessment Somatic tinnitus (Italian)Radiofrequency principles (Italian)TMJ pain and bruxism

Frequently asked questions

Is pulsed or thermal radiofrequency used?

The procedure described uses pulsed radiofrequency (PRF) for neuromodulation, rather than thermal ablative radiofrequency.

Is the ultrasound-guided block performed before PRF?

In the PONOS pathway, the ultrasound-guided diagnostic block precedes the treatment decision and contributes to target selection alongside clinical assessment.

Does PRF always eliminate tinnitus?

No. The response may be partial, temporary or absent. Available evidence is limited, and treatment is not indicated indiscriminately for every type of tinnitus.

Is this the same as treatment of the third occipital nerve?

No. These are different nerves and anatomical targets. Any cervical component requires a dedicated assessment and should not be confused with auriculotemporal treatment.

Key references

Koning HM et al. Pulsed Radiofrequency of the Auriculotemporal Nerve to Reduce the Intensity of Tinnitus.
Tereshko Y et al. Pulsed Radiofrequency for Auriculotemporal Neuralgia: A Case Report. 2024.

General information that does not replace a medical consultation. Indications, expected benefits and risks are discussed individually.