Radiation otalgia is mainly caused by neurovascular involvement. Some patients with transverse cervical syndrome may have symptoms of large nerve involvement in the ear, mainly manifesting as tinnitus, deafness, hard of hearing, etc., and radiating pain around the auricle. x-ray open-mouth views show unequal atlanto-occipital gaps to the left and right, and inconsistent lateral atlanto-axial blocks. The atlanto-occipital gap is narrowed in the lateral view. Depending on the degree of neurovascular involvement, radiating auricular pain can be examined by symptoms: 1. small occipital nerve involvement: some patients may have symptoms of small occipital nerve involvement, mainly manifesting as radiating pain to the temporal region. 2. Occipital greater nerve involvement: Some patients may have symptoms of occipital greater nerve involvement, mainly manifesting as pain in the posterior occipital region and the top of the head toward the forehead. 3. Large nerve involvement: Some patients may have symptoms of large nerve involvement, mainly manifesting as tinnitus, deafness, hard of hearing, etc., and radiating pain around the auricle. 4, sympathetic nerve involvement: some patients can show symptoms of sympathetic nerve involvement, because the paravertebral sympathetic ganglion is located in front of the cervical 1-2 transverse process and above the prevertebral fascia, when the cervical 1 transverse process is involved, patients can often stimulate the sympathetic ganglion, and symptoms such as sympathetic disorder, irritability and dreaminess, insomnia and dreaminess can appear clinically. 5, vertebral artery involvement: some patients may have symptoms of vertebral artery involvement, because the vertebral artery bypasses the atlantoaxial region with two 90 degree bends, when the cervical 1 transverse process lesion, it can cause compression and spasm of the vertebral artery, and cause insufficient blood supply to the vertebrobasilar artery and cerebral ischemia. 6. Paraneoplastic nerve involvement: A small number of patients can show symptoms of paraneoplastic nerve involvement because it emanates from the skull base venous foramen at 2.5 cm of the anterior medial deep surface of the temporalis mastoid, then the anterior deep surface of the sternocleidomastoid muscle, the middle and upper 3/1, and then penetrates and travels through the middle and lower 3/1 of the deep surface of the trapezius muscle. When there is soft tissue injury or rotational displacement of the cervical 1 transverse process, the paraspinal nerve can be stimulated. Clinically, the patient mainly manifests as shrugging shoulder and head turning motor function is weakened. When the collateral nerve is damaged, one side of the trapezius muscle or sternocleidomastoid muscle tone decreases, and muscle atrophy may appear in serious cases. 7. Vagus nerve involvement: Some patients may have vagus nerve involvement because it emanates from the skull base venous foramen at 2.5 cm of the anterior medial deep surface of the temporalis mastoid process, and when there is soft tissue injury or rotational displacement of the cervical 1 transverse process, it can stimulate the vagus nerve. Therefore, in clinical practice, patients present with symptoms such as chest discomfort and heartbeat panic, which are called cervicogenic heart disease.