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All About Red Ear Syndrome

"Red Ear Syndrome" attacks are episodes of burning pain of one ear, often provoked by touch, neck movement or straining.

The condition has probably been around for centuries, but was only ever published in 1994 by the Australian Neurologist JW Lance.

It is another provoked head or face pain, and can be experienced after lying on the affected side, or contact with cold or hot water.



It mostly affects women (8 to 1 in one paper!), with people aged from mid-20's to mid-70's reported.

Attacks of Red Ear can last anything from 15 minutes to a couple of days, although most seem to last no more than a few hours.

Some people will have a few minutes of a red, hot ear, and the redness does not spread beyond the ear.

This is followed by pain on the same side of the head or face or ear.

The pain is usually restricted to the area of the head behind or above the ear, but can involve the upper neck, cheek or temple on the same side.

Some people will only have reddening of the ear without much in the way of pain. Others will experience an unpleasant burning sensation when the ear reddens.

Recorded triggers include:

  1. Neck rotation
  2. Touch e.g. lying down on the affected side
  3. Cough
  4. Sneezing
  5. Hot environment
  6. Washing or brushing hair
  7. Drinking or chewing

A model of the ear - the bit that goes red is the fleshy bit on the outside of the ear called the pinna



What conditions are associated with Red Ear?

The condition is often unexplained, but a few diseases have been recorded alongside cases of red ear syndrome:

  1. Chiari Malformation
  2. Osteoarthritic degeneration of C2/3 facet (zygoapophyseal) joints
  3. Thalamic Stroke (which causes a centrally generated pain syndrome)
  4. TMJ Dysfunction
  5. Carotid Body Tumour (which can also cause pulsatile tinnitus)
  6. Herpes Zoster
  7. Migraine with aura - may occur at same time as red ear or independently of red ear


What are the Treatments for Red Ear Syndrome?

Red ears may be due to abnormal regulation of the blood flow to the ear due to sypmpathetic nerve dysfunction. This results in increased blood flow, which then causes the ear to turn red.

Treatment tried in individual cases include the following, but they are strcitly ona trial and error basis.

None are proven in scientific studies, but are seen as a reasonable bet given that these treatments seem to work in other headache disorders:

  1. Flunarazine
  2. Indomethacin
  3. Occipital Nerve Block
  4. Famciclovir (Herpes Zoster cases only)
  5. Amitryptiline,
  6. Piroxicam
  7. Methysergide
  8. C2/3 facet joint denervation
  9. Posterior Auricular Nerve Block
  10. Auriculotemporal Nerve Block
  11. Propranolol
  12. Imipramine
  13. Ice-pack
  14. Nimodipine

In my limited experience - this can be difficult to treat. However, very disabling cases are not commonly reported, and there is at least a list of medications to try, even if on a speculative basis.



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