Indomethacin-Responsive Idiopathic Red Ear Syndrome: Case Report and Pathophysiology

Idiopathic red ear syndrome: A rare case report

Red ear syndrome (RES) is a very rare disorder that is characterized by a unilateral or bilateral attack of paroxysmal burning sensation and reddening of the external ear. The duration of symptoms ranges from a few seconds to hours. It can occur spontaneously or be triggered by rubbing of the ear, heat or cold stimulation, brushing of hair, and neck movement. Diagnosis and treatment of this condition are challenging. The pathophysiology of RES is still unclear and hypotheses involving peripheral or central nervous system mechanisms have been proposed. RES is regarded as refractory to medical treatments, although some migraine preventative treatments have shown moderate benefit mainly in patients with migraine‐related attacks. We report a case with Idiopathic RES who presented with paroxysmal redness of the bilateral pinnae partially benefitted by medical treatment.

Pediatric red ear syndrome: A case report of an erythromelalgia type and review of the literature

Red ear syndrome has been reported in the literature to have similarities to erythromelalgia with auricular involvement; however, the distinction between the two is controversial. Red ear syndrome has previously been classified as idiopathic (primary) or secondary, with headaches being the most common association in the idiopathic or primary form. We present a case of pediatric red ear syndrome with hand and foot involvement that we believe represents auricular erythromelalgia. In this report, we propose a classification system to unify the diagnoses of red ear syndrome and erythromelalgia and review the literature on pediatric cases of red ear syndrome.

Current pain management strategies for patients with erythromelalgia: a critical review

Erythromelalgia (EM) is a rare disorder characterized by erythematous, warm, painful extremities, which is often precipitated by cold conditions. The pathophysiology of EM is incompletely understood. Recent investigations have identified sodium channelopathy as a genetic cause for this pain condition, classified as primary inherited EM. Other subtypes are idiopathic EM and secondary EM. The management of pain in EM is challenging as no single therapy has been found to be effective. There is varying response to pharmacotherapy and significant variability within this clinical population, resulting in a stepwise trial and error approach. Consequently, EM is often associated with poorer health-related quality of life with higher morbidity. There is currently no consensus or guidelines on management of pain in EM. This is a review of the literature on management of pain using pharmacologic, procedural intervention and nonpharmacologic treatment in children and adults with EM.

Red Ear: Syndrome or Symptom?

Red ear syndrome (RES) is a rare disorder characterized by attacks of unilateral ear pain during which the ear becomes red. Episodes can occur spontaneously, or be triggered, in most cases, by rubbing or touching the ear. Both duration and frequency are variable. RES has been explained by a dysfunction of cervical spinal nerves (C3 root) and a dysregulation with disinhibition of brainstem trigemino-autonomic circuits, leading to sympathetic inhibition and parasympathetic hyperactivity producing vasodilation. We describe 6 new cases of RES with different characteristics. Although all presented the cardinal symptom of red ear, the headache patterns were suggestive of other primary headaches (migraine or cluster headache). Therapeutic response was obtained when directed to the associated primary headache phenotype, suggesting that RES may be a phenomena associated with different headaches, rather than a syndrome in itself.