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Sigdel B, Pokhrel A. Idiopathic red ear syndrome: A rare case report. Clin Case Rep 2022; 10:e05564. [PMID: 35310317 PMCID: PMC8917311 DOI: 10.1002/ccr3.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Brihaspati Sigdel
- Department of Otolaryngology & Head and Neck Surgery Gandaki Medical College Pokhara Nepal
- Metrocity Hospital Pokhara Nepal
| | - Amrit Pokhrel
- Department of Emergency Metrocity Hospital Pokhara Nepal
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Borri J, Silva Junior HMD. Red Ear Syndrome and migraine: case report and review of this peculiar association. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction: The "Red Ear Syndrome" (RES) is a rare condition (about 100 cases were published in 25 years). It is characterized by episodes of hyperemia of the ear associated with burning pain. Although the association of this syndrome and primary headaches is contemplated in literature, its etiology and treatments are still poorly defined.
The aim of this paper is to report a case of RES related to migraine and possible pathophysiologic mechanisms.
Case Report: A 31-year-old woman presented with stabbing pain and marked erythema and edema of the right ear accompanied by burning and local hyperhidrosis. These attacks lasted 2 hours on average, and either occurred spontaneously or were associated with migraine without aura. The only means of relief during the attacks was cooling the local with ice.
Extensive laboratory-chemical, microbiological, ear-nose-throat, clinical and neurological examinations, magnetic resonance of the brain and cervical spine were unremarkable.
Conclusion: Uncertainty about the etiology of this syndrome is an obstacle to treatment. The frequent relationship between RES and migraine suggests that is necessary to investigate the syndrome in migraineurs. Furthermore, new reports about this disorder are important to increase the knowledge of physicians, to reduce the delay in diagnosis and suffering of patients.
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Oliveira ADP, Silva-Néto RP. Circadian rhythmicity on red ear syndrome in a patient with migraine: A case report. Headache 2021; 61:1581-1583. [PMID: 34873689 DOI: 10.1111/head.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.
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D'Amico A, Galati C, Manzo ML, Reina F, Nocera GM, Raieli V. Red ear syndrome in children: Review of literature and report of three cases. Int J Pediatr Otorhinolaryngol 2021; 142:110615. [PMID: 33440309 DOI: 10.1016/j.ijporl.2021.110615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Red ear syndrome (RES) is a neurological syndrome that is characterized by attacks of redness and pain that is localized in the earlobe, accompanied by a burning sensation, swelling or otalgia. The exact pathophysiology of RES is not known. Several pediatric cases have been described. They show an extreme variability in clinical presentation and therapeutic response, and therefore there are numerous difficulties in the diagnostic-therapeutic approach and in the comprehension of the physiopathology. The goal of this report is to present three clinical cases of red ear syndrome in children. These cases show various characteristics that can give useful indications regarding the differential diagnosis and the pathogenetic mechanisms that are involved, particularly when they are compared with cases published in the literature. CASE-REPORTS We report three pediatric RES cases: 1) a boy whose condition offered a typical example of the association that occurs between migraine and RES. 2) a girl with idiopathic RES. 3) a child who suffered RES attacks that showed many similarities with trigeminal autonomic cephalalgias. CONCLUSION Our clinical series shows the different ways in which RES can be expressed and they support the reported scientific literature. We suggest that the different forms of RES have a common final autonomic pathogenetic mechanism that is activated by parasympathetic hyperactivity and sympathetic inhibition. The different temporal characteristics, frequency, etc. may depend on the activation of distinct physiopathological modules that are related to the pain circuits, as suggested by the modular theory which describes that groups of neurons are defined as a module, where each module is responsible for a symptom and the individual's headache is defined by the activated modules.
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Affiliation(s)
- Antonina D'Amico
- Child Neuropsychiatry School - University of Palermo, Piazzale Delle Cliniche Palermo, 90100, Italy
| | - Cristina Galati
- Child Neuropsychiatry School - University of Palermo, Piazzale Delle Cliniche Palermo, 90100, Italy
| | - Maria Laura Manzo
- Child Neuropsychiatry School - University of Palermo, Piazzale Delle Cliniche Palermo, 90100, Italy
| | - Federica Reina
- Child Neuropsychiatry School - University of Palermo, Piazzale Delle Cliniche Palermo, 90100, Italy
| | - Giovanna Martina Nocera
- Child Neuropsychiatry School - University of Palermo, Piazzale Delle Cliniche Palermo, 90100, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit- ISMEP -P.O. Cristina - ARNAS Civico, Via Dei Benedettini 1Palermo, 90100, Italy.
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Cinats AK, Haber RM. Pediatric red ear syndrome: A case report of an erythromelalgia type and review of the literature. Pediatr Dermatol 2019; 36:686-689. [PMID: 31259429 DOI: 10.1111/pde.13911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Allison K Cinats
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard M Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Affiliation(s)
- R. Allan Purdy
- Professor of Medicine (Neurology); Dalhousie University; Halifax Canada
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Abstract
Migraine and tension-type headaches are common primary headache disorders encountered among children and adolescents presenting to a pediatric clinic. At times, children present with a headache with unusual or peculiar features that can be alarming and perplexing. These can be in the form of a brief stabbing headache with lacrimation in one eye or a continuous headache locked to one side of the head or face. These headache syndromes tend to be more common among adults but, on occasion, are known to occur or have their onset during childhood. This review outlines some of the uncommon primary headache disorders in children and adolescents that may be encountered in a pediatric clinic. Knowledge of these interesting conditions may avert the need for immediate neurological consultation and prevent delays in initiating specific therapy. [Pediatr Ann. 2018;47(2):e69-e73.].
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Moitri MO, Banglawala SM, Archibald J. Red ear syndrome: literature review and a pediatric case report. Int J Pediatr Otorhinolaryngol 2015; 79:281-5. [PMID: 25583087 DOI: 10.1016/j.ijporl.2014.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/25/2022]
Abstract
Red ear syndrome (RES) is characterized by recurrent unilateral or bilateral painful attacks of the external ear, accompanied by ear redness, burning, or warmth. Proposed etiologies of this rare condition include dysregulation of sympathetic outflow, upper cervical pathology, glossopharyngeal and trigeminal neuralgia, TMJ dysfunction, thalamic syndrome, and primary headache syndromes. Idiopathic cases also exist in the literature. Pediatric cases are particularly rare and more commonly associated with migraine. Given the various potential etiologies, no single treatment is effective in all cases. This paper summarizes the current understanding and management of RES, and describes a case of idiopathic pediatric RES.
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Affiliation(s)
- Misha O Moitri
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
| | - Sarfaraz M Banglawala
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
| | - Jason Archibald
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
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Raieli V, Giordano G, Spitaleri C, Consolo F, Buffa D, Santangelo G, Savettieri G, Vanadia F, D'Amelio M. Migraine and cranial autonomic symptoms in children and adolescents: a clinical study. J Child Neurol 2015; 30:182-6. [PMID: 24846900 DOI: 10.1177/0883073814535494] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The frequency of cranial autonomic symptoms in children affected by primary headaches is uncertain. The aim of our study was to estimate the frequency of symptoms in pediatric headaches and correlate it with main migraine characteristics. A questionnaire investigating the presence of cranial autonomic symptoms was administered to all children with primary headache for 2 years. A total of 230 children with primary headache (105 males, 125 females) were included. Two hundred two children were affected by migraine and 28 (12.2%) by other primary headaches. Cranial autonomic symptoms were significantly complained by migraineurs (55% vs. 17.8%) (P < .001) and by children with higher frequency of migraine attacks (odds ratio = 2.6, confidence interval = 1.4-4.7, P = .001). Our findings show that cranial autonomic symptoms are rather common during pediatric migraine attacks. The association between cranial autonomic symptoms and higher frequency of attacks might suggest the role of the trigeminal-autonomic reflex in migraine pathophysiology.
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Affiliation(s)
- V Raieli
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Giordano
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | - C Spitaleri
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | - F Consolo
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - D Buffa
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Santangelo
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Savettieri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - F Vanadia
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - M D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Chan CC, Ghosh S. Red ear syndrome precipitated by a dietary trigger: a case report. J Med Case Rep 2014; 8:338. [PMID: 25303997 PMCID: PMC4196464 DOI: 10.1186/1752-1947-8-338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Red ear syndrome is a rare condition characterized by episodic attacks of erythema of the ear accompanied by burning ear pain. Symptoms are brought on by touch, exertion, heat or cold, stress, neck movements and washing or brushing of hair. Diagnosis and treatment of this condition are challenging. The case we report here involves a woman whose symptoms were brought on by a dietary trigger: orange juice as well as stress, causing significant physical and psychological morbidity. Avoidance of triggers resulted in symptomatic improvement. Case presentation A 22-year-old Caucasian woman who was a student presented twice to our department with evolving symptoms, the first time with hyperacusis (abnormal sound sensitivity arising from within the auditory system to sounds of moderate volume), intermittent right tinnitus and subjective hearing difficulties. She presented five years later with highly distressing episodes of erythematous ears, which were associated with burning pain around the ear and temporal areas, and intolerance to noise. After keeping a symptom diary, she identified orange juice and stress as triggers of her symptoms. No local head and neck pathology was present. Investigations and imaging were negative. Avoidance of triggers led to great symptomatic improvement. To the best of our knowledge, dietary triggers have not previously been reported as a trigger for this syndrome. This case shows a direct temporal link to a dietary trigger and supports a primary pathogenesis. Recognition and management of primary headache disorder and simple dietary and lifestyle changes brought about symptomatic relief. Conclusion Red ear syndrome is a little-known clinical syndrome of unknown etiology and management. To the best of our knowledge, our present case report is the first to describe primary red ear syndrome triggered by orange juice. Clinical benefit derived from avoidance of this trigger, which is already known to precipitate migraines, gives some insight into the pathogenesis of red ear syndrome.
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Affiliation(s)
- Chung Chi Chan
- Department of Audiovestibular Medicine, St Ann's Hospital, St Ann's Road, London N15 3TH, UK.
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Lambru G, Bakar NA, Matharu M. SUNA and red ear syndrome: a new association and pathophysiological considerations. J Headache Pain 2013; 14:32. [PMID: 23565730 PMCID: PMC3631130 DOI: 10.1186/1129-2377-14-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022] Open
Abstract
Red ear syndrome (RES) is characterised by attacks of unilateral or bilateral burning ear pain associated with erythema. Primary and secondary forms have been described. Primary RES appears to have a frequent association with primary headaches especially migraine. Here, we describe the case of a woman with short-lasting unilateral neuralgiform attacks with cranial autonomic symptoms (SUNA) and recurrent episodes of ipsilateral red ear triggerable by cutaneous stimulation. Lamotrigine was beneficial for her SUNA but not for the RES. Both these disorders are extremely rare therefore their coexistence in the same individual may suggest similar pathophysiological mechanisms rather than a chance association.
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Affiliation(s)
- Giorgio Lambru
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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Eismann R, Gaul C, Wohlrab J, Marsch WC, Fiedler E. Red Ear Syndrome: Case Report and Review of the Literature. Dermatology 2011; 223:196-9. [DOI: 10.1159/000331578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/19/2011] [Indexed: 11/19/2022] Open
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Raieli V, Compagno A, Brighina F, La Franca G, Puma D, Ragusa D, Savettieri G, D'Amelio M. Prevalence of red ear syndrome in juvenile primary headaches. Cephalalgia 2010; 31:597-602. [PMID: 21123628 DOI: 10.1177/0333102410388437] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have suggested a relationship between 'red ear syndrome' (RES) and pediatric migraine. Aims of this study were (i) to assess the frequency, specificity and sensitivity of RES in a population of pediatric migraineurs and (ii) to establish the pathophysiological mechanisms of RES associated with migraine. METHODS AND RESULTS A total of 226 children suffering from headache (aged 4-17 years) were enrolled. One hundred and seventy-two (76.4%) were affected by migraine, the remaining 54 (23.6%) by other primary headaches. RES was followed significantly more frequently by migraine (23.3%; p < .0001), and was characterized by high specificity and positive predictive value (96.3 and 95.3%, respectively). According to the univariate statistical analysis, RES showed a statistically significant association with male gender, throbbing quality of the pain, vomiting and phonophobia. It was confirmed by a multivariate stepwise logistic regression model only for the throbbing quality of the pain, vomiting and male gender. CONCLUSIONS Our study showed that (i) in children, RES is a highly specific sign for migraine. In addition, the evidence of an association of RES with some migraine features partially provoked by the parasympathetic system supports the hypothesis of a shared pathophysiological background (e.g. via the activation of the trigeminal-autonomic reflex).
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Affiliation(s)
- V Raieli
- U.O. di Neuropsichiatria Infantile, P.O. G. Di Cristina, Palermo, Italy.
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