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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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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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de Amorim IL, Kauppila LA, Martins IP. Red Ear: Syndrome or Symptom? Headache 2018; 58:885-891. [PMID: 29802637 DOI: 10.1111/head.13333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Isabel Loução de Amorim
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Linda Azevedo Kauppila
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Isabel Pavão Martins
- Department of Neurology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Chan TLH, Becker WJ, Jog M. Indomethacin-Responsive Idiopathic Red Ear Syndrome: Case Report and Pathophysiology. Headache 2017; 58:306-308. [PMID: 29193054 DOI: 10.1111/head.13237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tommy L H Chan
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
| | - Werner J Becker
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
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Bender SD. Primary and Secondary Red Ear Syndrome: Implications For Treatment. Cephalalgia 2016; 27:1286-7; author reply 1287. [DOI: 10.1111/j.1468-2982.2007.01411_1.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Flicinski J, Wigowska-Sowinska J, Winczewska-Wiktor A, Steinborn B. Red ear syndrome – Case report and review of literature. Neurol Neurochir Pol 2015; 49:74-7. [DOI: 10.1016/j.pjnns.2015.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
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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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Luo DQ, Zhao YK, Xu QF, He XQ, Wu LC. Recurrent facial erythema with burning sensation and increased temperature: a variant of erythromelalgia or a new entity? PAIN MEDICINE 2014; 15:1007-10. [PMID: 24433512 DOI: 10.1111/pme.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Erythromelalgia is a rare clinical syndrome characterized by episodic attacks of burning pain, erythema, and increased temperature, primarily affecting the extremities, and in rare instances, involving the ear, face, neck, and the scrotum. The dermatoscopic features of erythromelalgia in a case with solely facial involvement have never been described previously. OBSERVATIONS We describe a 14-year-old female who presented with erythema, burning sensation, and warmth on her face only, which mimic the features of erythromelalgia. Physical examination showed higher temperature on the involved cheeks than on axillas during the episode, while the temperature on both areas was the same between episodes. Dermatoscope showed more dilated vessels inside the erythema during the episodes than between the episodes. The symptoms had excellent response to the combination treatment of gabapentin, indomethacin, and topical lidocaine compounds. CONCLUSIONS The present case is considered to be a variant of erythromelalgia. Its erythema may be resulted from the dilated vessels. Combination of modalities may provide effective management for erythromelalgia. "Erythermalgia" may be better than "erythromelalgia" to describe such conditions.
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Affiliation(s)
- Di-Qing Luo
- Department of Dermatology, Huangpu Hospital of The First Affiliated Hospital
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Abstract
Red Ear Syndrome (RES) is a very rare disorder, with approximately 100 published cases in the medical literature. Red ear (RE) episodes are characterised by unilateral or bilateral attacks of paroxysmal burning sensations and reddening of the external ear. The duration of these episodes ranges from a few seconds to several hours. The attacks occur with a frequency ranging from several a day to a few per year. Episodes can occur spontaneously or be triggered, most frequently by rubbing or touching the ear, heat or cold, chewing, brushing of the hair, neck movements or exertion. Early-onset idiopathic RES seems to be associated with migraine, whereas late-onset idiopathic forms have been reported in association with trigeminal autonomic cephalalgias (TACs). Secondary forms of RES occur with upper cervical spine disorders or temporo-mandibular joint dysfunction. RES is regarded refractory to medical treatments, although some migraine preventative treatments have shown moderate benefit mainly in patients with migraine-related attacks. The pathophysiology of RES is still unclear but several hypotheses involving peripheral or central nervous system mechanisms have been proposed.
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Affiliation(s)
- Giorgio Lambru
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Sarah Miller
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Manjit S Matharu
- Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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Picco PP, D’Alessandro M, Leoni M, Doglio M, Martini A. Primary red ear syndrome associated with cochleo-vestibular symptomatology: A paediatric case report. Cephalalgia 2013; 33:1277-80. [DOI: 10.1177/0333102413493527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Red ear syndrome (RES), first described by Lance in 1996 in an adult series, may be primary or associated with headache syndromes, upper cervical disorders or vascular anomalies. Clinically the disease is characterised by recurrent episodes of reddening and burning pain in the auricle, usually elicited by different triggers. The prevalence of RES in the paediatric age group remains poorly understood. Several therapeutic approaches have been tried with heterogeneous clinical response. Case results We report a paediatric patient suffering from primary RES associated with debilitating cochleo-vestibular symptomatology causing severe discomfort. Three years after the disease onset, the patient also developed headache, with clinical features of migraine. Discussion The temporal and spatial association could suggest shared pathogenetic features between neurological (cochleo-vestibular) and vascular (red and burning ear) symptomatology, likely related to trigeminal autonomic reflex activation, although further studies are required for full comprehension of RES pathogenesis.
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Affiliation(s)
- Paolo P Picco
- Department of Paediatric Rheumatology, G Gaslini Institute, Italy
| | | | | | - Matteo Doglio
- Department of Paediatric Rheumatology, G Gaslini Institute, Italy
| | - Alberto Martini
- Department of Paediatric Rheumatology, G Gaslini Institute, University of Genoa, Italy
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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Abstract
Background Red ear syndrome is characterised by episodic unilateral erythema of the ear associated with pain and burning sensation. Patients and methods We describe the case of a young woman with daily, frequent, recurrent episodes of red ear syndrome in the absence of any structural lesions, primary headache disorder or obvious triggers. We review all previously described cases and discuss postulated mechanisms for this syndrome. Conclusions The exact cause of this rare headache disorder remains unknown and treatment options vary considerably.
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Affiliation(s)
- Suzanne Ryan
- Division of Medical Sciences, John Radcliffe Hospital, UK
| | | | - Paul Davies
- Department of Neurology, John Radcliffe Hospital, UK
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Maranhão-Filho PA, Vincent MB. The mystery of two red ears: A bilateral simultaneous case. Cephalalgia 2011; 31:1587. [DOI: 10.1177/0333102411421684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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Créac'h C, Duthel R, Barral F, Nuti C, Navez M, Demarquay G, Laurent B, Peyron R. Positional cluster-like headache. A case report of a neurovascular compression between the third cervical root and the vertebral artery. Cephalalgia 2010; 30:1509-13. [PMID: 20974591 DOI: 10.1177/0333102410373158] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Symptomatic cluster-like headaches have been described with lesions of the trigeminal and parasympathetic systems. Here, we report the case of a 44-year-old woman with continuous auricular pain and a positional cluster-like headache associated with red ear syndrome. Clinical data and morphological investigations raised the hypothesis of a neurovascular compression between the C3 root and vertebral artery. Neurosurgical exploration found a fibrosis surrounding both the C3 root and the vertebral artery. The excellent outcome after microvascular cervical decompression suggests a causal relationship between the cluster-like headache and the vertebral constraint on the C3 root.
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Grimaldi D, Batista S, Poisson A, Verschelde HL, Vázquez-Sánchez F. The Almirall European Headache Awards 2009. J Headache Pain 2010; 11:207-14. [PMID: 20369271 PMCID: PMC3451906 DOI: 10.1007/s10194-010-0209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 03/16/2010] [Indexed: 01/21/2023] Open
Abstract
The Almirall European Headache Awards (AEHA) were organized in conjunction with the European Headache Federation. The awards were held in 2009, aiming to share clinical experience and best practice in headache-related disease management. 56 unusual and challenging cases of headache from 5 European countries (Belgium, France, Italy, Portugal and Spain) were judged by a Scientific Committee including expert representatives from participating countries, acting as reviewers. Three cases were selected from each country. The 15 resulting cases were presented to the Scientific Committee in Madrid, Spain in November 2009 and awards were given to the top 5 presentations. This article presents details of these cases, including the award winning entries. They have been categorized into four main groups: (a) headaches in rare syndromes; (b) secondary headaches to infectious/autoimmune causes or post-trauma/mass occupation; (c) headache in unresolved cases; and (d) other relevant cases. First prize was awarded to a case involving a 55-year-old male with familial thrombocytopenia and a unilateral neuralgiform headache secondary to trigeminal vascular contact, and which was successfully treated with carbamazepine. Conclusions from the meeting include: rare syndromes do occur and require appropriate treatment to improve outcomes; concomitant diseases may impair adequate diagnosis and should be investigated; physicians should be cautious and treat possible serious underlying disease, whilst accurately clarifying the correct diagnosis; neurological examination and complementary tests may be required; consideration should be given to possible rare medication events; and some cases may remain without a clear cause or diagnosis and symptoms should be treated whilst investigations continue.
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Affiliation(s)
- Daniela Grimaldi
- Neurological Sciences Department, University of Bologna, Via U Foscolo 7, 40123 Bologna, Italy.
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Selekler M, Kutlu A, Uçar S, Almaç A. Immediate Response to Greater Auricular Nerve Blockade in Red Ear Syndrome. Cephalalgia 2009; 29:478-9. [DOI: 10.1111/j.1468-2982.2008.01756.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Selekler
- Department of Neurology, Medical Faculty, Kocaeli University, Umuttepe, Turkey
| | - A Kutlu
- Department of Neurology, Medical Faculty, Kocaeli University, Umuttepe, Turkey
| | - S Uçar
- Department of Otolaryngology, Medical Faculty, Kocaeli University, Umuttepe, Turkey
| | - A Almaç
- Department of Otolaryngology, Medical Faculty, Kocaeli University, Umuttepe, Turkey
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Abstract
The red ear syndrome is a rare syndrome originally described by Lance in 1994. It involves pain in and around the ear and associated autonomic phenomena, the most significant of which is cutaneous erythema of the ear ipsilateral to the pain and obvious to the patient and examiner during the attack. It may well represent an auriculo-autonomic cephalgia and/or be part of the group of disorders recognized as trigeminal autonomic cephalalgias. As a syndrome, it still lacks specificity in regard to etiology, mechanisms, and treatment but is important to recognize clinically because of its associations.
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Affiliation(s)
- R Allan Purdy
- Division of Neurology, Department of Medicine, Dalhousie University, QEII Health Sciences Center, Halifax, Nova Scotia, B3H 3Y9, Canada.
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