What Is Red Ear Syndrome?

I’m not embarrassed, I’m not drunk, and I’m not frostbitten, so why are my ears bright red? Most of us have probably never heard of something that doctors refer to as the “red ear syndrome”. Don’t worry. Many doctors have never heard of it either. I certainly had never heard of such a thing until it happened to me last year.

Mine was a delayed side effect from receiving my MMR vaccine. I had large hives that started on my legs, turned into a red polka dot fest on my torso, hives again on my arms, and then for the finale, 2 bright red, stinging and burning hot tamales for ears. Thanks to being in the heart of Covid lockdown, I wasn’t able to see my doctor about this. It wasn’t considered life-threatening enough. So, I just emailed her. She didn’t seem too concerned. In the end, the red ear part lasted maybe an annoying month or so and completely resolved on its own with no treatment other than ice packs to cool down my ears. It was only worsened by Covid masking mandates and being a dentist. The earloops on the masks were really uncomfortable around my ears during that time. It made my ears itch, burn, and sting.

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What is Red Ear Syndrome?

So what exactly am I referring to as this “red ear syndrome”? I’m not referring to the times when your ear gets red from being out in the cold for too long, or when you’ve had a few too many martinis. Yes, you know what I’m talking about. Those situations are considered normal consequences of either local (the cold temperature) or systemic (alcohol consumption) factors that cause blood to rush to our ears. “Red ear syndrome” refers to a different medical condition.
The phrase “red ear syndrome” was first officially coined by Dr. James Lance in 1994. So what did Dr. Lance have to say about this mysterious phenomenon?

The Red Ear Syndrome (RES) is a relatively unknown neurological syndrome. RES is characterized by unilateral/bilateral episodes of ear erythema, generally associated with burning pain, frequently precipitated by touch, movements of the head or neck, or temperature changes.

Pain is usually described as burning and moderately disabling. The duration of episodes widely varies, with most attacks lasting less than one hour. The frequency of attacks is also variable. (Raeili et al, 2016)

RES can be classified into two types: Primary RES and Secondary RES. Primary type RES occurs more in younger individuals and is short-lasting with variable recurrence and most of them have a history of migraine. In contrast, secondary RES occurs in older with female predominance and without a history of migraine or associated with the trigger.

Secondary RES has been attributed to a number of disorders such as cervical arachnoiditis, traction injury of upper cervical roots, atypical neuralgias, temporomandibular joint dysfunction, or thalamic syndrome. (Raeili et al, 2019)

In English, basically, it’s ears that have decided that they’re tired of being overshadowed by the rest of the head so they demand to be seen and heard. It can involve one or both ears, and commonly results in bright red, burning to the touch, stinging, and just generally uncomfortable ears.

What causes it?

Honestly, no one has any idea why this really happens. But there are some theories.

Is it dangerous?

So far, no, it doesn’t appear to have any dangerous consequences. It can be annoying and uncomfortable. It can increase your stress from not knowing what’s wrong with your ear. And it can be embarrassing to have 1 or 2 bright red beets dangling off the sides of your head.

Does it need treatment?

Need? No, not really. Part of the issue is that no one really knows what causes the red ears, so it makes it kind of difficult to come up with a treatment. Because it is believed to be related to some different types of headaches, some doctors have tried different headache treatments for red ear syndrome. Some work. Some don’t. Whether you get any sort of treatment doesn’t really matter since the red ears usually resolve on their own. So consider yourself lucky enough to have experienced a true medical mystery.

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  • Raieli V, Compagno A, D’Amelio M. Red Ear Syndrome. Curr Pain Headache Rep. 2016 Mar;20(3):19. doi: 10.1007/s11916-016-0547-y. PMID: 26879877.

  • Raieli V, D’Amelio M, Brighina F. The Mystery of “Red Ear Syndrome”: Sign or Syndrome. Headache. 2019 Apr;59(4):624-625. doi: 10.1111/head.13524. PMID: 30973193.

  • Patel I, Desai D, Desai S. Red Ear Syndrome: Case Series and Review of a Less Recognized Headache Disorder. Ann Indian Acad Neurol. 2020 Sep-Oct;23(5):715-718. doi: 10.4103/aian.AIAN_1_20. Epub 2020 Apr 7. PMID: 33623284; PMCID: PMC7887477.

  • Lance JW. The mystery of one red ear. Clin Exp Neurol. 1994;31:13-8. PMID: 7586661.

  • Lance JW. The red ear syndrome. Neurology. 1996 Sep;47(3):617-20. doi: 10.1212/wnl.47.3.617. PMID: 8797453.

  • Lambru G, Miller S, Matharu MS. The red ear syndrome. J Headache Pain. 2013 Oct 4;14(1):83. doi: 10.1186/1129-2377-14-83. PMID: 24093332; PMCID: PMC3850925.
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