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Same Issues
I have been googling for months, trying to find someone with related symptoms to what I've been experiencing. I'm a 25 year old female. I've been experiencing red ears for 5 months now. I've gone to an allergist, PCP, immunologist, and rheumatologist about my symptoms. No one seems to know what's going on. Anyway, my ears get extremely red and hot. And eye twitched for months. It finally stopped whenever I was at my tipping point of annoyance, ironically, the day before I went back to my PCP. Since my eye stopped twitching, I've been experiencing frequent, intense twitching on other parts of my body on the left side-- leg, thumb, forearm, etc. I've had extreme back pain that has left me unable to walk well for days at a time. The most shocking part of our similarities (or the most diagnostically critical part) is that my mom, like your sister, has MS. I noticed that your post was 8 years ago, so I pray you still receive this message. I'd love to know what you've found out so I can steer my doctors in the same direction. Thank you very much.
This discussion is related to Eye twitch and 'Hot Ear' attacks frequent. Worried about Nerve Disorder.
Hi. :) I don't know if this will help you, but I was reading about something called Red Ear Syndrome yesterday. I hope you feel better soon.
Red Ear Syndrome
The RES was first described by Lance, in 1994.[20] This syndrome is commonly unilateral and implies discomfort or burning pain as well as change in color (erythema) that may involve the adjacent skin of the cheek. The pain may radiate to the cheek, forehead, a strip behind or below the mandible, the area behind the ear, occiput, and the upper posterior aspect of the neck on the same side.[21,22] Attacks may be either spontaneous or may be precipitated by exercise, stress, exposure to heat or cold, touching the ear, drinking, coughing, chewing, sneezing, or neck movement.[23,24] The involvement, in fact, may be unilateral or bilateral;[23,25,26] symptoms are often present beyond the ear, and color change is only one of the many symptoms reported by patients.[27] The duration of the pain is variable, lasting from 10 minutes to many hours.[22] The frequency is also variable, from less than one per month to four per day.[22] The cutaneous erythema should be observable to the patient and the examiner, during the attack.[28] Various case reports have shown that the disorder need not necessarily result in significant ear pain but rather only redness of the ear.[29] More than 80 cases have been reported, so far. About 60% of the cases are in women and 40% are in men.[30]
No association with primary headache disorders, including migraine, hemicrania continua, chronic paroxysmal hemicrania, and SUNCT has been reported in adults. Raieli et al[23,31,32] have shown that this syndrome is very frequent (24%) in children and adolescents with migraine with and without aura. In this population, RES was significantly more prevalent in males, with throbbing pain and vomiting.[31] If patients also experience migraine, RES may be in association with migraine attacks or not.[22]
Because of varied etiology, this entity may have primary and secondary forms. RES may exist as an idiopathic, primary trigeminal or cervical autonomic cephalgia, it may coexist with migraine and other trigeminal autonomic cephalgias,[33] and there may be secondary forms, in association upper cervical disorders with irritation of the third cervical root, temporomandibular joint dysfunction, glossopharyngeal, and trigeminal neuralgia, or thalamic syndrome.[21,29,30] Probably, the idiopathic forms are more frequent in children while the secondary ones are more common in the elderly.[24,34] In a child with systemic lupus erythematosus, a thalamic lesion, caused by a vasculitis of the middle cerebral artery, was the most probable cause of RES.[35] Activation of the trigeminovascular system may represent a common pathophysiologic mechanism of all etiologies,[23] with an antidromic discharge of impulses along the third cervical root, and release of vasodilator peptides in the ear, such as substance P, calcitonin gene-related peptide, and nitric oxide, which are responsible for pain and vasodilatation.[21,27,30,36]
Differential diagnoses of RES includes erysipelas, herpes zoster, diffuse otitis externa (Pseudomonas aeroginosa), streptococcal infections, borrelial lymphocytoma, Hansen's disease, erythromelalgia, relapsing polychondritis, chondrodermatitis, nodularis helices, cartilaginous pseudocyst, eczematous diseases, granulomatous diseases, and photodermatoses.[30,37] Erythromelalgia is the main differential diagnosis. Most patients with erythromelalgia experience the symptoms in the feet (90%) and/or in the hands (25%), but only rarely involves just the ears.[38, 39] It is usually bilateral, but may be unilateral, especially in secondary cases. Since RES and erythromelalgia have several diagnostic criteria in common (erythema, elevated temperature, burning pain, and pain aggravated by warmth and relieved by coldness), they probably have a similar pathogenesis. Today, some authors believe that erythromelalgia is a component of RES, and it is possible that RES is the auricular variant of erythromelalgia.[37]
A variety of treatments have been used for RES. Because of the multiplicity of potential causes, there is no a treatment of choice, and many patients are resistant to all treatments.[28,29] A temporary or permanent relief can be achieved by a local anesthetic block or even section of the third cervical root.[21,24] A case of fibrosis surrounding the C3 root and the vertebral artery responded dramatically to microvascular cervical decompression.[33] Some cases have responded to amitriptyline,[21,39,40] gabapentin,[22,41] indomethacin,[22,40] flunarizine,[23] nimodipine,[23] and ibuprofen.[29,41]
Red Ear Syndrome
The RES was first described by Lance, in 1994.[20] This syndrome is commonly unilateral and implies discomfort or burning pain as well as change in color (erythema) that may involve the adjacent skin of the cheek. The pain may radiate to the cheek, forehead, a strip behind or below the mandible, the area behind the ear, occiput, and the upper posterior aspect of the neck on the same side.[21,22] Attacks may be either spontaneous or may be precipitated by exercise, stress, exposure to heat or cold, touching the ear, drinking, coughing, chewing, sneezing, or neck movement.[23,24] The involvement, in fact, may be unilateral or bilateral;[23,25,26] symptoms are often present beyond the ear, and color change is only one of the many symptoms reported by patients.[27] The duration of the pain is variable, lasting from 10 minutes to many hours.[22] The frequency is also variable, from less than one per month to four per day.[22] The cutaneous erythema should be observable to the patient and the examiner, during the attack.[28] Various case reports have shown that the disorder need not necessarily result in significant ear pain but rather only redness of the ear.[29] More than 80 cases have been reported, so far. About 60% of the cases are in women and 40% are in men.[30]
No association with primary headache disorders, including migraine, hemicrania continua, chronic paroxysmal hemicrania, and SUNCT has been reported in adults. Raieli et al[23,31,32] have shown that this syndrome is very frequent (24%) in children and adolescents with migraine with and without aura. In this population, RES was significantly more prevalent in males, with throbbing pain and vomiting.[31] If patients also experience migraine, RES may be in association with migraine attacks or not.[22]
Because of varied etiology, this entity may have primary and secondary forms. RES may exist as an idiopathic, primary trigeminal or cervical autonomic cephalgia, it may coexist with migraine and other trigeminal autonomic cephalgias,[33] and there may be secondary forms, in association upper cervical disorders with irritation of the third cervical root, temporomandibular joint dysfunction, glossopharyngeal, and trigeminal neuralgia, or thalamic syndrome.[21,29,30] Probably, the idiopathic forms are more frequent in children while the secondary ones are more common in the elderly.[24,34] In a child with systemic lupus erythematosus, a thalamic lesion, caused by a vasculitis of the middle cerebral artery, was the most probable cause of RES.[35] Activation of the trigeminovascular system may represent a common pathophysiologic mechanism of all etiologies,[23] with an antidromic discharge of impulses along the third cervical root, and release of vasodilator peptides in the ear, such as substance P, calcitonin gene-related peptide, and nitric oxide, which are responsible for pain and vasodilatation.[21,27,30,36]
Differential diagnoses of RES includes erysipelas, herpes zoster, diffuse otitis externa (Pseudomonas aeroginosa), streptococcal infections, borrelial lymphocytoma, Hansen's disease, erythromelalgia, relapsing polychondritis, chondrodermatitis, nodularis helices, cartilaginous pseudocyst, eczematous diseases, granulomatous diseases, and photodermatoses.[30,37] Erythromelalgia is the main differential diagnosis. Most patients with erythromelalgia experience the symptoms in the feet (90%) and/or in the hands (25%), but only rarely involves just the ears.[38, 39] It is usually bilateral, but may be unilateral, especially in secondary cases. Since RES and erythromelalgia have several diagnostic criteria in common (erythema, elevated temperature, burning pain, and pain aggravated by warmth and relieved by coldness), they probably have a similar pathogenesis. Today, some authors believe that erythromelalgia is a component of RES, and it is possible that RES is the auricular variant of erythromelalgia.[37]
A variety of treatments have been used for RES. Because of the multiplicity of potential causes, there is no a treatment of choice, and many patients are resistant to all treatments.[28,29] A temporary or permanent relief can be achieved by a local anesthetic block or even section of the third cervical root.[21,24] A case of fibrosis surrounding the C3 root and the vertebral artery responded dramatically to microvascular cervical decompression.[33] Some cases have responded to amitriptyline,[21,39,40] gabapentin,[22,41] indomethacin,[22,40] flunarizine,[23] nimodipine,[23] and ibuprofen.[29,41]
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