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Neurology
Red colour of a painful ear: red ear syndrome in paediatric age
  1. Catarina Fernandes1 and
  2. Filipe Palavra2,3
  1. 1Neurology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
  2. 2Center for Child Development - Neuropaediatrics Unit, Hospital Pediátrico, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
  3. 3Laboratory of Pharmacology and Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra University, Coimbra, Portugal
  1. Correspondence to Dr Catarina Fernandes; catarinasfernandes{at}hotmail.com

Abstract

A middle childhood boy with no disclosed medical history presented with paroxysmal episodes of pain in the left ear accompanied by redness of the earlobe over a 3-month period. The attacks occurred suddenly, lasted for hours and had a variable frequency. He denied experiencing a headache or other neurological symptoms and had previously attempted treatment with gabapentin, prednisolone, ibuprofen and topical lidocaine without success. Suspecting red ear syndrome (RES), we requested cervical and brain MRI and initiated a therapeutic trial with indomethacin 75 mg/day. The MRI revealed a loop of the right anterior inferior cerebellar artery in the internal auditory canal, without pathological significance. An improvement in both the frequency and intensity of the paroxysms was observed. Subsequently, indomethacin was gradually tapered, and treatment with flunarizine was introduced, yielding a favourable response. RES is a rare disorder with an unknown pathophysiology, and its optimal treatment approach remains largely empirical.

  • Neurology (drugs and medicines)
  • Headache (including migraines)
  • Pain (neurology)

https://doi.org/10.1136/bcr-2024-263784

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    Footnotes

    • Contributors FP is the guarantor. FP is responsible for the overall content. Planning and writing: CF. Revision: FP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.