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Red colour of a painful ear: red ear syndrome in paediatric age
Catarina Fernandes1, Filipe Palavra2,3
1Neurology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal catarinasfernandes@hotmail.com.
Insights
This study reports a case of red ear syndrome (RES) in a child, successfully treated with indomethacin and flunarizine. It highlights the empirical nature of RES treatment.
Area of Science:
- Neurology
- Otolaryngology
Background:
- Red ear syndrome (RES) is a rare disorder characterized by paroxysmal ear pain and redness.
- Its pathophysiology remains largely unknown, and treatment is empirical.
Purpose of the Study:
- To describe a case of red ear syndrome in a middle childhood boy.
- To evaluate the effectiveness of indomethacin and flunarizine in managing RES symptoms.
Main Methods:
- Cervical and brain MRI were performed to rule out other pathologies.
- A therapeutic trial with indomethacin (75 mg/day) was initiated.
- Flunarizine was introduced after tapering indomethacin.
Main Results:
- MRI revealed a loop of the right anterior inferior cerebellar artery without pathological significance.
- Indomethacin treatment led to improvement in the frequency and intensity of paroxysmal episodes.
- Flunarizine provided a favorable response, indicating its potential efficacy.
Conclusions:
- This case suggests that indomethacin and flunarizine may be effective treatments for red ear syndrome.
- Further research is needed to elucidate the pathophysiology and optimize treatment strategies for RES.
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.
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