The mystery of one red ear.

Flushing and a sensation of tightness or pain in one ear lobe was a presenting complaint of 3 patients. In one case the symptoms were confined to the ear, another was associated with sensory impairment in the distribution of the C2 and C3 segments, while the 3rd patient experienced discomfort in the area of the 1st division of the trigeminal nerve on the same side. Two out of 3 patients had evidence of hypertrophy of the ipsilateral C2-3 facet joint and the symptoms of the 3rd patient were improved by an ipsilateral C2-3 root block. A possible mechanism could be the antidromic release of vasodilator peptides from afferent nerve terminals in response to irritation of the C3 root which supplies sensory innervation to the pinna.