Redness in the Ear: What Causes a Red Ear

Red ears without other symptoms

The ears have a rich blood supply close to the surface, so they flush easily. Ears that turn red and hot for minutes to an hour, then return to normal, are almost always caused by:

• Emotion: embarrassment, anger or anxiety (the same response as blushing)
• Temperature change: coming into a warm room from the cold
• Exercise or a hot drink or meal
• Alcohol: especially in people who flush with alcohol
• Pressure: lying on one ear, tight headphones or a hat
• Hormones: hot flushes in perimenopause
• Medicines: niacin, some blood pressure medicines and others that cause flushing

Rarely, red ear syndrome causes attacks of burning pain and redness of one ear, sometimes linked to migraine. A neurologist can help if attacks are frequent.

Redness of the outer ear (pinna)

Skin infection

Cellulitis of the ear makes the earlobe and pinna red, warm, swollen and tender. It often follows a scratch, insect bite or infected piercing. Erysipelas, a more superficial infection, causes a bright red, raised area with a sharp edge, often with fever.

Perichondritis

Perichondritis is infection of the tissue covering the ear cartilage. The upper ear becomes red, swollen and very painful, but the earlobe, which has no cartilage, is usually spared. This is a useful clue. It is most often linked to piercings through the upper ear cartilage, burns and ear surgery. It needs prompt antibiotics, because untreated infection can destroy cartilage and leave a deformed "cauliflower ear".

Sunburn and frostbite

The tops of the ears are a common place to get sunburn, and also to develop skin cancers later from long-term sun exposure. In cold weather, ears are vulnerable to frostbite, which leaves them red, swollen and painful as they rewarm.

Eczema and dermatitis

• Allergic contact dermatitis: red, itchy, sometimes weeping earlobes, usually from nickel in earrings. Hair dyes, shampoos and hearing aid materials can also trigger it.
• Seborrheic dermatitis: red, greasy, flaky skin in the ear canal, the bowl of the ear and behind the ear.
• Atopic eczema: dry, cracked, red skin, often with splits where the earlobe joins the face.
• Psoriasis: thick, scaly red patches in or around the ear.

Injury

A blow to the ear can cause bruising and a collection of blood under the skin (auricular hematoma). It needs draining within days, or the cartilage may die and thicken into cauliflower ear.

Inflammation of the cartilage without infection

Relapsing polychondritis is a rare autoimmune disease that causes repeated episodes of red, painful, swollen ear cartilage in both ears, sometimes with nose, joint or eye inflammation. Recurrent episodes that do not respond to antibiotics should raise this possibility.

Redness inside the ear

Ear canal

Swimmer's ear (otitis externa) is infection of the ear canal skin. The canal is red and swollen, and pulling the ear or pressing the flap in front of the canal hurts. You may have itching, discharge and muffled hearing. It follows swimming, cotton bud use, hearing aids or eczema. People with diabetes or a weak immune system can develop a severe form that spreads to bone, which needs urgent care.

Eardrum

A red, bulging eardrum seen by a doctor is a sign of middle ear infection. You cannot see this yourself; the clues are ear pain, fever and reduced hearing, often after a cold. A mildly pink eardrum from crying or fever alone does not mean infection.

How to tell common causes apart

How doctors find the cause

A doctor will ask about piercings, swimming, injuries, earrings, skin conditions, diabetes and how long the redness lasts. They look at the ear and into the canal with an otoscope. A swab of any discharge is taken if infection is severe or not improving. Blood tests and a specialist referral are used when recurrent cartilage inflammation suggests an autoimmune cause.

Treatment

• Flushing: usually needs no treatment. Avoid triggers if it bothers you.
• Swimmer's ear: antibiotic or antibiotic-steroid ear drops, and keeping the ear dry.
• Cellulitis and perichondritis: antibiotics, sometimes intravenous. Infected cartilage piercings often need the jewelry removed and a doctor's review.
• Dermatitis: avoid the trigger and use a steroid or anti-yeast cream as prescribed. Switch to nickel-free, surgical-grade titanium or gold earrings.
• Sunburn: cool compresses, moisturizer and pain relief; use sunscreen or a wide-brimmed hat in future.
• Hematoma: drainage by a doctor and a pressure dressing.

Pain relievers such as acetaminophen (paracetamol) or ibuprofen help with sore ears. Follow the label dose, and do not give aspirin to children or teenagers. Do not put cotton buds, oils or home remedies into an ear that is painful or discharging.

Frequently asked questions

Why are my ears red and hot?

Red, hot ears that come and go are usually flushing caused by emotion, heat, exercise, alcohol or hormones. If the redness lasts, hurts, or comes with swelling, itching or discharge, an infection, sunburn or dermatitis is more likely.

What causes constant ear redness?

Long-lasting redness is often seborrheic dermatitis, eczema, an allergy to earrings, psoriasis or sun damage. Recurrent painful redness of the cartilage in both ears can be relapsing polychondritis, a rare autoimmune condition. A doctor can examine the ear and identify the cause.

What does redness inside the ear mean?

Redness inside the ear canal with pain, itching or discharge usually means swimmer's ear. A red eardrum, which only a doctor can see, can mean a middle ear infection. Redness with flaky skin in the canal suggests seborrheic dermatitis or eczema.

Is a red, swollen ear after piercing serious?

It can be. A red, swollen, painful upper ear after a cartilage piercing may be perichondritis, which needs prompt antibiotics to prevent cartilage damage. Redness confined to the earlobe is less risky, but see a doctor if it spreads or you have fever.