What causes a heat feeling in the ears?

Causes of Heat Feeling in Ears

A heat sensation in the ears is most commonly caused by inflammatory conditions of the ear canal (otitis externa, contact dermatitis, seborrheic dermatitis), referred pain from temporomandibular joint syndrome, or rarely, erythermalgia—a vascular disorder characterized by episodic burning, warmth, and erythema. 1, 2, 3

Primary Ear-Related Causes

Inflammatory Ear Canal Conditions

Otitis externa presents with ear pain, tenderness, and warmth, often accompanied by discharge and fever. 2 The pain can be intense because the highly sensitive periosteum lies close to the ear canal skin. 2

Contact dermatitis (both irritant and allergic types) causes inflammation with erythema, edema, and warmth in the ear canal. 1 Common triggers include:

• Metals (nickel in earrings affects ~10% of women with pierced ears) 1
• Topical medications (neomycin causes reactions in 5-15% of patients with chronic external otitis) 1
• Cosmetics, soaps, shampoos, and hearing aid materials 1

Seborrheic dermatitis presents with greasy yellowish scaling, itching, and secondary inflammation, creating warmth in affected areas including the ears. 1, 2

Localized Infections

Furunculosis (infected hair follicle in the outer ear canal) causes localized warmth, tenderness, focal swelling, and pustular lesions. 1, 2 Treatment includes local heat, incision and drainage, or systemic antibiotics covering Staphylococcus aureus. 1

Auricular perichondritis presents as painful swelling, warmth, and redness of the auricle (typically sparing the earlobe), most commonly occurring within the first month after ear piercing. 1 This requires fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) targeting Pseudomonas aeruginosa. 1

Referred Pain Causes

Temporomandibular joint (TMJ) syndrome is the most common cause of referred ear pain and warmth in adults. 1, 2 Patients report pain radiating to the periauricular area, temple, or neck, with tenderness over the affected TMJ and possible crepitus. 1

Upper aerodigestive tract malignancies can present with isolated ear pain and warmth, particularly in older patients with tobacco and alcohol use history or younger patients with human papillomavirus infection. 2 A complete head and neck examination with visualization of mucosal surfaces is mandatory. 1

Rare Vascular Disorders

Erythermalgia (erythromelalgia) is a rare cutaneous disorder characterized by episodic erythema, burning pain, and increased temperature. 3, 4 While it primarily affects extremities, rare variants involve the face and ears exclusively. 4 Key features include:

• Symptoms exacerbated by heat and relieved by cooling 3, 4
• Visible vessel dilation on dermatoscopy during episodes 4
• Response to aspirin combined with paroxetine or amitriptyline (oral and topical) 3, 4

Red ear syndrome shares features with erythermalgia but may have distinct triggers and associations. 4

Environmental and Systemic Factors

Heat exposure during exercise can raise body temperature by 2-3°C, causing peripheral vasodilation and warmth in exposed areas like the ears. 1 This is a normal physiologic response, not pathologic. 1

Menopausal hot flashes cause profuse sweating, peripheral vasodilation, and feelings of intense internal heat due to narrowed thermoneutral zones. 5 While typically generalized, they can manifest as warmth in the face and ears. 5

Critical Pitfalls to Avoid

• Do not miss referred pain from malignancy: Any adult with persistent ear warmth/pain and risk factors (tobacco, alcohol use) requires complete head and neck examination to exclude cancer. 2
• Do not confuse otitis externa with otitis media: Otitis externa causes canal tenderness and warmth; otitis media does not. 2
• Do not ignore persistent symptoms: Failure to respond to appropriate treatment suggests resistant organisms, fungal infection, or underlying conditions like diabetes requiring evaluation for necrotizing otitis externa. 2
• Do not overlook contact allergens: Remove suspected sensitizing agents (earrings, hearing aids, topical medications) and apply topical steroids or calcineurin inhibitors. 1