Hot Ears High Blood Pressure

Causes of hot ears

The feeling that your ears are hot can often be an unusual and somewhat alarming sensation. Although the primary concerns of most individuals with this symptom are high blood pressure and infection, a pathology need not lie behind this puzzling sense.  Among the most common causes of the feeling of hot ears is emotional stress. Think back to a time when you felt embarrassed or angry. You might recall the feeling of blood rushing to your face, with your head feeling heavy, red, and hot. With increased blood flow, you may experience facial flushing and heat in your face, and the same happens in and around your ears as well.¹ This stress response is called the sympathetic (or fight-or-flight) response, however, this same response is also responsible for raising your blood pressure, so the feeling of hot ears often goes hand-in-hand with an increase in blood pressure, even if high blood pressure may not be responsible for the sensation per se. In this article, we will look at the causes of hot ears, how they relate to high blood pressure and other symptoms, and when and when not you should be concerned. 

Understanding high blood pressure

In simple terms, you can think of the cardiovascular system as a water pump and a hose. The pump is the heart and the hose is your blood vessels. The pressure that the water exerts on the hose as it passes through is your blood pressure (measured in mmHg). The more forceful your pump, the more pressure there is. So one factor that determines blood pressure is how hard your heart is contracting. This mostly affects your systolic pressure, which is your blood pressure during the period of your heart’s contraction, or systole in cardiology lingo and beat in layman’s terms. However, between contractions, your heart takes some time to fill up with blood to prepare for the next beat. This period is called the diastole. Your blood continues to flow during this period, but how forceful your heart is pumping blood is irrelevant now. The blood pressure of this period, which is your diastolic pressure, is determined by three things: How much total blood is in your arteries (the volume), how stiff your blood vessels are (compliance), and whether your blood vessels are narrowed or not (which is caused by atherosclerosis).² When you take all of this into account, we can see that high blood pressure is caused by one and/or more of the following: A heart that is contracting very forcefully, too much blood in your arteries (which is directly caused by too little blood in your veins), blood vessels that are too narrow and blood vessels that are too stiff. 

Causes 

So we briefly explained how high blood pressure comes to be in a mechanical sense, but what are the reasons why these physical changes occur in your blood vessels or your heart? As it turns out, two forces are engaged in a constant battle of tug-of-war in your body. These are your sympathetic and parasympathetic nervous systems. The sympathetic nervous system is activated by adrenaline and is all about fight-or-flight - it’s a response to stress, intense emotions such as anger, fear or embarrassment, and aggression. The sympathetic response primes your body to action - it wants your muscles to be ready to fight to the death or run to the edge of your limits, wants your brain to remain in a state of complete alertness and concentration, and wants your cardiovascular system to be able to support this intense potential physical and mental exertion. It diverts blood flow away from your inner organs to your muscles and brain, and pools as much of it away from your veins into your arteries, ready to fire. So to support such exertion, your heart beats faster and stronger (the combination of the two is referred to as your cardiac output), less blood is idly sitting in your veins and more blood is circulating actively in your arteries, and your vessels become a lot stiffer, both to make your blood pump faster and so that if you get cut, coagulation becomes easier to achieve. If you recall, these are all factors that lead to elevated blood pressure. So the sympathetic nervous system increases blood pressure (there are some specific cases where the reverse happens too but that is beyond the scope of this article).³ 

The parasympathetic nervous system, in contrast, is referred to as the rest-and-digest response. When you are relaxed and have no stressors around,  your body can sit back, put your primed muscles at ease and focus on regulating your inner organs, aiding in digestion and metabolism. The result is a decrease in blood pressure.⁴

So with all of that in mind, we can surmise that pathologies in blood pressure can be a result of two things: Dysregulation in the balance between the sympathetic and parasympathetic nervous systems, or structural anomalies in the pumping system. Let’s start with the first option. 

Stress leads to an activation of the sympathetic system, therefore chronic stress caused by a stressful lifestyle may lead to chronic activation of the sympathetic system, eventually leading to the baseline balance skewing towards the sympathetic side, resulting in hypertension.^3,5,6 Joyner et al. from the Mayo Clinic suggest that “humans with high baseline sympathetic traffic might be at increased risk for hypertension if the 'balance' among factors deteriorates or is lost”.⁷ and many scientists now believe that this balance deteriorates remarkably with ageing and long-term exposure to stress. Many diseases lead to hypertension as a consequence (rather than hypertension being the primary problem - referred to as essential hypertension), and when this happens, it’s called secondary hypertension. These diseases are often related to a problem with hormones (such as Graves disease associated with thyroid hormones, acromegaly associated with growth hormone, Conn syndrome associated with aldosterone, pheochromocytoma associated with adrenaline) or the kidneys (such as renal artery stenosis, chronic kidney disease), and in these instances, high blood pressure symptoms are a lot more common and pronounced, and blood pressure medication is often ineffective,⁸(Harrison chapter 277). 

But just as important are structural problems in the pumping system. A heart that doesn’t beat quite as forceful as it should is referred to as heart failure, a type of chronic heart disease. Heart failure predominantly affects the left side of the heart (which pumps blood into your body) and the right side (which pumps blood into your lungs) is usually less affected. This means that a normal amount of blood is going into your lungs, but your heart can’t pump that blood out to your body. This causes excess blood to pool up in your lungs, which can lead to pulmonary hypertension, which can be deadly. Since the left side of your heart can’t pump out blood as effectively, heart failure can even lead to low blood pressure (called hypotension), which can manifest with dizziness or loss of balance when standing up, called orthostatic hypotension. Additionally, exceptionally severe heart attacks (where your heart doesn’t receive enough blood and heart cells begin to die, usually as a result of a blood clot blocking the coronary arteries that feed your heart itself and blocking the heart’s blood supply) often result in an acute deterioration of your heart’s pumping abilities, which can lead to acute heart failure and shock.⁹ (Harrison chapter 257) 

But what about blood vessels? As it turns out, for essential hypertension, blood vessels are key. A process called atherosclerosis causes fat (or more accurately degenerated and inflamed fat) to accumulate within the walls of your blood vessels. This narrows your vessels and completely disrupts their mechanics, causing them to be overly stiff and unresponsive to hormonal and physiological balances, acting more like a rusty pipe rather than actual living tissue. When this process happens in a lot of blood vessels at the same time (as is often the case with increased sympathetic tone and an unhealthy lifestyle), diastolic pressure rises and becomes unresponsive to your body’s own cues. These vessels even become too sticky, causing red blood cells to stick on their walls which can lead to the formation of blood clots that can then lodge off and block the coronary arteries, leading to heart attack or other cardiovascular diseases,⁸ (Harrison chapter 277). 

Symptoms 

Since your heart spends one-third of its cycle in systole and two-thirds in diastole, your diastolic pressure is much more significant to your health, but since the highest pressures are reached during systole, your systolic pressure is more relevant for the occurrence of subjective symptoms of high blood pressure and hypertensive emergencies (such as malignant hypertension, which is when an acute rise in blood pressure causes irreversible damage in your organs). 

Symptomatic hypertension usually occurs when the change in blood pressure is acute. When your blood pressure rises gradually over time, your body can often adapt to the changes to some degree, at the very least preventing the occurrence of malignant hypertension. Symptomatic chronic hypertension is more common in secondary hypertension, but can also happen in essential hypertension as well.¹⁰ The association between headache and hypertension is well known, though scientific studies indicate that this association is only true for very severe hypertension. More interesting, however, is the fact that chronic hypertension can cause migraine patients to have their migraines become more severe and chronic. Finocchi et al. suggest that “Hypertension has been identified as one of the most important factors of chronic transformation of episodic migraine and increases the cerebrovascular and cardiovascular risk of migraine patients”.¹¹ In addition, patients with hypertension are at higher risk of nosebleeds and much higher risk of their nosebleeds requiring emergency assessment.^10,12

The link between high blood pressure and your hearing health

It turns out that the presence of high blood pressure can have a myriad of effects on your hearing and ears in general. One study of 192 people demonstrated that patients with hypertension have a significantly higher risk of developing early onset hearing loss (18-55 years old) compared to non-hypertensive patients (37.4% vs 14.1%), as demonstrated by hearing tests. Similar rates have been documented for tinnitus (ringing in the ears) as well.¹³ Another study has demonstrated that among hypertensive patients the longer the patient is hypertensive, the faster and more pronounced the progress of hearing loss becomes.¹⁴ Furthermore, elevated systolic blood pressure readings in midlife are a significant risk factor for the development of hearing loss later in life.¹⁵ Aside from the hearing loss, hypertension is also noted as a significant risk factor for the development of bell’s palsy (facial nerve weakness or paralysis due to inflammation of the inner ear), which causes temporary and rarely permanent facial drooping.¹⁶ The bottom line is keeping blood pressure in check is an excellent way of reducing risk factors and achieving disease control against hearing loss and the need to use hearing aids. 

High blood pressure and hot ears

But what about hot ears? You probably came here to find out if your hot ears have any association with hypertension and received a comprehensive review of hypertension and its relation with hearing. As previously stated, the sympathetic response can cause generalized flushing that can affect the ears as well as your face, causing them to feel hot and reddish, and this response also causes an increase in blood pressure. However, there is very little scientific evidence to suggest that hot ears are any indication of underlying hypertension, and no causal link between hot ears and blood pressure has been documented. 

Are hot ears a sign of high blood pressure?

We learned that your blood pressure is very closely associated with the quality of your hearing, and also learned that hot ears are not a sign of high blood pressure. But the fact remains that your ears are hot, and you came here to learn about this symptom. Aside from sympathetic activation, hot ears can be caused by problems related to your ears themselves. For instance, one of the hallmarks of inflammation is heat, and it should be no surprise that ear infections can cause your ears to feel hot. Otitis media is an infection of your middle ear and can cause a feeling of heat deep within your ears in addition to pain, especially when caused by bacteria. Otitis externa is an infection of your ear canal, and perichondritis is an infection of your auricle (the external part of your ear). All of these ear infections are associated with both pain and redness and heat in the affected areas. However, inflammation is not only due to infection. Trauma causes significant inflammation as well, and trauma to your ears can cause similar symptoms. In addition, the buildup of earwax can also cause your ears to feel hot alongside a feeling of pressure, and dermatitis (or eczema) of the ear canals can give rise to the feeling of hot ears alongside itching,¹⁷ (Scott Brown section 1). 

Treatment for hot ears

Treatment is dependent on the cause. Hot ears that are a result of emotional stress need no treatment. Ear infections may need no treatment or require treatment with antibiotics as determined by a healthcare professional. Earwax can benefit from softeners and/or micro suction and eczema of the ears is often responsive to specialized eczema medication. 

Managing high blood pressure

Treatment of high blood pressure is a multi-faceted and complex topic. As the American Heart Association aptly suggests, “an ounce of prevention is worth a pound of cure”(18). Indeed, preventing hypertension is one of the single most important things you can do for your overall health. The American Heart Association has a comprehensive list of measures you can take to lead a healthier lifestyle and in doing so reduce your risk of developing hypertension which includes eating a well-balanced diet with low salt, limiting alcohol, quitting smoking, and exercising regularly.¹⁸ 

If you do develop hypertension, however, there’s still no need for concern. Keeping up with the above-mentioned steps in addition to taking appropriate blood pressure medicines can successfully keep hypertension and its consequences in check. Regular checkups with your doctor are important to ensure your blood pressure readings remain under control. The National Institute of Health has a brief overview of blood pressure medicines, though it is best to get a professional overview from your doctor.¹⁹ 

When to consult a doctor

If hot ears are accompanied by significant pain, itching, hearing loss, or facial drooping, you should consult a doctor. Even though hot ears can be precipitated by emotional stress, if additional symptoms of high blood pressure (such as an intense headache, nosebleed, chest pain, or blurry vision) are present after the stressor, you should consult a doctor.

Summary

We went on a journey delving into hypertension, how high blood pressure affects your ears and hearing, and whether the feeling of hot ears is one of those effects. Though the relationship between the two appears non-existent, we hope that this article has educated you on both manners and you now feel confident about taking steps to preserve your hearing by keeping your blood pressure at bay.