Ear Kiss Syndrome

It sounds so weird. Like some sort of urban legend. But the fact is well-meaning smoochers have actually done damage to the hearing of the kiss recipient when the kiss is placed just outside the ear canal, aka “the ear kiss.”

Kissing comes naturally. You give your spouse a peck on the cheek, a raspberry belly to the youngest son, a meaningful hug to son number two – all bonding gestures meant to impart feelings of good will.

The problem isn’t in the show of affection – that’s always a good thing, but instead when that show of affection takes place too close to the ear of the recipient of all that koochie-koo.

It’s Not the Sound, It’s the Suction

Gail Schwartzman had her hearing damaged when her four-year old daughter planted a harmless kiss on mom’s ear. The Hicksville, Long Island resident reports it was not the loudness from the kiss, but instead suction that left her with pain, decreased hearing and tinnitus (ringing in her ear).

After a year of various physician appointments, tests and exams, Ms. Schwartzman still did not have answers as to why the hearing loss occurred following her daughter’s kiss. Frustrated she sought the care from Dr. Levi A. Reiter – Professor of Audiology at Hofstra University whom she had seen featured in a Newsday article.

A Case Study by Levi A. Reiter

Dr. Levi Reiter

In an interview with AudiologyOnline Dr. Reiter reports on the case study (which was first published in the Hearing Journal) that when Ms. Schwartzman visited him for the first time she presented hearing loss in the ear that was kissed, difficulty hearing on the phone, over sensitivity to loud sounds, dysacusis (distortion of sounds) and occasional facial twitching near her ear. Fortunately after a year, the tinnitus had resolved itself.

Dr. Reiter went on to explain another symptom she reported to him, “…she had another interesting symptom…ear flutter. Basically, whenever she would turn her head from side to side, it felt like something was loose inside her ear”.

At first Dr. Reiter thought Ms. Schwartzman may have suffered either acoustic trauma –damage to the inner ear structures from excessively loud sound – or physical damage to the tiny middle ear bones that help transmit sound through the ear. However, after performing further audiological evaluations on Ms. Schwartzman, he concluded that this was not the case.

Dr. Reiter continued his quest to determine exactly how this kiss had caused Ms. Schwartzman’s hearing loss and ear symptoms. After extensive testing, Dr. Reiter has concluded the most probable explanation to her symptoms is combined damage to a middle ear ligament called the stapedial ligament and to the outer hair cells of the inner ear.

The stapedial ligament connects the stapedial muscle to the stapes, one of three small bones within our middle ear that helps transmit sound to the inner ear. Dr. Reiter surmises that the suction of the kiss pulled the stapes away from the inner ear causing a tsunami of sorts in the inner ear fluids, and damaging the delicate outer hair cells permanently. Stapedial ligament damage may also help to explain Ms. Schwartzman’s sensitivity to sound, since this ligament is instrumental in protecting our inner ear from loud sounds. If the stapedial ligament is damaged, it can’t effectively perform its protective function, thus allowing too much sound to the inner ear, causing discomfort and sensitivity to sound.

An Isolated Case of Bad Luck?

Unfortunately, no. In fact, in an interview with Healthy Hearing, Dr. Reiter reports since this first case of what has now been labeled Reiter’s Ear Kiss Syndrome (REKS) by Dr. Carolyn Smaka of AudiologyOnline, the media attention has brought many persons from across the US with similar cases to come forth. A kiss, followed by pain, followed by hearing loss.

In one case, Dr. Reiter described a man at a family gathering. The man’s son-in-law kissed the man on one cheek and as he went to kiss him on the other, the man moved his head – causing his son-in-law’s kiss to meet the outer part of his ear.

Dr. Reiter reports the man experienced intense pain and testing showed that the individual’s existing mild high frequency hearing loss had now expanded to all frequencies, i.e. it got worse. Once again, Dr. Reiter is careful to point out that it isn’t the loudness of the kiss but instead the suction of the kiss that caused the damage.

The second case Dr. Reiter described was a woman who was kissed on both ears by a date and now experiences hearing loss in both ears. This naturally leads to an obvious question:

Has this been going on for a long time and we just didn’t notice the connection between hearing loss and an ear kiss?

By all logic, that would seem to be the case rather than three isolated instances of REKS appearing within the space of a couple of years. Since kissing is a widespread show of affection in almost every culture, it’s reasonable to assume that these occurrences have happened in the past. In fact, Dr. Reiter said he continues to receive calls from persons who feel they have hearing loss due to a kiss in the past and also audiologists who have seen patients in the past reporting this same scenario.

Mystery Solved?

Not quite yet. Although Dr. Reiter feels he has a pretty good understanding of the mechanisms involved with this patient and others, he still does not have all the answers. He continues to assess new patients reporting similar incidences and has future studies planned to investigate the effects from a kiss on the ear – specifically the effects of the suction. He has been measureing normal variations in both the loudness and pressure produced by kisses in artificial ear canals.

No More Kissing?

Ahh, the world would be much drearier without displays of affection, so in a word – “No.” Kiss away.

Dr. Reiter’s daughter, Dvorah Leah and granddaughter, Chaya Mushka

However Dr. Reiter cautions, “My biggest concern as far as warning the public and getting this out is regarding newborns and infants. Mothers and fathers, and even sisters and brothers or grandparents, they love to smooch up that little baby, give him a whole kissing frenzy. And the ear canal of an infant is very small, so the pressure, that negative pressure that is applied to the ear canal is going to have a much greater impact than on an adult. I’m afraid there are infants out there who are experiencing this, but they can’t say “Mommy, I can’t hear in one ear,” and the net result is that five years later, when they have a hearing test, no one will ever know to relate it to a kiss.”

So as you go in for that kiss on a cheek be aware of: (1) the delicate nature of the hearing mechanism and how easily it can be damaged even under the most benign circumstances and (2) keep those kisses away from the ear.