Rensink, Michael J.; Martin, Robert L.
Michael J. Rensink, MD, an Otolaryngologist in the San Diego area, has been in practice for more than 30 years. Robert L. Martin, PhD, has been in private audiology practice in the San Diego area for 30 years and has been writing Nuts & Bolts since 1989. Correspondence to Dr. Martin at 7750 University Avenue, La Mesa, CA 91941.
One complaint often heard in the office is, “My ears itch. They're driving me crazy!” This month, we'll look at some of the causes and treatments of itchy ears. This discussion is not an all-inclusive list of causes or treatments. Rather, we want to present a practical discussion of “itchy ears” in hopes of giving you a broader understanding of the problem.
Figure. Robert L. Ma...Image Tools
Ear canal skin is highly innervated with neural fibers and very sensitive to the touch. The slightest accumulation of debris, even a dead hair, is often reported as itching in the ear. It is no surprise, then, that people who wear hearing aids report that their ears itch. Considering the increase in humidity caused by wearing hearing aids and the bad habits of many people (getting water in their ear canals on a daily basis, aggressively cleaning their ears), the surprise is that more patients don't have itchy ears.
Complicating the problem is the idea that you need to clean your ears everyday, as well as the ready availability of Q-Tips and the common misconception that you are supposed to use them to remove wax from your ears.
The lead author of this article (Dr. Rensink) or any other physician who specializes in ear, noise, and throat medicine, can attest that it is very common to see cases of ear trauma caused by patients who have attempted to clean their ears using Q-tips, paper clips, bobby pins, or an assortment of other items.
Symptoms like “itchy ears” tend to be chronic unless the underlying problem is found and effectively addressed. It is important to discuss the problem with the patient thoroughly, as many patients have habits that create unhealthy conditions in their ears, e.g., frequent inappropriate cleaning.
It is also important to take good notes. Many patients will not follow directions and you need good records of what you have instructed the patient to do.
Of course, a comprehensive otoscopic exam is essential. The appearance of the ear tissue often confirms the patient's report.
COMMON CAUSES OF ITCHY EARS
Some ears produce no wax, and as a result the skin is dry, devoid of natural body oil. These ears tend to accumulate flakes of dry dead skin that cause the sensation of “itch.” A physician may have the patient use baby oil or mineral oil in the ears to alleviate dryness.
Sometimes ears make wax but become dry anyway because of excessive cleaning. Having some wax in the ear is a good thing from a medical point of view. It provides a protective barrier to water, lubricates the tissue, repels insects, and is slightly bacteriostatic.
Occasionally, the plastic of a hearing aid case or the polish on the surface of the plastic will cause an allergic reaction in the ears of a hearing aid wearer. If your lab uses a polish to “shine” the case or earmold and if the patient has a known allergy to polishes, it is helpful to wipe the instrument carefully with alcohol before fitting it.
When patients get water in their ears, hearing aids can indirectly lead to a problem by trapping the moisture inside. Instruct patients to keep water out of their ears. If they ask, “But how do I clean my ears?” tell them, “Most ears will clean themselves, given a chance. If you clean them out too much, you remove all the wax, which is the protective coating of the ear canal. This causes dryness and itching. Cleaning ears too much can also lead to skin abrasions. It is best not to clean your ears.”
Tell patients to avoid putting water in their ears, and, if needed, make them a pair of custom silicone “water plugs” to keep the water out of their ears when they shower or bathe.
Hearing aids can also cause itching if a bump or edge on the instrument puts pressure on the skin in the ear canal and creates an irritation. When a patient reports such an irritation, use a fiber-optic otoscope to find exactly where the hearing aid is putting pressure on the skin. Then eliminate the point on the hearing aid that is creating the problem.
Other ear problems
Innumerable diseases and other problems can affect the tissues in the ear. Many people have allergic reactions to household products or environmental contaminants. There are many types of dermatitis: atopic dermatitis is an allergy-like skin condition (rash) caused by allergens such as pollens, foods, dander, and insect venoms. Seborrheic dermatitis is caused by overactive oil glands of the skin. We sometimes see psoriasis in the ear. Psoriasis is a rash with discrete, reddish, silver-scaled maculopapules (bumps). And there are countless other skin and ear disorders that may cause itching.
Gentle, thorough cleaning on a regular basis by a competent professional whose license-definition includes this task is one of the best treatments for itchy ears.
Healthy ear tissue is naturally lubricated and self-cleaning. It does not itch. Treatment regimens seek to return the tissue in the ear to a healthy state. This usually includes keeping the ear dry (water-free), lubricated (if needed), and clean (free of debris), removing any irritant caused by the hearing aid or earmold, and treating any existing ear disease.
Patients are often told to use over-the-counter steroid creams to treat the itching in their ears. These products have some value in creating protective barriers on the outer surface of the skin, and the steroid in the cream may provide some benefit. However, practitioners and patients must understand that the amount of steroid in over-the-counter products is minimal. A prescription product such as Decadron has a steroid concentration that may be 100 times stronger than that found in an over-the-counter product.
Treating an ongoing ear inflammation may require more than one or two office visits. Some patients are reluctant to return to the doctor if they have tried the recommended medication and experienced no improvement. But they need to understand the nature of skin disease. Often it takes multiple treatments to restore tissue to normal. Persistence can be essential in resolving the problem.
When you encounter patients who insist on cleaning their ears despite having been told by doctors not to, you need to treat the person as much as you treat his ears. You may have better luck getting people to mend their behavior if you schedule them for periodic ear cleaning in an appropriate office. It may also be helpful to change their regime to a less destructive behavior. For example, have them put drops of baby oil in their ears to soften and remove the earwax.
THE POWER OF MEDICINE
Ear-nose-throat physicians have many medications and other resources and much experience to draw upon in dealing with complaints of itchy ears. It is possible to help most patients resolve their “itchy ears.” The audiologist and hearing aid specialist can do much to help resolve this problem by working with their patient and ENT physician.
© 2005 Lippincott Williams & Wilkins, Inc.