One of the more common problems I see in my practice is that of itchy ears. The patient would have, by the time they present, tried all sorts of remedies including the dangerous practice of using ears buds, match sticks and a miscellany of other harmful instruments to rid the ear of the itch.
The causes commonly arise from the external ear, and less commonly from the middle ear.
External ear causes
1. Eczema: There are various types of eczema. It can be allergic dermatitis. These patients may have a history of allergies such as asthma or hay fever. It can be in the form of irritating or contact dermatitis: a reaction to products such as shampoos or oils when these come into contact with the skin of the external canal. Ear piercing may lead to eczema if the patient reacts to certain metals, such as nickel, in the ear ring.
2. Infections: eczema can lead to infections of the external ear. This is referred to as otitis externa, and can be caused by bacterial, fungal or viral agents.
Bacterial Otits externa is typically caused by streptococcus and staphylococci bacteria. Very rarely is pseudomonas responsible. It typically presents with itching, and later pain, associated with a purulent ear discharge. The skin of the ear is reddened and thickened. Sometimes the ear canal will be completely stenosed, and with the ear drum barely visible. Hearing might also be affected.
Treatment: entails the use of antibiotic ear drops. The ear must be kept dry since moisture exacerbates the infection. Analgesics are often necessary.
Fungal otitis externa is less common than the bacterial variety. The commonest fungal agent will be candida albicans, and to a lesser extent aspergillus negri. The symptoms will be similar to bacterial otitis externa. Clinical examination will reveal the presence of fungal spores in the external ear canal.
Treatment: consists of the use of topical anti-fungal agents.
Viral otitis externa: are also uncommon and may follow an upper respiratory tract infection. Bell’s palsy and shingles are often associated with inflammation of the external canal due to blisters forming along the track of the Facial nerve.
3. Impacted wax (cerumen accumulation)
Wax is normally produced by the wax glands that situated in the external canal. Wax or cerumen provides a protective function to the ear.
Because of the outward movement in which the ear sheds its skin, wax normally makes its way to the external opening of the ear where it falls out. But there are some people who are genetically overproducers of wax (producing more wax than the ear can remove), leading to impaction in the external ear canal. This wax may either be hard or soft. The other cause of wax impaction is the use of ear-buds, which tend to push the wax deep into the ear canal. Symptoms of ear impaction include itching, pain, and even deafness.
A variety of oils are used to soften the hard wax. Suctioning and irrigation of the ear are also used. Instrumental removal with a curette is also common.
For genetic overproducers recurrences are common.
Middle ear causes
Otitis media is a common cause of itching in ear. The build-up of fluid in the middle ear causes the ear to itch, and this may later change to pain. Also, this can happen with the rupture of the eardrum and the discharge constantly making the external ear wet.
Treatment consists of dealing with the underlying condition.
“Itchy ears” is a relatively common presenting symptom. Often the diagnosis is easy to make, and the treatment simple. Undiagnosed and poorly treated conditions can however lead to serious complications