Just a little scratch

Qtip. Fingernail. Hairpin. Safety pin. Nail. Ballpoint pen. Pencil. Paper clip. Screwdriver.

The list goes on. When your ears itch it can drive you CRAZY! and leads to all the bad decisions above. So-what causes an itchy ear and what can you do about it?

Our ear canals are lined with skin and just like skin elsewhere on the body, it is a protective barrier. There are two sections:  the part of the ear canal you can reach with those above “instruments” is the lateral canal.  The part closer to the eardrum is the medial canal. The lateral canal skin is thicker and has sweat and oil glands just below the surface, layered on top of a cartilage framework. The medial canal skin is very thin and rests on top of the bone that creates the canal’s tube-like shape. Damage to this barrier puts you at risk for infections.  The objects above may have intentionally or accidently scratched the skin, but conditions such as eczema and psoriasis can also damage the skin barrier. I have even seen earbud overuse cause problems.

There is also a skin microbiome (normal collection of bacteria, virus and fungi) that is part of a healthy ear canal. Any disruption in this balance of organisms can lead to a rise in pathogenic growth (disease causing organisms) and when combined with a damaged skin barrier, you get deep spread of bacteria or fungus that causes problems.

The immune system detects this damage and spread of an organism into a “restricted area” and sends cells equipped to fight that infection.  This often leads to swelling, redness, sometimes pain and itching.  And starts the cycle…

It is usually here that the scratching starts. And just like a bug bite, the more you scratch, the more the skin breaks and oozes, the more histamine is released from those immune cells which causes more itching.   The longer this process cycles, the higher the chance the surface damage and immune system activation under the skin causes permanent scarring.  The skin will thicken, the glands will cease to work, and immune cells will take up permanent residence.

HERE IS WHAT TO DO

New itch:

When you are faced with a newly itchy ear, be gentle. DO NOT use a sharp object! Take your finger and gently feel if something is there (a piece of wax, a bump on the skin). If not, allow a small gentle rub and then stop.

If there is wax, gently wipe it away with a thin washcloth. 

If a skin bump is there it is likely a small irritation or infection in the skin and just like a pimple on your face, do not attempt to pop it. Use warm compresses and allow the area to be cleansed with mild soap water in the shower.  If it doesn’t resolve after a week or two, have your provider look to see if a topical antibiotic is necessary.  

If nothing is found on exam, consider using a plant oil to lubricate and heal. Olive oil, tea tree oil, coconut oil, and oil of oregano can heal the skin barrier, in addition to often being anti-inflammatory, anti-viral and anti-bacterial.  Avoid mineral oil (petroleum based).

Long time itch:

It’s been years of scratching. This type of itchy ear is often a result of nerve damage in the skin layer, and you must “retrain” the nerves not to send that signal to your brain constantly, while healing the barrier as much as possible.

You are going to have to do the hard work of breaking that cycle. I will often have patients use a topical steroid cream or ointment for an initiation period of 5 days to dampen the urge to itch but remind patients that they must keep fingers/Qtips/etc out of the ear completely.  Wear gloves at night if you have too!  Within 5 days the urge to itch will decline and after about 2-3 weeks we start to see evidence of the skin healing.  It can take months for the immune cells to become less reactive and the neural itch to cease, so don’t restart that cycle.

Troubleshooting:

If this doesn’t work, you should see a provider (preferably an ENT) who can evaluate for possible bacterial or fungal infection, skin disorders such as psoriasis, or other causes.  A culture of the ear canal can be helpful. 

But how do I clean my ears? See my previous blog post “All Things Earwax” (hint: you don’t need to clean a healthy ear)