Itchy ears
Itchy ears are caused by an inflammation and possible infection of the skin of the outer ear canal. The problem is very common. Symptoms include itching, ear discharge, temporarily dulled hearing, and pain.
The medical name is 'otitis externa'. There are two different types. Acute otitis externa will often seem to occur just 'overnight' for no specific reason, but it may be related to a swimming event. Chronic otitis externa occurs when the otitis externa persists for several weeks and then recurs at intervals after that.
There is also a rare, severe form of otitis externa that can occur in people of any age who have problems with their immune system, but it tends to be experienced by older people with diabetes. If you are one of these people and have severe ear pain and discharge it is important to see your doctor at the earliest opportunity to prevent it becoming worse.
What causes acute otitis externa?
Generally, outer ear infections are caused by a bacterial infection of the skin of the canal, although occasionally it may be due to a fungus or yeast. The skin can become so swollen that the ear canal closes, causing temporary deafness, and there can be some discharge from the ear. It occurs commonly in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people with narrow ear canals or who swim a great deal.
One of the most common causes of this condition is swimming in pools which have not been maintained to a high standard or have a higher percentage of chlorine in the water than is advisable. Another cause is a hot humid climate when the ear canal perspires more, causing a damp condition in which bacteria breed easily. The use of hairsprays, shampoo or some soaps can cause irritation of the skin and some people seem more prone to this problem than others. If your ear canal is itchy and you scratch it, you may damage the skin which is more likely to become infected if there is static water in the ear canal. Rubbing the skin causes inflammation which in turn can become infected. When the ear requires irrigating (syringing), if damage to the skin has occurred through attempts at self-cleaning or scratching, it is more likely that an infection or inflammation will occur following this procedure.
Another type of acute otitis externa is a boil (an infected hair follicle) at the entrance to the ear canal known as a furuncle. This can occur for no reason like other spots on the skin or can occur where skin has been damaged with a cotton bud, fingernail or any other object.
The main symptom of a furuncle is severe pain with no discharge. The outer ear may be too painful to touch but the spot in the ear may actually be very small. A small infective spot is likely to recover without treatment but if the pain is severe it may require antibiotic capsules. Pain-reducing tablets will be required and sometimes a warm cloth held against the ear helps to relieve the pain. If the boil bursts there may be a sudden discharge of smelly pus from the ear and then the pain will subside and the ear will recover.
How can otitis externa be treated?
The first line of treatment is to gently remove all the discharge and debris (results of the infection) lying in the ear canal. This may be done by a doctor or nurse who may irrigate or wipe the ear with a cotton-covered instrument. If your ear is dry, itchy or inflamed (but not infected) your doctor may use steroid drops to treat the otitis externa. If your ear is infected, an antibiotic treatment may be used. A dressing covered in antibiotic ointment may be inserted into the ear to remain in place for two days. This allows the antibiotic to be in constant contact with the whole ear canal. The dressing may be inserted soaked in the steroid drops for the same reason.
Alternatively, you may be prescribed a short course of ear drops or an ear spray. These usually contain an antibiotic to clear the bacteria and a steroid to reduce the inflammation. If the bacteria in the ear are sensitive to the antibiotic in the ear spray/drops/ointment, the infection should clear by the end of the treatment. If there is little change after three days' treatment it may require a different antibiotic drop to remove the bacteria as they could be resistant to the first treatment. At this stage the doctor or nurse will take a sample of the discharge on a cotton swab and send it to the laboratory to find out which bacteria are causing the infection and which antibiotic will remove it.
If the infection is very painful and affecting the face and scalp around the ear, antibiotic tablets or medicine may also be prescribed. Pain relieving tablets may also be required.
Why might otitis externa persist despite treatment?
The infection will persist despite treatment if the cause of the problem is not removed. For example, some people are more sensitive to certain shampoos, hair sprays and soap. Washing the hair by lying down in the bath with the head under water can also cause re-infection if the bath water becomes trapped behind the wax in the ear canal. Scratching or poking the ear can also re-infect the canal. Inserting ear plugs with dirty hands and reusing ear plugs encourages repeat infections. People with skin disorders elsewhere (for example, eczema or psoriasis) may experience the same symptoms in the ear canal when the skin disorders flare up from time to time. This is not necessarily an infection, it could just be an episode of the known skin disorder.
As explained above, resistant bacteria may require more than one type of antibiotic drop or dressing or there may be a fungal infection in addition to the bacteria. The swab sent to the laboratory will identify the cause of the repeated infection.
A fungal infection is identified by the type of discharge in the ear canal and the intense itching which it causes. A fungus is a spore which is not killed by antibiotics and it lies dormant for three weeks before recurring. The ear canal has to be cleaned meticulously and treated with antifungal ointment or drops for three weeks after all symptoms have gone. This type of infection may be suspected if the otitis externa does not improve with the above treatment.
Persistent otitis externa may occur because there is disease in the middle ear and the discharge from this runs out into the ear canal. This usually requires ENT consultant advice. This disease is evident once all the discharge has been cleared from the ear canal and the doctor will refer you to the hospital for specialist advice. Meanwhile it is best to continue keeping the ear clear and treating with the prescribed drops.
What can I do to prevent an external ear canal infection?
There is now an ear spray obtainable over-the-counter from a pharmacy which provides an acid environment in the ear canal, which deters bacteria. If you are susceptible to ear canal infections, it might be a good idea to keep such a spray in a First Aid kit to be used at the first sign of infection, to prevent the ear becoming worse until it is possible to consult a doctor.
If you have an ear infection, it is advisable to keep the ear out of water for at least two weeks during treatment, to rest the ear until the infection has been resolved. It is then less likely to recur. Keep all water out of the ear by filling the outside of the ear with cotton wool smeared with petroleum jelly (to waterproof the cotton wool) before you wash your hair or have a shower. When swimming, wear silicone ear plugs. Please note that if the ear plugs have been used when the ear is infected they must be replaced with new ear plugs or there is a risk of re-infecting the ear.
A good rule to follow is: if you tend to have problems with your ears, keep them dry. Keep dirty hands, bath water, sub-standard swimming pool water and hair sprays away from ears. If ear plugs are part of safety equipment at work, ensure a clean pair is used every day. Allow earwax to protect the ear canal – do not use cotton buds to push it into the wrong place.
If the ear has started to discharge it is best not to clean it with a cotton bud, as this may damage the skin. Also do not leave cotton wool at the entrance of the ear canal as this stops the discharge running out of the ear and may cause the infection to get worse. If the discharge gets worse, wipe it away with a tissue from time to time but allow air to enter the canal and seek medical advice as soon as possible.
