For the last couple of years I have had trouble with both ears itching inside the ear canal. The ear itches so bad I wake up in the night and find that I am rubbing my ear with the tip of my finger and the ear then becomes infected requiring the use of antibiotics and/or a cortisone cream. Nothing seems to get rid of this completely.
Answer ---------------------
The symptoms described are fairly common and usually caused by a chronic eczema of the skin in the outer ear canal. The hallmark symptoms are itching, scaling of the skin, occasionally watery fluid drainage, and crusting. The itching, when severe, can lead to traumatization of the skin in the ear canal due to intense scratching allowing for introduction of bacteria through the skin barrier and ultimately resulting in an outer ear infection associated with pain and swelling.
The usual findings on examination include dry scaling skin, serous weeping from the skin, and ear canals that are devoid of normal cerumen (ear wax). The ear drums are usually normal in appearance and there is usually no association with middle ear disease. The condition may in some cases be related to overly meticulous cleansing of wax from the ear canals (particularly with cotton-swabs), excessive introduction of soap and water into the ears from frequent bathing or showering, frequent swimming, etc. All of these factors tend to result in removal of the natural wax coating the ear canal which acts as a protective barrier and natural emollient for the skin.
Treatment frequently requires the use of mild topical steroid drops or cream applied to the outer ear canal such as fluocinolone (Synalar) or betamethasone (Valisone). Long term treatment is occasionally necessary. Preventative measures include avoidance of excessive water in the ears as well as avoidance of overly meticulous cleansing of ear wax. When the condition progresses to overt infection, short term use of topical antibiotic solutions are usually necessary.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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