Ask the doctor: Why are my ears so dry and itchy and what can I do about it?

Question: I am a woman in my early 50s. My ears have become very dry and itchy recently. I don’t use cotton buds. When I clean them with a tissue they are dry and powdery. What do you think this could be?

Dr Grant replies: It sounds like you may be suffering from a form of external otitis or inflammation of the external ear canal. There are multiple causes underlying the inflammation such as infection, allergy or skin conditions like eczema or psoriasis that can cause external otitis. This is a common condition affecting up to 10pc of people during their lifetime.

The delicate skin that lines the ear canal contains a type of keratinising squamous cell that is continually regenerating and sloughing (clearing) away, with the help of the fine hair cells, resulting in the migration of ear wax and keratin debris towards the outside.

Ear wax is hydrophobic (meaning it repels water) and helps create an acidic environment in the ear canal, making it less likely to allow bacteria or fungal infections take hold. Any disturbance to the delicate balance may result in external otitis.

Some of the well-known risk factors causing a breakdown in the ear’s skin-wax barrier include regular swimming, excessive moisture exposure, minor trauma from excessive scratching/cleaning, excessive wearing of ear pieces (eg, hearing aids or earphones), allergic contact dermatitis or other skin conditions.

Typically patients will complain of ear pain, itch and/or ear discharge. Itch is often a prominent feature in allergic contact dermatitis. Patients may have a feeling that something is in the ear canal. In severe cases, when the ear canal is completely occluded from debris and oedema (swelling), there may be an element of hearing loss.

Unfortunately, you need to attend a GP for a clinical examination and proper history of your onset of symptoms. You ear needs to be examined and a treatment plan put in place. Treatment will vary depending on the most likely underlying cause.

The initial first step usually involves appropriate professional ‘aural toilet’ or ear cleaning of the external canal. Removing all the debris in the ear canal enhances healing and enables better penetration of topical ear drops. In patients with diabetes, or who have a compromised immune system, or if the ear is extremely tender, or the eardrum (tympanic membrane) may be ruptured, then referral to an ENT specialist doctor for cleaning and further management is best advised.

In your case, it sounds like mild external otitis that should respond within one week of treatment, typically involving a combination topical preparation such as acetic acid (an acidifying agent) and hydrocortisone (a steroid). If your ear fails to respond to topical treatment or your ear symptoms get worse then you need to reattend your doctor within two to three days for re-assessment.

At this point, ear swabs may need to be taken of the external ear canal and sent for culture with antibiotic sensitivities. The ear needs to be protected from water during treatment for external otitis such as when showering. Ideally, place a cotton ball coated with petroleum jelly into the ear canal. No swimming and water sports are allowed for at least seven to 10 days during treatment.

In order to prevent the condition recurring, it is important to remember that the ear canal is self-cleaning. You should not insert your fingers, the corner of a towel, cotton swabs, or other foreign objects (marketed as cleaning devices) into the ear canal. It is safe to dry the ear after water exposure by using a blow dryer (on low speed and low heat-setting) at least 12 inches away from the ear. Hearing aids or earphones should be cleaned regularly.

​Dr Jennifer Grant is a GP with Beacon HealthCheck

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