Driven crazy by the itch in your ear??

It seems like an obscure problem to have because nobody talks about it, but actually it’s not. If you’ve come here desperate for help I will do my best to offer a solution, and definitely some commiseration; I have been sufferer of the devil itch for over 20 years and counting.

Itchy ears: Technically can be called Otitis externa. Otitis meaning inflammation of the ear, externa referring to the outer portion, that is the ear canal. Probably the first thing people will think of when they hear this medical term is that it is referring to an infection, such as in the picture above. But actually it is referring the inflammatory itchy state - which could be caused by infection, a skin condition, or irritation by hard wax.

For this post I going to try to stick to simple recommendations on how to manage itchy ears, because I honestly could harp on for ages on the subject.

If this is the first time you have had to deal with otitis externa: it’s really itchy, it’s driving you crazy, you tried x,y,z ear drops from the pharmacy, you are itching yourself in public places; this is what I would recommend:

• Go see a doctor. I say this as I didn’t go see the doctor for ages when I got it the first time. I thought it's just a little problem and the doctor would be overqualified for it. Whether the doctor is overqualified to sort out your ears or not, you should go see him/her because you need someone to actually look into your ear for you. With an otoscope. Who else is going to be able to do it? That is the thing about your ear canals, they are hard to reach and hard to look into. They will be able to tell you if you have a problem with wax, or if not whether there is an infection present. Infections can easily to treated with antibiotic/fungal drops. 

•  If your ears are blocked with wax, then follow the procedure recommended by the doctor to remove it (or see my recommendations below). For the first time it is worth getting a nurse or doctor to confirm your ears are clear after the treatment just so you are not guessing. Also once the wax has been cleared away the doctor can then see much better whether there is an infection or skin problem present.

• If they are still itching, even after the wax is gone and the doctor says he/she can’t see any infection, you might need to give the inflammation/itch a few days to settle down. Perhaps your ears are dry and the skin is irritated. You can try instilling your ears with olive oil (see below), if it’s unbearable try taking an antihistamine tablet, such as Piriton (chlorpheniramine or chlorphenamine) as well. If you have any steroid cream such as hydrocortisone you could try applying a small amount to the outside of your ear canal – maybe the warmth of your body will make it spread into your ear. Give it a week or two, if the itch still doesn't settle down then go back to see the doctor. Half the issue with this problem is not being able to see what is going on in your ear. Perhaps you have a skin condition or maybe a mild infection they missed first time round they can treat with drops. 

Naturally I don't recommend trying to scratch the itch in your ears with toothpicks or whatever, not even with a proper ear pick that I've seen sold in some shops. You might damage the delicate skin inside, if there's a wax plug you might push it further into your ear. If you're really clumsy you might even damage your ear drum by accident. 

Ear infections in the ear canal: are often caused by wax plugs, which make it difficult for the canal to dry if water gets into them eg. after swimming. If you clear out the plug this will go half way towards sorting out this problem. Of course antibiotic ear drops can sort it out too, but bear in mind if there is a wax plug, the doctor cannot actually see if there is any infection present. If they give you any drops without removing the plug they would just be guessing at what might be causing the itch. You can try the drops and see what happens, but go back if they don’t work.

Please note: this is different from deeper ear infections associated with colds which tend to affect children – these tend to cause pain/fever rather than chronic persistent itch.

Read on for more in detail into causes and treatments you can try particularly if you’re a chronic sufferer like myself and like to self medicate in between trips to the doctor.

Causes of itchy ear (otitis externa):

• Infection: The ear canal, being a canal, is prone to becoming a breeding ground for bacteria or fungi if they don’t stay dry. A common cause of prolonged dampness is swimming accompanied with ear wax build up (aka swimmer’s ear).
• Ear Wax build up/plug: Wax is naturally secreted by the ears and is meant to be protective. In some people for some reason the ear wax doesn’t drain out of the ears efficiently, and builds up to form a plug in the ear. This may not affect you at all, or it may make it difficult for your ears to dry if water gets into the canal. The hard dry wax plug itself can irritate the skin of the ear canal, which is delicate and sensitive.
• Dermatitis: this means any kind of skin rash or skin condition which causes itching and inflammation. It’s possible to get dermatitis inside the ear canal.

DIY Ways to help prevent/treat ear infection:

• Ear plugs when swimming. Maybe also when you take a shower or wash your hair to try ensure your ears stay as dry as possible. 
• You could try drying your ears using a hair dryer, it might also be possible to get a device designed specifically to dry your ears.

You can buy empty glass bottles which come with pipettes from a pharmacy and try out some any of the following:

• Rubbing alcohol/isopropyl alcohol  (atleast 75%): instil into your ears after swimming, or when you think they are damp. You can buy from a pharmacy or from supermarkets. Isopropyl alcohol is the stuff they put into alcohol wipes and disinfecting hand gels, in theory it is supposed to kill 99.9% of bacteria and fungi. In addition it evaporates quickly, helping to dry the ear canals and giving a nice cooling effect. Bear in mind if you have dermatitis in your ears it could aggravate it – imagine putting neat alcohol onto a rash or broken skin.
• Vinegar (Acetic Acid): try instilling this mixed with alcohol, roughly half and half. Acetic acid is antimicrobial. If you try this use white vinegar, it is the cleanest/purest (we're just interested in the acetic acid content) of the different types of vinegar.
• Garlic in olive oil: Roughly chop a clove up and stick it into the bottle with a small amount of the oil, say 30 ml. This is a traditional Indian remedy. Garlic has antibacterial and anti-fungal properties, olive oil will help soften/dissolve ear wax. The obvious downside is if you are paranoid about smelling of garlic. I use this combo a lot.
• Tea tree oil: Try adding a few drops of tea tree oil to something like olive oil. Tea tree oil is a pleasant smelling natural antiseptic .

If you don't like DIY, there are also ready made ear drops available, have a look around your local chemist, speak to the pharmacist. Or pharmacy websites, for example Boots, Chemist Direct (UK).

Antibiotic (and steroid) drops

When none of the above work and the itch in your ear is in full swing, you can get ear drops containing proper antimicrobial drug from the doctor. Often these also have a steroid which targets inflammation/ itching, giving them dual activity.

Drops I have tried are Sofradex, Otomize, Otosporin, and Locorten-Vioform. These four contain antibiotic (kills bacteria). Locorten-Vioform is also anti-fungal. If they are going to work, they will work and they will work really dramatically straightaway, and you will know then that was the cause of your itching. If they don’t work don’t waste time continuing putting them in your ears for weeks wondering why they’re not working, go back to the doctor.

If there is a wax plug present you can still use these drops and see what happens, but if you have a full on infection in your ears it may be best to clean them out for hygiene reasons.

There are drops which only contain steroid in them (eg. Predsol). I do not recommend these if the wax plug has not been cleared out and the doctor can not confirm there is no infection present. If there is an infection there, not only will they not work they will make the infection worse.

Sorting out ear wax:

• Oils: If you have very dry, hard wax in your ears it is well worth trying out something as simple as olive oil. Olive oil will lubricate dry ears, sooth raw skin, and soften the plug. It is gentle and safe. It is a good moisturizer and cleanser (it is also good at removing make-up) and may even have its own intrinsic anti-inflammatory properties. Plus it's olive oil, you can buy it everywhere, you probably have some in your kitchen already. You could try other types of oil as well, such as almond oil. Oils are able to dissolve wax. However large plugs will not be dissolved completely, but they will become more softened and lubricated.

Some examples of commercially available drops for ear wax:

• Cerumol contains Arachis oil (from peanuts), with a couple of other ingredients which help the oil penetrate the wax. If there is dermatitis present it may aggravate it though. The Cerumol people now have a second Cerumol product containing Olive Oil. People with severe peanut allergy are advised not to use Arachis oil.
• Earex Advance contains glycerin – an oily substance which can soften wax, and urea peroxide. The peroxide component releases oxygen bubbles, which may help to break up the plug a bit more.
• Otex contains urea hydrogen peroxide to produce bubbles to break down wax. Hydrogen peroxide is also antimicrobial. The Otex people now also sell an ear cleaning kit which includes a bottle of Otex plus a rubber bulb syringe you can use to syringe your ears out with water once you’ve soften the wax plug.
• A-Cerumen: This is a product from France (available from Amazon) It’s in a nifty spray. Sprays are cooling, which help briefly calm inflammation. Sprays also enable product to last longer with less preservative, because it is more difficult for bacteria to enter the bottle. A-Cerumen contains two surfactants. Surfactants are the stuff which makes soaps and detergents dissolve grease and wax. The A-Cerumen surfactants are natural, plant based, gentle on the skin. It also doesn’t contain any preservative, very appealing if you’re into that sort of thing. Also sold in single use tubes, for people with serious wax plugs and want to put loads of the stuff into their ears.

If there is a large wax plug present, syringing the ear to flush the plug out of the canal may still be required. The longer you use the wax softening treatment for, the softer the wax plug will get, and the easier it will be to flush out.
I have tried putting oils and stuff in my ears for days on end to see whether this would dissolve the plug on their own without syringing, but I have never been able to achieve this. Plus if you do this, you might end up having to go months with an ear which is not only itchy, but also plugged up with oils and wax thus making you half deaf until you clear it out.

If you are someone who battles with wax plugs, you can use these products maybe once a week or so as maintenance. Don’t go overboard though, your ears are meant to have some wax in them, stripping them constantly may very well also cause irritation.

Applying ear drops

The best way to apply ear drops (or spray) is with you in a lying on your side position, instil the stuff into your ears and stay there for a good minute - ideally as long as possible, before getting up. This way you can maximize the contact time between the medicine and the contents of the ear canal. I like to fill the canal up and do this when I’m in bed, before I get up or after I settle down for the night. You can wipe off the excess which runs out, or put a bit of cotton wool in your ear to catch the run off (just don’t shove it right into the canal). If you are using drops it will tell you the number of drops to put in. The exact number doesn’t matter so much, you really just want to ensure there is sufficient amount of medicine to slosh around your ear. Ear sprays are pretty handy, only one or two sprays are needed. Antibiotic drops and steroid drops probably would work better if wax plugs are removed, but they will still work, if they are going to work.

You could try keeping your drops in the fridge so that they have a cooling effect when you use them. Oils might solidify in the fridge is all, but they should melt again when you take them out.

Ear syringing

Otex do a wax removal kit which contains a bulb syringe to syringe your own ear. It’s a step up from what I had to do before, which was use Otex or whichever wax softening product for 5-7 days, then make an appointment with my GP clinic’s nurse to syringe my ear. 
Each clinic is different, some insist that a Doctor have a look in your ear first, others don’t think this is necessary. Some use a big old fashioned metal syringe, some have an electric ear irrigator, which looks like a fancy plastic tube attached to a pump, but basically they irrigate your ears with a steady stream of water to force loose wax out.  

You can also buy ear sprays which contain saline water. I tried to use these without softening my ear plug, because it said I could, and I walked around half deaf with water in my ears for about a week, (which I finally sorted with olive oil). I would say on their own they don’t do anything, wax repels water. They might be useful for washing your ears a bit after wax softening treatment, though I don’t feel they generate enough water pressure - but to be fair I seem to get really hard plugs. Irrigating ears with water may help temporarily soothe itch/inflammation, kind of the gentler, safer way of 'scratching' inside your ears.

Recently I have found the combination of A-Cerumen with self -syringing working out. You can buy proper ear irrigation kits, but I use plastic syringes, the type used to measure out oral liquid medicine (oral medicine dose syringe, NOT insulin syringes which come with needles). I just fill it with warm water from a tap and squirt the water into my ear, if the wax is really soft it comes right out. I started off using a 10 ml syringe, then after that broke, a 5 ml one. Currently I’m using a dinky 3 ml one, I do have to squirt with it at least 3 or more times though. Interestingly enough, if you use cold water it makes you dizzy. If you do end up making yourself dizzy, then just stop and lie down for a bit until you feel better. If you want to try this, don’t ram the syringe in your ear, just rest the tip outside the opening of your canal and aim the jet of water into your ear. To be on the safe side apply gentle pressure. Don’t do this if your ear drum is perforated or you’re new to this and it’s really painful, get a doctor to look at it first. Use your common sense. Disclaimer: if you are dubious, or not confident about trying this out, then just don’t do it, get a nurse to syringe your ear.

Microsuction: I have tried this ‘high tech’ technique once, which removes ear wax plugs without requiring pre-treatment, done by an ENT specialist. The doctor used a tube similar to the one used by dentists to suck water and saliva out of the mouth. He attached the tube to the wax plug using suction and pulled the plug out, bit by bit. They had also set up an ear camera which displayed my ear canal and ear drum on a big screen in front of me. It was liberating, for the first time ever I watched my own ear canals which had troubled me for so long being cleaned out.  But at a cost of $2000 HKD this is not something I’m going to do on a regular basis, even if the doctor is more than happy to do it (for that amount of money I bet he is). Seems weird going to an expensive ENT specialist just to have wax removed from my ears. Maybe some day in the future they'll offer this service at medical beauty clinics where they'll give discounts via Groupon. Here's hoping.