Ear pruritus is an unpleasant skin sensation of itching of the auricle, the skin around the ear or the ear canal caused by slight stimulation of the sensory nerves in the skin of the external auditory canal. It can be caused by a variety of ear or systemic diseases, most commonly external ear eczema and otomycosis. It can occur suddenly, intermittently or continuously. It manifests as a tingling sensation, stinging sensation, or a crawling sensation. Severe itching often makes people irritable and unbearable, and they want to scratch or rub their skin.
Epidemiology
Prone populationNo special population
symptom
Typical manifestations
Itching of the ear is most common in external ear eczema, ear fungus infection, etc. It can be intermittent or continuous, and can occur suddenly. The specific manifestations of itching of the ear are pinpricks, stinging, and ants crawling. The itching of the ear is mild, like insects crawling, and it stops with a little scratching. In severe cases, it is extremely itchy and the itching is unbearable, and the itching is continuous, even causing local skin damage and bleeding. Depending on the location of the itching, itching of the ear canal can be divided into itching outside the ear canal and itching inside the ear canal.
1. Itching outside the ear canal
Itching of the auricle or the skin around the ear is common in ear rotator cicatrix or ear chilblain. Ear rotator cicatrix is more common in children, and is manifested as itching of the skin centered on the auricle, which can extend to the external auditory canal opening and the skin around the auricle. In the early stage, in addition to itching, there is often a burning or damp discomfort sensation on the skin. Children often scratch their ears with their hands, and infants and young children are prone to irritability and crying. Examination can show flushing, blistering, erosion, exudation, and crusting of the auricle, the external auditory canal opening, or the skin around the auricle. If the course of the disease is long, local skin thickening, desquamation, chapped, and indurated, and the surface is rough and uneven. If the lesions mainly occur at the external auditory canal opening, the external auditory canal opening may be narrowed. Ear chilblains generally occur on the auricle, and are more common in cold seasons in cold northern regions. In the early stage, the auricle skin often has mild itching and burning sensation. Examination can show local skin cyanosis and swelling. In the later stage, ear pain and discomfort may occur.
2. Itching in the ear canal
The skin inside the ear canal is itchy, so that the patient often can’t help but pick the ear, which is common in diseases such as ear sores and foreign bodies in the ear. The course of ear sores can be long or short, and can be divided into two types: wet itching and dry itching according to different clinical manifestations.
(1) Wet and itchy: When the ear itches, the ear canal becomes damp and even leaks water. Examination shows that the skin in the external auditory canal is flushed, swollen, and leaks fluid. Sometimes, the secretions in the ear canal form lumps and accumulate. Due to long-term dampness in the ear canal, some patients may have accumulation of white moldy substances in the ear canal. If there is a lot of accumulation, it may cause a feeling of ear blockage and hearing loss. The patient feels that the ear is extremely itchy and unbearable, so he keeps picking his ears. If the skin of the external auditory canal is damaged by ear picking, pain may occur.
(2) Dry itching: Only pain and itching in the ear occur, without water seepage, blockage or hearing loss. Examination shows dry skin in the external auditory canal. If the patient frequently picks his ears, the skin in the ear canal may become red, rough or thickened. In some patients, the skin in the external auditory canal may be normal. Foreign bodies in the ear may also cause itching. Small insects such as ants and mosquitoes enter the ear canal and move around, often causing itching. Foreign bodies can be found by examination of the external auditory canal.
reason
OverviewLocal ear lesions often cause ear itching. Systemic diseases such as diabetes and uremia can also cause ear itching. In addition, some patients develop the habit of picking their ears, which can cause ear itching without any disease.
Cause of symptoms
1. Western medical causes
(1) Local ear lesions
① Infant and young child eczema during lactation often occurs in the bilateral auricles, postauricular grooves and external auditory canals. The ears are severely itchy, with local erosion and exudation. The outer ear skin develops erythema, papules, blisters, exudate, scabs, scales, cracks, etc., which can gradually spread to the cheeks and scalp. Children often suffer from unbearable itching, irritability, and even affect their diet and sleep. It is often related to allergic constitution and artificial feeding.
②Seborrheic dermatitis, chronic external ear eczema and diffuse external otitis can all cause ear itching.
③ Long-term pus discharge from otitis media irritates the skin, causing eczema-like dermatitis and scabs, leading to ear itching.
④ Fungal diseases of the external auditory canal, such as Aspergillus, candidiasis and penicillosis, are particularly prone to occur in warm and humid environments. Fungal growth stimulates the surface of the skin and can invade deeper into the skin, causing diffuse inflammation. The ear will feel burning and itchy, and excessive exudation can block the external auditory canal and affect hearing. When dry, a layer of powdery substance can be seen on the surface of the dry scab, and fungi can be seen under the microscope.
⑤ Psoriasis and senile pruritus, dry skin inside the ear, scaling, and severe itching.
⑥Drug allergy or drug contact dermatitis, history of ear drops, edema and exudation, improved after stopping the drug.
⑦ Foreign objects in the ear, such as crawling insects, or other foreign objects such as earwax, can cause ear itching.
⑧Auricular lichen occurs simultaneously with skin lichen.
⑨Insect stings or bites can cause ear itching.
⑩ Frostbite of the auricle occurs when exposed to cold, with initial numbness, followed by redness, swelling, burning and itching.
(2) Systemic diseases
For example, patients with diabetes and dry skin can cause itching; bile duct obstruction and increased bile salt levels in the body can cause itching; uremia and hemodialysis can cause systemic itching, which can also occur in the ears.
(3) Others
There are no itchy diseases in the ears, but we have developed a habit of picking our ears; when we have free time, we want to use matchsticks, hairpins, etc. to pick our ears, and we will feel itchy if we don’t pick our ears.
2. TCM etiology and pathogenesis
According to traditional Chinese medicine, ear itching is mainly related to wind evil, and itching occurs when wind prevails. Wind evil can be divided into external wind and internal wind: external wind often invades the human body with cold, heat, and dampness. Because the auricle is exposed, it is easy to be invaded by wind and cold. Cold stagnation causes blood stasis, which can lead to ear frostbite, itching and even redness and swelling of the auricle skin; wind evil with dampness and heat invades the ear orifice, often causing itching, dampness, exudation, and even mold in the ear. Internal wind is mainly caused by deficiency of qi and blood, which causes blood deficiency to turn into dryness and generate wind, which disturbs the ear orifice and causes ear itching.
Common diseases
Infant and young child breastfeeding eczema, chronic external ear eczema, diffuse external otitis, otitis media, dermatitis, eczematoid dermatitis, external ear canal fungal disease, drug allergy, drug contact dermatitis, foreign body in the ear, ear skin lichen, skin lichen, auricle frostbite, etc.
Medical treatment
Emergency (120) Indications
1. Suspected foreign matter, such as insects, has entered the ear;
2. Itchy ears, accompanied by severe ear pain, pus discharge from the ears, significant hearing loss, fever, etc.;
3. Other emergency situations occur.
All of the above require prompt emergency treatment in the emergency room or at an ENT specialist.
Outpatient Indications
1. Accompanied by erythema, papules, blisters, exudate, scabs, scales, cracks, etc. on the skin of the external ear;
2. Accompanied by redness and erosion of the ear canal skin, with clear boundaries and lumpy deposits on the surface;
3. Frostbite of the auricle in winter, numbness and tingling of the local skin, unbearable itching after being heated, and dark red nodules;
4. Accompanied by repeated or persistent ear pain, stuffy feeling in the ear, tinnitus, pus discharge from the ear and other symptoms of ear inflammation;
5. Accompanied by rashes and itching in other parts of the body;
6. Symptoms are related to emotions and mental state;
7. Other severe, persistent or progressive symptoms and signs occur.
If you experience repeated or persistent ear itching accompanied by the above conditions, you should seek medical advice promptly.
Department
1. Severe ear infections and foreign bodies in the ear can be treated in the emergency department or urgently in an ENT specialist.
2. If the itching of the ear is suspected to be caused by ear lesions, the patient can undergo relevant examinations and treatment in the otolaryngology department.
3. Patients who suspect that skin lesions have spread to the ears and caused itchy ears can undergo relevant diagnosis and treatment measures in the dermatology department.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor will conduct a detailed physical examination of the patient’s ears and recommends that the patient not wear too many accessories on the ears to avoid affecting the doctor’s observation.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can carry the medicine box.
5. For patients with severe symptoms, the elderly and frail, or minors, it is recommended that family members accompany them to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
In order to ensure that the medical process goes smoothly, patients are advised to take the above preparatory measures in advance.
Questions your doctor may ask you
1. When did your ears itch? How long did this symptom last? Is there any pattern of change?
2. Are there any signs of aggravation or relief? Under what circumstances would there be aggravation or relief?
3. Did your ear itching appear suddenly or gradually?
4. In addition to itchy ears, are there any itchy symptoms in other parts of the body?
5. What cosmetics have you used recently? Have you come into contact with any foreign matter, such as dust mites, animal hair, pollen, etc.?
6. In addition to the symptoms of itchy ears, are there any other symptoms, such as stuffy ears, tinnitus, increased secretions, hearing loss, etc.?
7. Have you used any medication recently, such as ear drops?
8. Do you have other diseases such as diabetes?
9. Have you seen a doctor before? What treatment did you receive? How effective was the treatment? Did the disease relapse?
10. Has your ear been injured recently? Have you ever had any injury or surgery in the past?
Questions patients can ask their doctors
1. What is the most likely cause of my itchy ears?
2. Are there any other possible reasons?
3. What tests do I need to do?
4. Do I need to be hospitalized?
5. What methods will be used to treat my disease? Can it be cured?
6. What are the risks of these treatments? Will they cause other adverse effects on my body?
7. Is there a definite diagnosis now? What is the diagnosis? What is the next step in treatment? How do you ask me to cooperate?
8. I have other physical discomforts. Will it affect my treatment this time?
9. What aspects of my daily life do I need to strengthen? What should I pay attention to?
10. If medication is possible, what are the usage, dosage, and precautions?
11. Do I need a follow-up examination? How often? What items are usually reviewed?
examine
Estimated inspectionThe doctor will first perform a physical examination, ear swab bacterial culture, fungal culture, and otoscopy. Depending on the patient’s condition, he or she will also select imaging examinations such as X-ray and CT for further evaluation.
Physical examinationThere is no local skin manifestation, and the external auditory canal and eardrum may be covered with yellow or white powdery or villous moss, and sometimes the secretions or crusts are cylindrical. When combined with bacterial infection, there may be ear pain and pus. In mild cases, there may be no symptoms and only discovered during examination.
Laboratory testsBacterial and fungal cultures of ear swabs may reveal pathogenic bacteria.
Imaging testsDepending on the patient’s specific condition, imaging examinations such as X-ray and CT may be selected when necessary.
Other tests
Otoscopic examination can be used to check for itchy ears. In the acute stage of otitis media, radial vascular patterns are seen around the tympanic membrane. The tense part of the tympanic membrane is indented, manifested as shortened, deformed or disappeared light cones; the handle of the malleus is displaced backward and upward; and the short process of the malleus is prominently protruding outward.
diagnosis
Diagnostic principles
A clear diagnosis can be made based on a detailed medical history, combined with ear swab bacterial culture, fungal culture, otoscope and other auxiliary examinations. When inquiring about the medical history, attention should be paid to whether the patient has experienced foreign objects in the ear canal or frostbite, whether there is a history of infectious diseases or other diseases, and at the same time, a preliminary judgment of the cause should be made based on symptoms such as fever and pus discharge. Chronic external otitis, diffuse external otitis, external auditory canal eczema, otitis media, infantile eczema during lactation, external auditory canal fungal disease, auricular frostbite and other diseases often cause ear itching, which needs to be differentiated.
Differential Diagnosis
1. Chronic otitis externa
Chronic external otitis only causes discomfort or itching, the ear canal skin becomes congested or thickened, and is covered with pus crusts, but there is no mold growth. It can be distinguished by bacterial culture or microscopic examination.
2. Diffuse otitis externa
Bacterial infection of the skin of the external auditory canal is caused by swimming, ear picking, pus discharge from the middle ear, etc. The external auditory canal is itchy and stinging, as if there are ants crawling. The skin of the external auditory canal is diffusely congested, swollen, and locally tender. In severe cases, the external auditory canal is narrowed or blocked, and there is often light yellow liquid exudation, scabs, and desquamation. In the chronic stage, cracks or erosions can be seen in the skin of the external auditory canal. Severe cases may be accompanied by fever and lymphadenitis.
3. External auditory canal eczema
It is more common in children. This disease is commonly known as “impetigo”. Its cause may be allergy to certain foods or inhalants. In addition, pus from the middle ear irritating the skin of the external auditory canal may also cause eczema. In the acute stage, the ear is extremely itchy, and children often cry and scratch the affected area with their hands, causing skin damage and secondary bacterial infection, followed by burning and discomfort. As the disease progresses, small yellow transparent blisters appear on the skin. After the blisters burst, light yellow liquid flows out to form jelly-like nodules or small pustules, and the skin erodes. In the chronic stage, the skin desquamation and cracks appear at the opening of the external auditory canal. If the external auditory canal eczema recurs, it can cause fibrosis and thickening, and finally lead to stenosis of the external auditory canal.
4. Otitis media
Hearing loss, ear pain, a feeling of stuffiness or blockage in the ear, tinnitus, discharge or pus, long-term pus discharge, skin irritation, dermatitis, eczematoid dermatitis, and scabs causing ear itching.
5. Infant and young child eczema during breastfeeding
It often occurs in the bilateral auricles, postauricular groove and external auditory canal. The ears are severely itchy, with local erosion and exudation. The skin of the external ear appears erythema, papules, blisters, exudate, scabs, scales, cracks, etc., which can gradually spread to the cheeks and scalp. Children often have unbearable itching, irritability, and even affect their diet and sleep. It is often related to allergic constitution and artificial feeding.
6. Fungal infection of the external auditory canal
Such as Aspergillus, candidiasis and penicillosis, which are diseases caused by fungal infection of the external auditory canal due to swimming, bathing or abuse of antibiotics. The external auditory canal is itchy and painful after secondary suppurative infection. The surface of the external auditory canal and eardrum is moist and covered with a layer of gray-black scab, which is similar to a moldy fluffy mass. When the scab blocks the external auditory canal, tinnitus, hearing loss and a feeling of stuffiness and occlusion in the external auditory canal may occur. Smear examination of external auditory canal secretions can reveal fungal hyphae and spores.
7. Frostbite of the auricle
Once the auricle is frostbitten, the local skin will become numb and tingling; it will become extremely itchy when heated; then small dark red nodules will appear, the auricle will swell and become hard, and in severe cases, blisters will appear, tissue will necrotize, and the auricle will become deformed.
treat
Expected treatmentMake a clear diagnosis, find the cause of the disease, and adopt corresponding treatment measures for different causes. For example, patients with infectious diseases should be given anti-infection treatment, and patients with foreign objects in the ear canal should have the foreign objects removed in time. While treating the cause, pay attention to symptomatic treatment to relieve the patient’s symptoms.
Treatment
1. Principles of Western medicine treatment
(1) Choose anti-inflammatory, antibacterial, steroid hormone, and anti-allergic ear preparations based on the cause of the disease.
(2) Remove scales and earwax from the ear.
(3) It is strictly forbidden to pick your ears. If it itches severely, you can apply an antipruritic.
(4) Treat systemic diseases promptly.
(5) When there is a lot of exudate, use astringent wet compresses.
2. Principles of TCM treatment
(1) For those with wind-cold invasion and blood stasis in the ears, the treatment should focus on dispelling wind and cold, promoting blood circulation and relieving itching.
(2) When wind, heat and dampness invade the ear orifices, the treatment should focus on dispelling wind and heat, removing dampness and relieving itching.
(3) For those with wind caused by blood deficiency, the treatment should focus on replenishing qi and blood, moistening dryness and calming wind.
(4) In addition to the main treatment, different external treatments can also be used according to different situations. For foreign bodies in the ear, the principle of treatment is to remove the foreign body with external treatments.
prevention
Precautions
1. To prevent ear itching caused by frostbite, keep your ears warm in winter and spring. When your ears feel cold, rub them gently with both hands frequently to increase local blood circulation.
2. The bad habit of picking your ears should be abandoned.
3. Prevent dirty water from entering the ears. Before taking a bath, washing your hair, or swimming, you can use a special rubber plug or a clean cotton ball to plug the external auditory canal.
4. Medical tweezers, otoscope, etc. must be strictly disinfected.
5. After being ill, be sure to keep your ears dry and clean.