What is the treatment for pruritus (itching) of the ears?

From the Guidelines

For itching ears, the most effective treatment approach is to identify the underlying cause and address it specifically, with the goal of reducing morbidity, mortality, and improving quality of life. The causes of itching ears can be diverse, including dry skin, allergies, irritation, wax buildup, or infections. According to 1, management of conditions like eczema, seborrheic dermatitis, and other inflammatory dermatoses involving the ear canal includes gentle skin care, application of emollients, prevention of secondary skin infection, and the use of topical corticosteroids and other antipruritics.

For dry skin, applying a few drops of mineral oil, baby oil, or glycerin to moisturize the ear canal can be beneficial. For allergies or irritation, over-the-counter antihistamines like cetirizine (Zyrtec) or diphenhydramine (Benadryl) can help reduce itching, as suggested by general medical knowledge. If wax buildup is the issue, using over-the-counter ear drops like Debrox or Murine to soften the wax, followed by gentle irrigation with warm water using a bulb syringe, is recommended.

It's crucial to avoid inserting objects into the ear canal, as this can cause damage or push wax deeper, potentially leading to more serious conditions. If itching persists beyond a few days, is accompanied by pain, discharge, hearing loss, or dizziness, seeking medical attention is necessary, as these symptoms may indicate a more serious condition requiring professional treatment, such as necrotizing otitis externa or otomycosis, as discussed in 1.

In cases of fungal or bacterial infections, prescription ear drops containing antifungals or antibiotics may be necessary, and consultation with a healthcare provider is essential for proper diagnosis and treatment. Regular topical skincare with emollients and exclusion of skin infections, as recommended in 1, can also help in managing pruritus associated with conditions like congenital ichthyoses.

Given the potential for serious underlying conditions, it is essential to prioritize a thorough evaluation and appropriate treatment to minimize morbidity, mortality, and improve quality of life. This approach aligns with the principles of managing conditions that could affect the outcome of acute otitis externa, as outlined in 1, emphasizing the importance of identifying and addressing underlying causes to prevent complications and ensure the best possible outcomes.

From the FDA Drug Label

For the treatment of superficial infections of the external auditory canal caused by organisms susceptible to the action of the antimicrobial, complicated by inflammation. Carefully remove all cerumen and debris to allow hydrocortisone 1% and acetic acid 2% otic solution to contact infected surfaces directly.

The treatment for itching ears, if caused by a superficial infection of the external auditory canal, may involve the use of hydrocortisone (OTIC), as it is indicated for the treatment of such infections complicated by inflammation 2 and 2.

• The patient should carefully remove all cerumen and debris from the ear canal.
• A wick of cotton saturated with the solution should be inserted into the ear canal to promote continuous contact.
• The patient should keep the wick in for at least 24 hours and keep it moist by adding 3 to 5 drops of the solution every 4 to 6 hours.
• After removing the wick, the patient should continue to instill 5 drops of the solution 3 or 4 times daily.

From the Research

Treatment Options for Itching Ears

• Itching ears can be a symptom of various conditions, including atopic dermatitis and other inflammatory skin diseases.
• Topical corticosteroids are a common treatment option for inflammatory skin conditions, including those that may cause itching ears 3, 4.
• The choice of topical corticosteroid and its mode of application depends on the context and should respect "Good clinical practice" guidelines to select the best benefit/risk ratio 4.
• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3.
• For itching ears caused by atopic dermatitis, a combination therapy of H1-antihistamines and topical corticosteroids may be effective, with H1-antihistamines having a synergistic effect when combined with topical steroids 5.

Application and Precautions

• Correct patient application is critical to successful use of topical corticosteroids, and patients may be taught application using the fingertip unit method 3.
• The risk of adverse effects from topical corticosteroids increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin 3.
• Lower potencies and shorter durations of topical corticosteroids should be used when prescribing for children 3.