From the Guidelines
Ear itching in the elderly is most commonly caused by dry skin, earwax buildup, or skin conditions like eczema or psoriasis, and the best course of action is to apply a few drops of mineral oil or baby oil to the outer ear canal for dry skin-related itching, or use over-the-counter earwax removal drops containing carbamide peroxide for earwax buildup, as recommended by the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1.
Causes of Ear Itching in the Elderly
- Dry skin or xerosis, which is commonly associated with pruritus in the elderly, as stated in the British Association of Dermatologists' guidelines 1
- Earwax buildup, which can cause itching, hearing problems, or a sense of fullness in the ear canal, as mentioned in the clinical practice guideline for earwax (cerumen impaction) 1
- Skin conditions like eczema or psoriasis, which can mimic acute otitis externa and cause itching, as discussed in the clinical practice guideline for acute otitis externa 1
Treatment Options
- Applying a few drops of mineral oil or baby oil to the outer ear canal can provide relief for dry skin-related itching
- Using over-the-counter earwax removal drops containing carbamide peroxide (like Debrox) twice daily for 3-4 days can help soften and remove excess wax
- Applying a 1% hydrocortisone cream to the outer ear (never inside the ear canal) can reduce inflammation for persistent itching
- Avoiding inserting objects into the ear canal, as this can worsen itching and potentially damage the ear, as warned by the clinical practice guideline for earwax (cerumen impaction) 1
Important Considerations
- Underlying conditions like fungal infections may require prescription antifungal drops such as clotrimazole 1% solution
- If itching persists beyond two weeks, is accompanied by pain, discharge, hearing loss, or dizziness, medical attention should be sought promptly
- Age-related changes in skin elasticity and decreased oil production make elderly individuals more susceptible to dry, itchy ears, while reduced immune function can increase vulnerability to infections that cause itching, as noted in the British Association of Dermatologists' guidelines 1
From the Research
Causes of Ear Itching in the Elderly
- Ear itching in the elderly can be caused by various factors, including dry skin 2
- Immunosenescence and neural degeneration can also contribute to ear itching in the elderly 2
- Skin diseases such as seborrhoeic dermatitis and stasis dermatitis can cause itch, including in the ear area 2
- Systemic conditions like end-stage renal disease and diabetes can also lead to ear itching 2
- Certain medications, including thiazides and calcium channel blockers, can cause itch in elderly patients, potentially affecting the ear area 2
Role of Earwax in Ear Itching
- Earwax can contribute to ear itching, and the use of cerumenolytic agents can help disintegrate earwax 3
- Aqueous cerumenolytics, such as sodium bicarbonate, are more effective than organic agents in disintegrating earwax 3
- However, the relationship between earwax and ear itching in the elderly is not fully understood and may require further research
Management of Ear Itching in the Elderly
- Topical treatment, including skin hydration and barrier repair, is the mainstay of therapy for ear itching in the elderly 2
- Emollient therapy can be beneficial for dry skin conditions, including those that may affect the ear area 4
- Management of ear itching in the elderly should be tailored according to the underlying cause and should take into account changes in metabolism and pharmacokinetics of drugs in the aging population 2