How to treat excoriation from aggressive ear digging?

Treatment of Excoriation from Aggressive Ear Digging

The most effective treatment for excoriation from aggressive ear digging is to stop the behavior completely by avoiding insertion of any objects smaller than your elbow into the ear canal, while treating any existing inflammation with topical therapy and addressing underlying psychological factors. 1

Understanding the Problem

Aggressive ear digging can lead to several complications:

• Skin abrasions and lacerations in the ear canal
• Ear canal infection (otitis externa)
• Perforation of the tympanic membrane
• Increased cerumen impaction
• Chronic inflammation and excoriation

Treatment Algorithm

1. Immediate Management of Ear Canal Injury

• For minor excoriation/inflammation without infection:

  • Clean the ear canal gently with dry mop technique (blotting with cotton-tipped applicator) under proper visualization 1
  • Avoid irrigation in patients with diabetes or immunocompromised state 1
  • Apply topical corticosteroid drops to reduce inflammation

• For infected excoriation (otitis externa):

  • Topical quinolone antibiotic drops (e.g., ciprofloxacin with corticosteroid) are first-line treatment 2
  • Standard dosing: 5 drops twice daily for 7-10 days (ages 1-12) or 10 drops twice daily for 7-10 days (ages 12+) 2
  • For severe edema: Consider placing a wick to ensure medication delivery 1

2. Stop the Harmful Behavior

• Patient education is critical:
  • Explain that earwax is normal and serves protective functions 1
  • Emphasize that nothing smaller than an elbow should be inserted into the ear 1
  • Warn about risks of cotton swabs, bobby pins, paper clips, etc. 1
  • Discuss that excessive cleaning irritates the ear canal and may increase chances of cerumen impaction 1

3. Address Underlying Psychological Factors

Excoriation disorder is often driven by psychological factors that require specific treatment:

• First-line pharmacotherapy:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine or escitalopram 3, 4
  • N-acetylcysteine has shown promise in reducing picking behaviors 5, 4

• Psychological interventions:

  • Cognitive-behavioral therapy specifically designed for excoriation disorder 4
  • Habit reversal training
  • Stress reduction techniques

• Alternative therapies to consider:

  • Yoga and aerobic exercise have shown benefit in reducing body-focused repetitive behaviors 5
  • Biofeedback may help reduce picking behaviors 5

Follow-up and Monitoring

• Schedule follow-up within 7-14 days to assess healing and treatment response
• Monitor for signs of infection: increased pain, drainage, fever
• Assess adherence to behavioral modifications
• Consider referral to psychiatry/psychology if excoriation behavior persists

Important Caveats and Pitfalls

• Never irrigate ears in patients with diabetes or immunocompromised states as this can lead to malignant otitis externa 1
• Avoid aminoglycoside-containing drops in patients with perforated tympanic membranes due to potential ototoxicity 2
• Be alert for necrotizing otitis externa in elderly, diabetic, or immunocompromised patients, which presents with granulation tissue on the floor of the canal and requires urgent referral 1
• Do not use ear candles as they provide no benefit and can cause serious damage to the ear canal and eardrum 1
• Recognize when to refer: Persistent symptoms despite treatment, suspicion of tympanic membrane perforation, or severe psychiatric comorbidity require specialist consultation

By addressing both the physical injury and the underlying behavior, this comprehensive approach offers the best chance for healing and prevention of recurrence in patients with excoriation from aggressive ear digging.