What is the treatment for chronic ear pruritus (itching)?

From the Guidelines

Chronic ear itching should be treated based on the underlying cause, and for most cases, gentle cleaning and avoidance of irritants are the first steps, but if the cause is related to a systemic condition like uraemic pruritus, ensuring adequate dialysis and using treatments like BB-UVB phototherapy may be necessary, as suggested by the British Association of Dermatologists' guidelines 1.

Treatment Approaches

• For mild cases, start with gentle cleaning using a few drops of mineral oil, baby oil, or over-the-counter ear drops like Debrox to soften earwax, followed by gentle irrigation with warm water using a bulb syringe.
• Avoid inserting cotton swabs deep into the ear canal as this can push wax deeper or damage the ear canal.
• If allergies are causing the itching, try antihistamines, but note that cetirizine is not effective in uraemic pruritus 1.
• For fungal infections, antifungal ear drops such as clotrimazole 1% solution can be effective.
• Bacterial infections may require antibiotic ear drops.
• For eczema or dermatitis in the ear, hydrocortisone 1% cream applied sparingly to the outer ear can provide relief.

Systemic Conditions

• If the ear itching is part of a systemic condition like uraemic pruritus, ensuring adequate dialysis, normalizing calcium–phosphate balance, controlling parathyroid hormone levels, correcting any anaemia with erythropoietin, and using emollients for xerosis are essential steps before considering other treatments 1.
• BB-UVB phototherapy is an effective treatment for many patients with uraemic pruritus, with a strength of recommendation A 1.
• Other treatments like capsaicin cream, topical calcipotriol, or oral gabapentin may be considered for uraemic pruritus, but with a lower strength of recommendation D 1.

Quality of Life

• Persistent itching requires medical evaluation as it could indicate more serious conditions that need specialized treatment.
• Keeping ears dry after swimming or bathing by tilting your head to each side or using a hair dryer on low setting can help prevent recurrence of ear infections that cause itching.
• Patient support groups and psychosocial interventions may be beneficial for patients with chronic pruritus, including those with psychological and emotional factors contributing to their condition 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The hydrocortisone cream can be used to relieve itching associated with minor skin irritations and inflammations. However, there is no direct information about chronic ear itching treatment in the provided drug labels.

• The labels mention itching relief for skin irritations, inflammations, and rashes.
• They also mention external anal and genital itching relief.
• But, they do not specifically mention chronic ear itching. 2 2

From the Research

Chronic Ear Itching Treatment

• Chronic ear itching can be a symptom of various conditions, including chronic otitis externa, eczema, or psoriasis 3, 4.
• Treatment options for chronic ear itching include:
  • Topical antibiotics or corticosteroids to reduce inflammation and infection 5, 6.
  • Topical tacrolimus, a nonsteroidal immunosuppressant, to reduce inflammation and itching 4.
  • Cleaning and drying the ear canal to prevent infection and irritation 5, 7.
  • Avoiding irritants such as Q-tips, water, or harsh chemicals 3.
• In some cases, underlying conditions such as autoimmune disorders or allergies may need to be addressed to resolve symptoms 3, 4.
• It is essential to consult a healthcare professional for proper diagnosis and treatment, as chronic ear itching can be a symptom of an underlying condition that requires medical attention 3, 7.

Treatment Options

• Topical antibiotics:
  • Effective in reducing bacterial infections and inflammation 5, 6.
  • May be used in combination with corticosteroids for enhanced effectiveness 5.
• Topical corticosteroids:
  • Effective in reducing inflammation and itching 3, 4.
  • May be used in combination with antibiotics for enhanced effectiveness 5.
• Topical tacrolimus:
  • Effective in reducing inflammation and itching in chronic dermatitis of the ear 4.
  • May be used as a alternative to corticosteroids in some cases 4.

Ear Canal Care

• Cleaning and drying the ear canal is essential to prevent infection and irritation 5, 7.
• Avoid using Q-tips or other objects to clean the ear canal, as this can push wax and debris further into the ear 7.
• Using ear drops or ointments as directed by a healthcare professional can help to reduce inflammation and itching 5, 4.