From the Guidelines
To treat ear canal itchiness, start with over-the-counter options like 1% hydrocortisone ear drops, applying 2-3 drops twice daily for up to 7 days, as this approach is supported by the clinical practice guideline for acute otitis externa 1.
Key Considerations
- Ear canal itchiness often results from excess moisture, eczema, or mild infections that disrupt the protective acidic environment of the ear canal.
- Avoid scratching or touching the ear and do not insert anything into the ear canal, including cotton-tipped swabs, to prevent further irritation 1.
- Keep the ear canal dry by avoiding swimming or using earplugs, and refrain from inserting objects like cotton swabs which can worsen irritation.
- If symptoms persist beyond a week, are accompanied by discharge, pain, or hearing changes, seek medical attention as these may indicate a more serious condition requiring professional treatment.
Treatment Options
- Over-the-counter 1% hydrocortisone ear drops
- A mixture of equal parts white vinegar and rubbing alcohol as drops to help restore proper pH and dry excess moisture
- Prescription antibiotic-steroid combination drops like Ciprodex (ciprofloxacin/dexamethasone) for severe itching
Important Reminders
- Eardrops are, in general, very safe and well tolerated, but some people may report local rash, itching, irritation, or discomfort 1.
- If symptoms do not improve within 48 to 72 hours of treatment, or if they worsen, seek medical attention to rule out more serious conditions like necrotizing otitis externa or malignant otitis externa 1.
From the Research
Ear Canal Itchiness Treatment Options
- Topical treatment is the first-line treatment for inflammation of the external auditory canal and chronic otitis media, without the need of systemic antimicrobial drug therapy 2
- A combinatorial broad-spectrum antibiotic/corticosteroid ear drop is the most effective remedy for bacterial inflammation, whereas the most important therapeutic procedure in fungal infections is cleaning and topical medication 2
- Topical pimecrolimus appears to be as effective as topical hydrocortisone in relieving external auditory canal pruritus 3
Comparison of Treatment Options
- A study comparing topical pimecrolimus versus hydrocortisone in treating external auditory canal pruritus found that topical pimecrolimus had decreased itching scores by 52.3% by the third week of treatment and by 77.6% by the third month, whereas the scores of patients receiving topical hydrocortisone had decreased by 34.4% by the third week and by 64.2% by the third month 3
- Another study compared the long-term response to pimecrolimus versus clobetasone butyrate in treating eczematous external otitis and found that pimecrolimus had a much greater and sustained improvement at month 12 4
Considerations for Treatment
- Systemic hydrocortisone can elicit allergic skin reactions in patients with contact hypersensitivity to hydrocortisone 5
- Treatment of eczema, which can cause ear canal itchiness, requires a manifold approach to therapy, including skin moisturization, topical anti-inflammatory agents, and proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors 6