16 Oct Itching in the ear: a symptom with many possible causes

The skin in the outer ear and at the entrance to the ear canal is sensitive and depends on a balanced interaction between moisture and earwax. If this natural balance is disturbed, the skin dries out, becomes tight and starts to itch. After frequent showering, bathing or swimming in particular, too much earwax can be rinsed out, resulting in a lack of protective film.

Dry room air, frequent wearing of in-ear headphones or hearing aids and intensive ear cleaning put additional strain on the skin. Typical symptoms are a fine feeling of tension, tiny flakes of skin or a tingling sensation in the ear canal.

The so-called. Cerumen fulfils an important protective function in the ear. It keeps the skin in the ear canal supple, traps dust and dirt particles and has a slight antibacterial effect. Normally, the cerumen is slowly transported outwards through natural chewing movements, where it dries up and falls off.

If this self-cleaning mechanism is disrupted, earwax can accumulate and harden. This happens, for example, if the ear canals are narrowed, the ear skin is very hairy or if earplugs, headphones or hearing aids are used frequently. Cotton buds also often push wax deeper into the ear canal instead of removing it.

Those affected often feel a dull itch, a foreign body sensation or slight pressure in the ear. In some cases, there is also a temporary loss of hearing or a crackling sensation when chewing.

The skin in the ear reacts sensitively to certain substances that come into contact with it. Metals in earrings or ingredients in cosmetics, shampoos and skin care products are often the triggers for itching. If such substances come into contact with the sensitive skin of the pinna or the ear canal, the immune system can react with a Contact allergy The skin reddens, swells slightly and begins to itch intensely.

Typically, the itching occurs suddenly, often accompanied by a warm or burning sensation. Sometimes a slight rash develops or the skin appears sore and irritated. If contact with the trigger persists, the symptoms can worsen.

Otitis externa is one of the most common causes of persistent itching in the ear. The sensitive skin that lines the ear canal becomes inflamed - usually due to bacteria or, more rarely, fungi. Even tiny injuries caused by cleaning or scratching can pave the way for germs.

Typical symptoms include intense itching, which can quickly develop into burning or pain, as well as a feeling of warmth in the ear. Some sufferers also notice that the ear canal is swollen or oozes clear or purulent fluid. In severe cases, hearing may be impaired because the ear canal is constricted by the swelling.

Otitis externa often occurs after swimming or bathing, when moisture remains in the ear and the environment becomes favourable for germs. This is why it is also known colloquially as "swimmer's ear".

Eczema, neurodermatitis or psoriasis change the structure of the skin: it becomes drier, flakier and loses its protective function. As a result, it reacts to even minor irritations with itching or redness.

A persistent or recurring itch is typical, which often manifests itself with fine scales or cracked skin. Those affected often describe that the ear canal is tight or feels sore. In the case of psoriasis, small, silvery, shiny skin flakes may also be visible, while atopic dermatitis tends to be characterised by red, itchy areas.

Scratching or cleaning usually worsens the symptoms because the already sensitive skin is further injured.

Fungi can also infect the external auditory canal and cause severe itching. This form of inflammation is called otomycosis. Yeasts or moulds are often involved, which feel particularly at home in the ear in a warm and humid climate. This is the case, for example, if water remains in the ear after swimming or showering or if you are in tropical regions.

A fungal infection is typically characterised by an intense, deep-seated itch that can intensify from day to day. Some sufferers experience a feeling of pressure or a slight burning sensation, others notice a change in odour or crumbly, discoloured deposits in the ear.

Hearing is often impaired because the ear canal is partially blocked by the fungal material.

Not all itching in the ear arises directly from the skin. In some cases, the ear canal reacts reflexively to stimuli from neighbouring nerves or organs. The vagus nerve, for example, which also supplies parts of the ear, is connected to the throat, larynx and even internal organs. If it is stimulated at another point, this can be perceived as itching or tingling in the ear.

Such sensations occur, for example, when the mucous membranes in the nasopharynx are inflamed, when there are pressure changes in the ear (e.g. due to colds or travelling by plane) or also due to tense jaw and neck muscles. The itching then often feels deeper - as if it is coming from inside. However, the skin in the ear remains completely inconspicuous.

At the beginning we ask for important details:

• How long has the itching been present?
• Does it occur on one or both sides?
• Are there accompanying symptoms such as Painpressure, oozing or hearing loss?
• Do you regularly use headphones, earplugs or hearing aids?
• Do you have allergies, skin diseases or frequent ear infections?

Next, we use an otoscope/ear microscope to look at the external auditory canal and the eardrum. We recognise this:

• whether earwax deposits are present,
• whether the skin is irritated, reddened or swollen,
• whether there is secretion or debris in the ear canal.

If an infection is suspected, we will take a swab. We have this analysed in the laboratory to identify possible bacteria or fungi.

In order to clarify whether it is an allergic reaction or a chronic skin disease, a Allergy test or a dermatological co-assessment may be useful.