Primary itching of external auditory canal and its management

Introduction:

Patients with itchy ear are said to be suffering from “itchy ear syndrome”. Sometimes the itching in the external auditory canal may be so severe that it may even disrupt sleep.

Classification of itchy ear:

Itchy ears has been classified into primary and secondary types.

Secondary itching: of the external auditory canal may be caused by:

1.Dermatitis – contact / seborrhoeic
/ dermatomycosis
2.Systemic disorders causing itching include – jaundice, diabetes, and renal pathology


Primary itching:

In patients with primary itching there is no evidence of dermatitis or systemic disorders which have been attributed to be the causative factors of secondary itching. These patients may at the most have pathogenic colonization of the external auditory canal.
These patients are commonly middle aged or elderly women.

Predisposing features of primary itching include:

1.Excess moisture in the external auditory canal
2.Changes in pH of cerumen
3.Obstruction to external auditory canal due to presence of wax


Management:

These patients can be managed by

1.Topical application of 2% acetic acid
2.Appication of soothing agents like coconut oil
3.Application of topical steroids like triamcinalone
4.Application of silver nitrate gel
5.Oral antihistamines

Long term application of topical steroids is frought with a lot of complications. This includes thinning of epidermis, decreased microvasculature and a reduction in the number of keratinocytes.

Current therapy:

Pimecrolimus
a new topical immunosuppressive agent has shown immense promise in the management of this disorder. This is an immunomodulating agent which has been successfully used in the management of atopic dermatitis. This drug is a macrolactum derivative and is known to inhibit calcineurin which is known to cause itching in these patients.