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“Itchy ears… don’t know what’s wrong” Just know that if left untreated, it’s probably not good because many people think ear itching is just a common symptom. Whenever it itches, they just find something to scratch or poke inside the ear to relieve the itch. But did you know? Doing that might cause the eardrum to rupture, potentially requiring eardrum repair surgery.
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After saying this, some might wonder if it can really be that serious. Today, Dr. Naparat Jirawatpholin, ENT specialist at Phyathai 3 Hospital will reveal and delve deep into all ear itching problems. We will learn what causes ear itching and how it should be treated.
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<h2>Getting to know the ear structure… first</h2>
Before discussing ear itching symptoms, Dr. Naparat says we should start by understanding the ear’s structure first. The doctor explains…
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“The human ear consists of 3 layers: the outer ear, middle ear, and inner ear. But the area most related to ear itching is the ‘outer ear’, which is like a cave about 2.5 cm deep. The skin at the entrance of the ear canal has hair follicles and sebaceous glands that can produce sweat and oil, similar to the skin on our face.
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Going a bit deeper inside, the ear becomes warmer, about the same temperature as the body temperature we use to measure fever. The important thing is that the deeper part of the outer ear canal has no hair and cannot produce earwax. So when the ear skin dries and forms scabs or sticky, wet earwax falls inside, it cannot flow out or fall off by itself.
 
Between the outer ear and middle ear is separated by the eardrum, which is about 0.8-1 cm in size and acts like a large oval door. Behind the eardrum is the middle ear, which contains three small bones called the malleus, incus, and stapes. These bones transmit sound to the inner ear. There is also a small tube connecting to the back of the nasal cavity called the Eustachian tube, which acts like an escape route or ventilation hole.
 
The innermost layer is the inner ear, shaped like a snail shell attached to three rings. This part contains the auditory nerve responsible for hearing and balance. When the ear is strained from nerve degeneration, dizziness from uneven fluid in the ear, or dislodged ear crystals, it occurs in the inner ear.”
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<h2>Ear itching: Know the cause for proper treatment</h2>
Ear itching may seem like a minor issue, but it is important to know the cause to handle it correctly. Dr. Naparat answers all questions about ear itching…
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“Most ear itching occurs in the outer ear, over 99%, but not in the middle or inner ear. If the itching is caused by earwax, it may be due to flaky earwax moving around, similar to itching when the skin is dry. Especially in winter, flakes form easily. When scabs form, itching occurs. If you scratch or pick, it may cause abrasions and infections, making the itch persistent, sometimes with bleeding and eventually ear pain.
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Scratching or poking the ear canal with fingers or cotton swabs is like cutting with a knife, causing injury. The ear canal normally has resident bacteria, so if wounds occur, bacteria can enter easily, causing infection and pus. This is mostly ‘ear itching from bacterial infection’.
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<h2>Ear itching from fungal infection</h2>
The doctor further explains… 
“There is another type of ear itching called ‘ear itching caused by fungal infection’ which comes from moisture. Cases often have a history of water entering the ear frequently without drying immediately, or people who swim often, causing moisture in the ear mixed with existing earwax, allowing fungi to grow. This type of ear itching is very itchy, accompanied by mild pain and sometimes discharge from the ear.
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The prevention method is to tilt the head to drain water out of the ear after washing hair or water entering the ear, then gently pat the outside with cotton wool only. You may also use a hairdryer on a low heat setting, but be warned that prolonged use may stimulate the inner ear, causing dizziness. This is a normal body mechanism because pressure changes from suction or air entering the ear canal disturb the inner ear, causing fluid movement and dizziness, which usually subsides within 2-3 minutes.
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Besides infections, skin diseases that cause frequent skin peeling like ‘psoriasis’ often cause ear itching and skin irritation. The skin flakes from this disease can irritate and fall into the ear canal, irritating the eardrum. Also, people with dry ear skin lacking moisture can develop flaky skin, often seen in cold, low humidity, and dry weather conditions. When skin peels, it causes irritation and ear itching.
 
For those with allergies, besides itchy nose and eyes, they may also have ‘allergic ear itching’. However, this type of itching usually involves the skin and is not very severe because it mainly affects the skin.”
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<h2>Earwax… an enemy that should be removed?</h2>
Regarding earwax, Dr. Naparat explains that normally earwax falls out naturally, except for some patients who need cleaning to prevent hearing problems…
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“Earwax looks like a lump of soil. If dry, it is dark to black in color, indicating it has been there for a long time, possibly over a year or even up to 10 years in some cases where the person never cleaned it. It becomes hard like a stone that can bounce. These patients come with ear pain and muffled hearing. New earwax is yellow, like candle wax, located near the outer ear and can fall out naturally by chewing or jaw movement, except in some cases with excessive earwax due to genetics.
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Cleaning by scratching the ear improperly can cause problems because pushing or spinning cotton swabs can push earwax deeper into the ear canal, where normally there is no earwax. This can cause itching, muffled hearing, and eventually earwax blockage.
 
For those with little earwax, it’s okay to leave it alone. But if there is excessive earwax, it should be managed by regularly checking the ear canal, possibly with help from someone close, since the ear is an organ we cannot see ourselves. Therefore, do not scratch blindly without seeing. For small earwax, it can be removed with a small cotton swab moistened with saline in some cases only or by using earwax-dissolving drops every 2-3 weeks. These drops help clear earwax to prevent blockage and muffled hearing. If symptoms do not improve within 1-2 days after using drops, consult a doctor promptly.”
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<h2>Otitis media… a complication from ear scratching</h2>
Although cleaning the ear is necessary, Dr. Naparat warns that improper or careless cleaning can lead to complications such as otitis media, possibly requiring eardrum repair surgery…
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“Another problem that may follow ear itching is otitis media, which causes eardrum perforation and continuous discharge. At this stage, hearing loss is more prominent than itching. Causes of eardrum perforation may include accidents where foreign objects pierce the ear, causing immediate severe pain. It can also result from colds, allergies, mucus, infections, or chronic sinusitis with forceful nose blowing or frequent sinus infections. These can cause swelling in the Eustachian tube, increasing pressure on the middle ear. When pressure is too high, the ear swells, and air cannot escape, causing small holes to form. Infection trapped in the middle ear causes fluid discharge, known as otitis media. Treatment involves infection control with ear drops, oral medication, and finally, when all fluid dries up, eardrum repair, which can be done in two ways:
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          1. Eardrum patching with paper patch Patients do not need hospitalization or anesthesia. This is for perforations not exceeding 25% of the eardrum. Medication is applied to stimulate tissue growth, combined with placing a medical paper patch on the eardrum for about 2-3 months to allow the eardrum tissue to fully close.
 
          2. Surgery using artificial tissue or tissue from behind the ear to patch the eardrum Performed as outpatient or inpatient surgery, suitable for perforations larger than 25%. Done in the operating room with local or general anesthesia. Postoperative care at home lasts 2-3 months as well.
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Besides these treatments, prevention to avoid recurrence involves treating the underlying causes such as allergies or sinusitis.” Knowing this… we should be careful not to scratch or pick the ear excessively because ear itching may not be just a simple condition that resolves on its own. If infected or with a ruptured eardrum, it requires prompt treatment to prevent worsening or difficult-to-treat complications.

Itching in the ear usually occurs in the outer ear or is caused by earwax that appears flaky and moves, which causes itching similar to dry skin. Scratching or picking may cause abrasions and subsequent infections, or bleeding and ear pain.

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