The Medical Consumer's Advocate

Itchy ears/candling

 

Q: I have very itchy ears. This probably sounds weird, but they itch constantly. I am often tempted to scratch using just about anything I can get my hands on. I know it is "dangerous" to put things into your ears -- but I become desperate. The worst part is that the more I scratch them, the more they itch. I've always had this problem, since childhood. Recently a friend told me to try an "ear candle," a product which can be found at health food stores, which somehow extracts wax from the ear by convection. Is this safe? Could the itchiness that I experience be caused by a wax build up?

A: Now, I don’t want to get too technical, but this is what dermatologists call the "itch-scratch syndrome." No kidding. The more you scratch, the more you itch.

There is a very straightforward explanation for this. Scattered throughout a number of tissues in your body are cells called mast cells. When sufficiently annoyed, these cells excrete into their environment a variety of chemicals (histamine being the most well-known to the public) which cause swelling and itching. While mast cells are usually triggered by a particular antigen (an antigen is something that you are allergic to, for example, goldenrod pollen), if they are aggravated (for example, by that paper clip you were just shoving down your ear canal), they will also spew out their irritating chemicals. This causes more itching, leading to more scratching... you get the idea.

The treatment for this is very simple. By applying a tiny amount of a steroid ointment to the outer part of your ear canal, you can stop the itching, which will (I hope) prevent you from further scratching. Over the counter steroid ointments will sometimes work, but often a prescription-strength ointment is necessary. (You'll need to talk to your doctor about this, of course.) Once your ears stop itching, stop using the ointment, since chronic use of these ointments can do unpleasant things to your skin. How much should you use? Enough to coat the skin, and no more; pretend that you are using a moisturizer, and you will have the right idea.

What about your ear wax? Without examining you, I have no idea if this is contributing to your problem. Ear wax alone usually does not cause itching. It’s what we do to remove the wax that causes itching.

Should you use a candle? Ear candles have to be one of the stupidest inventions in the history of ear wax. As the candle wax melts, it turns brown. I’m not sure how this happens; perhaps the candle smoke mixes with the wax, or perhaps there is something special about the chemical composition of this type of wax. In any event, when you miraculously pull gobs of brown wax from your ear, most (if not all) of this wax comes from the candle, not YOU. Candles rarely accomplish a thorough cleaning of the ear canal. There have also been case reports of candle wax dripping into the ear canal, causing painful burns of the ear canal skin or ear drum. These burns can easily become infected, causing further problems. And I am still dreading the inevitable report of a human torch due to candle use.

Over the counter remedies for ear wax are usually peroxide-based. A common problem with the use of these "wax-dissolving drops" is that the user may convert a partial impaction into a total impaction. No permanent harm done, but you will be miserable (from the hearing loss) until someone gets the wax out.

If the over the counter kit includes a bulb syringe, a more serious risk is that the user will irrigate his/her ear too vigorously. I have a similar gripe with primary care physicians (and their assistants) who irrigate ears too vigorously; I see about 2 ear drum perforations each year that are due to aggressive irrigation. If a patient has a pre-existing ear drum perforation, irrigation can lead to infection, even permanent hearing loss.

My recommendation for ear wax (which I admit is rather self-serving) is that you have your primary care physician diagnose but not treat this condition. If you need cleaning, see an ENT. The one exception to this would be the primary care doctor who is skilled in the use of a curette or hook to remove wax, since this (in trained hands) is much safer than irrigation. I would be delighted if the practice of irrigation would go the way of the dodo.

 

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