According to the custom in my hometown, on the day of the Chrysanthemum Festival, members of the whole extended family go back to their hometown for a gathering, which is quite lively.
While waiting for the “big pot of food” at the ancestral hall, my son whispered to me, “Mom, look at my aunt, she is always pulling out her ears with a toothpick.” I turned my head and saw that my aunt was really fiddling with her ears with a toothpick or rolling a paper towel into a tiny size and pulling it out into her ear canal.
My aunt noticed us looking at her and said awkwardly, “Excuse me!” Knowing that I was a doctor, my aunt went on to say, “My ears itch unbearably, and from time to time, water and bean curd-like things come out, but it only itches, not painfully. I went to the hospital many times, and the doctor said it was eczema in the external ear canal. He helped me flush the ear canal, and used 4% boric acid and ethanol ear drops and dermatological cream. But after two or three days of comfortable treatment each time, it would come back, and now I don’t even have the confidence to go to the doctor.”
The aunt also said that she uses at least ten cotton swabs to pull out her ears every day, and when the ear itch is really unbearable, she even pours windex into her ears.
Analysis: Based on the situation, the initial estimate is chronic eczema.
Examination: The ear was first examined with an otoscope, and it was found that the skin at the mouth of her external ear canal was crusted and cracked; there was a lot of secretion in the external ear canal, mainly beanbag-like material; the skin of the ear canal had thickened, vesicles and papules, but the tympanic membrane was intact.
Conclusion: Eczema of the external auditory canal, combined with fungal infection, and irregular treatment, so the condition was recurrent.
”Isn’t eczema easy to get only in children? I’m in my 50s and 60s and I still get it?” –Aunt’s question.
Children’s skin is more sensitive and their immune system is not perfect, so they are relatively easy to get eczema; however, adults can also get this disease, and the incidence is not very low.
Eczema of the external auditory canal is an allergic disease with complex causes. For example, extrinsic factors such as living environment and climatic conditions; bad habits such as excessive sweating and scratching; long-term stimulation by cosmetics such as balsam and daily household products such as soap; and intrinsic factors of the body such as endocrine and metabolic dysfunction can lead to eczema.
Fungal irritation of the external ear canal and otitis media can also induce eczema. Especially in Guangdong, where the climate is humid, the ear canal is prone to fungal infections and patients feel that their ears are itchy so they repeatedly pull out their ears. Excessive external stimulation makes the external ear canal more prone to eczema.
If the fungal infection of the ear canal and eczema exist at the same time, the course of the disease is more likely to recur, and the symptoms are mostly based on ear itching and increased secretion; if combined with otitis externa, the patient will feel pain.
When you hear eczema, the first thing you think is that it is incurable and recurrent. This is also true because the causes of eczema are complex and most clinical treatments are symptomatic, so prevention and treatment are important.
The first thing to do is to correct the bad habit of constantly pulling out your ears. Once the habit is formed, it does take willpower to stop it completely at once. Also, it is important to try to identify the cause of the disease and cooperate with regular treatment, which is helpful in stabilizing the condition.
Patients should remember.
Do not clean your own ears with hydrogen peroxide or weak acidic body wash, or buy some anti-inflammatory or hormonal creams to apply on your own, because.
① The ear canal is curved and deep, so it is not easy to clean the secretions by yourself; if mishandled, it can also easily damage the external ear canal and eardrum.
②Solutions such as hydrogen peroxide are irritating and can aggravate skin metaplasia if not cleaned.
③There are rules for local application of medication: when fungal otitis externa is combined with eczema, a compound Conalax cream with antifungal, bacterial and anti-inflammatory effects should be used; if there is no fungal infection, only simple anti-inflammatory creams, such as Pirexon, can be used. These topical creams have antibiotic or (and) hormonal components and are not suitable for long-term application.
Doctors treat ear itching this way.
Step 1: Carefully aspirate the external ear canal secretions with a negative pressure suction device.
Step 2: Gently wash the external ear canal completely with saline and a cotton swab for otology.
Step 3: Apply a thin layer of compound Conalax cream locally to the external ear canal. At the same time, the patient can be given oral antihistamines for 1 to 2 weeks, or some oral antifungal drugs for a short period of time if severe fungal infection is combined.
Step 4: Instruct the patient to visit the hospital every other day for external ear canal cleaning and medication.