EpistemisOtic pruritus
Specialty: Otolaryngology.
Why it occurs
- Otomycosis due to fungal overgrowth due to Aspergillus niger or Candida albicans, often after previous antibiotic treatments
- Otic eczema and contact dermatitis due to the use of cosmetics, soaps or hearing aids
- Circumscribed or diffuse external otitis in initial stages of bacterial colonization
- Physiological decrease or absence of earwax production that causes extreme dryness of the skin of the ear canal
Initial workup
Comprehensive otoscopy or aspiration under otomicroscopy to identify fungal hyphae or spores, ear canal smear for direct bacteriological and mycological culture, and skin patch testing if an allergic component or persistent contact dermatitis is suspected.
red flags
Sudden intense ear pain that replaces primary pruritus, foul-smelling purulent discharge (frank otorrhea), diffuse erythematous inflammation of the auricle that compromises the cartilage, or appearance of necrotic-looking granulation tissue on the floor of the ear canal in diabetic or immunocompromized patients.
Standard management
- Clotrimazole ear drops 1% — 3-4 drops every 12 hours in the affected external auditory canal for a minimum period of 14 days to ensure fungal eradication
- Ear drops with low-potency corticosteroids such as hydrocortisone or fluocinolone — 3 drops every 12 hours for 5-7 days in cases of non-infectious scaly eczema
- Borican alcohol to saturation — applied as an antiseptic and drying agent to prevent recurrences in patients exposed to humidity
- Second-generation systemic antihistamines such as rupatadine (10 mg every 24 hours orally to mitigate the neuropathic or allergic pruritus component).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4