DR MARTIN SCURR: The surprising cure for itchy ears

For years I’ve had an itch that affects both ears – but recently it has become maddening. I’ve read in an online forum that smearing Vaseline in the ear canal might help, but what do you recommend?

Sandra Cooke, Dorset.

Dr Martin Scurr replies: The most common cause of an inner-ear itch is eczematous otitis externa – a form of dermatitis (essentially, itchy dry skin) specifically in the ear canal.

The itch sensation is caused by inflammation as a result of damage to the skin.

It is typically triggered by long-term over-cleaning of the ear canal – for instance, as a result of regularly using cotton buds. An allergy to traces of shampoo is another potential cause.

Either of these could explain why it’s both ears that are affected in your case.

The most effective treatment is corticosteroid drops, which are available only on prescription and will help to suppress the inflammation.

Of course, avoiding further inflammation is also important. So if you use cotton buds, you must stop – the ear canals are naturally self-cleaning anyway (ear wax traps any dirt and dust, and then falls out, taking the ‘rubbish’ with it).

You should also avoid any other trauma to the ear canals, including scratching. The risk is not just prolonging the itching, but perforating your eardrum.

There is no need to use cotton buds, says Dr Martin Scurr, as the ear canals are naturally self-cleaning (ear wax traps dirt and then falls out, taking the ‘rubbish’ with it)

The simple way to check if shampoo is causing the problem is to switch to mild baby shampoo for a month.

I agree that there is nothing to be lost by using a smear of Vaseline or olive oil on the tip of your little finger to the most external area of the ear canal – if there is excessive dryness of the skin, this will help.

I’m 66 and during a very difficult pregnancy 35 years ago I suffered severe thrush. Heartbreakingly, my baby daughter died. I then suffered recurrent outbreaks for years and, recently, they have returned. Nothing seems to help. What can I do?

Name and address supplied.

Dr Martin Scurr replies: Firstly, I am terribly sorry to hear about the tragic loss of your daughter. I do think that perhaps this could be connected to what you are currently experiencing.

In your longer letter, you mention that tests (swabs and cultures) taken by your GP and a specialist you were referred to failed to identify the exact cause of your thrush symptoms.

You also mention eventually finding relief from a prescription drug called amitriptyline. This is slightly puzzling, as amitriptyline is an antidepressant and not an antifungal drug – the more common first-line treatment for thrush infections.

I think you did undoubtedly initially have thrush – Candida albicans is common in pregnancy. However, it’s possible that you then developed a secondary condition, neuropathic (or nerve) pain in the vaginal and vulva area.

The symptoms – soreness, rawness and the pain on intercourse as you describe in your longer letter – could easily be mistaken for thrush pain. Your traumatic pregnancy and subsequent bereavement may have triggered this nerve pain.

I imagine this is why you were prescribed amitriptyline, which as well as being an antidepressant is used to treat nerve pain (though in lower doses) – and this is why it has helped you.

You also mention that even at a higher dose this drug is no longer effective – this can happen as the brain effectively develops a tolerance to it.

However, there are other nerve pain medications your GP can prescribe, such as gabapentin.

You might also be referred to a vulva clinic, where specialists deal with this type of complex, long-term condition.

The encouraging message is that there is real hope for improvement – you haven’t run out of options.

In my view… Despite advances, patients lose out 

The death last month of the eminent surgeon Professor Harold Ellis was a reminder of how much better in some ways medical practice used to be, for all the advances that have transformed our work.

I trained under Professor Ellis as the most junior member of his ‘firm’ (a team consisting of a senior registrar, registrar, junior registrar and a houseman).

Dr Scurr says training for medics today is a ‘disaster’ compared to the ‘exhilarating’ and ‘rigorous’ learning he went through under Professor Harold Ellis, who passed away in March

He was inspirational but also uncompromising – uniquely available seven days and nights a week, which meant we had to do the same. The experience was intense and exhilarating, the learning could not be outclassed.

Every time I read one of your letters I am reminded of one of Professor Ellis’s catchphrases, ‘I’m glad you asked me that question…’ – always an opportunity to instruct, with many memorable anecdotes.

The demise of the ‘firm’ has been nothing short of a disaster for doctor training.

But, even worse, it has contributed to the shift of patient care from the control of doctors and nurses to management.

I write these words to honour a great man of medicine, and to lament a much missed approach to patient care.