Itchy Ears Wearing Hearing Aids | Sonant Hearing Clinic, Kent

Why are my ears itching with my hearing aids?

If you are a new hearing aid user, having a foreign device within your ear will take some getting used to. Before you wore hearing aids, nothing else really stayed inside your ears for lengths of time.  According to a 2024 study  (Alhussaini et. al 2024), itching ears is one of the commonly cited reasons for hearing aid users not wearing their aids. 

Reasons cited for the itchiness are varied. They include dry skin, foreign bodies, allergies to the materials used in hearing aids, materials used for the ear moulds,  earwax build-up, hormonal changes, other health conditions.

 Whether you're a first-time user or an experienced user, understanding the causes of this common issue is essential. There are practical solutions and tips available to help alleviate discomfort, ensuring that your hearing aids work effectively without interfering with your listening and hearing pleasure.

How Hearing Aids Can Contribute to Itchy Ears

In a study of 2143 (Vallur, et.al) patients visiting an ENT clinic. Common aetiologies causing ear irritation included otomycosis, ear wax buildup and otitis externa. Co-morbidities like diabetes was related to otomycosis. Elderly patients often presented with ear itching related to hearing aid use. Same elderly patients used hearing aids and had diabetes, thereby increasing their likelihood of experiencing itchy ears. Psoriasis was common in younger population.

Hearing aids, though incredibly beneficial, can sometimes contribute to itchy ears due to their interaction with the ear environment. One way this happens is through the creation of a warm, moist environment within the ear canal. Hearing aids can trap moisture and heat inside the ear, which can promote the growth of bacteria and fungi, leading to infections that cause itching. 

The physical presence of hearing aids can also lead to mechanical irritation. The constant rubbing of the device against the sensitive skin of the ear canal can cause microscopic abrasions that lead to itching. Over time, this irritation can become more pronounced, especially if the hearing aids do not fit properly. Regular consultations with your audiologist to ensure a proper fit and to make any necessary adjustments can help prevent this type of discomfort.

The introduction of foreign objects into the ear canal, such as hearing aids, can alter the natural balance of the ear’s environment. The ear is a delicate ecosystem, and changes in airflow, temperature, and moisture levels can all contribute to sensations of itching. Using hearing aids for shorter periods initially and gradually increasing wear time can help your ears acclimate to the new device.

Causes of Itchy Ears with hearing aids

To effectively address itchy ears while using hearing aids, understanding the underlying cause is crucial. The skin within the ear canal is very sensitive. On one hand a stray hair or a stray granule of earwax rolling around within the ear canal may cause itching, and on the other hand an ear infection or a buildup of wax may cause itching and require removal. 

Allergic reactions:

One common cause is an allergic reaction to the materials used in hearing aids or ear moulds. Some users may be sensitive to certain plastics, silicones, or metals, leading to an allergic reaction presented as itching, redness, or swelling. If you suspect an allergy, your audiologist could help identify the specific material by liasing with the manufacturer. Manufacturers often use hypo-allergenic materials for earmoulds and domes production. That being said, there are still rare cases, so it's worth noting.  

Bacterial or Fungicidal infection:

The earcanals may have been subjected to certain bacteria or fungi leading to an infection. An original study (Alhussaini et. al 2024) on patient's visiting an ENT department for itching ears cited bacteria, mainly from staphylococcal infections and fungi infections as common causes for external ear itching with hearing aids. This could be from hearing aids, domes or earmoulds being left in unsanitary places when not in use. Pockets, dusty cabinets, falling on to a dirty surface and not being cleaned before re-insertion into the ears are culprits we have observed in clinic. Also swimming in lakes, ponds, some pools have been other avenues for some patients to get exposure to certain bacteria leading to ear infection. 

Ear-wax buildup:

Another significant cause of itchy ears is earwax buildup. When you wear hearing aids, the devices could obstruct the free exit of wax out of the earcanal or hearing aids, whilst being inserted into the earcanal,  sometimes push earwax deeper into the ear canal, leading to impacted wax deeper within the ear canal.  The buildup of wax potentially impedes air-flow, traps dirt and water within the ear canal causing an irritation and the need to itch. This can also create a cyclical problem, as the more you scratch or touch your ears, the more likely you are to exacerbate the issue. In cases, where earwax has become impacted, you may require professional earwax removal by a healthcare provider.

Foreign Body:

Foreign bodies like sand or soil (from being at the beach or gardening), trapped hearing aid wax filters, hearing aid domes, even batteries, nail polish, insects or insect eggs can be trapped within the ear-canal and cause itching. Arranging an ear examination with a hearing professional or your GP would be a good way to start to address the issue. As they can advise on the status of your ear canals after examination. 

Skin Conditions:

Skin conditions such as eczema or psoriasis can also contribute to itchy ears. These conditions can cause the skin inside the ear canal to become dry, flaky, and irritated. Hearing aid users with these skin conditions may find that the constant presence of the device exacerbates their pre-existing symptoms. If you have a known skin condition, it's important to manage it with appropriate treatments and to communicate with your audiologist, GP and or dermatologist about your situation, so they can help you find a comfortable solution. You may find that you need to aerate the ear more often, review dietary or environmental irritants that predispose your ears to irritation. 

Comorbidities: 

An original research study speculates on the relationship between diabetes and otomycosis - a fungal infection which irritates the ear and causes itching. (Alhussaini et. al 2024) after examining the microbiome within the ear-canal of a number of patients reporting itch ears, the researchers claimed to find a relation between those with diabetes and those prone to fungicidal infections. However there have been other studies stating that no clear corelation has been found. 

Sensory Overload:

Some users may also experience a heightened sensitivity to the presence of the device, which can manifest as itching.

Hormonal Fluctuations:

Itching ears may occur independent of hearing aids and is a common symptom noted in perimenopausal women. Due to estrogen and progesterone fluctuations in the body affecting the estrogen receptors present within the ear canal. 

Preventive Measures for Itchy Ears While Using Hearing Aids 

Dealing with itchy ears due to hearing aids can be a persistent problem, but there are preventive measures that can help you maintain comfort.

1. One is to keep your hearing aids, domes and ear moulds clean. Regular cleaning can prevent the buildup of earwax and bacteria, which are common irritants that can cause itching. Using a soft, dry cloth to wipe down your hearing aids daily and using a specialized cleaning brush to reach small crevices can make a significant difference. Additionally, using a dehumidifier specifically designed for hearing aids can help keep them dry and free of moisture that can foster bacterial growth. If not ready to invest in a dehumidifier, dessicant sachets can be used as an alternative - these can be kept with the hearing aids inside the case or the hearing aid charger - close the lid to charge your aids whilst drawing out excessive moisture at the same time. Remember to replace the dessicant periodically. (Like the ones found in a new handbag to keep it dry).

2. Another important preventive measure is to ensure that your hearing aids fit properly. Poor-fitting hearing aids can cause friction and pressure points within the ear canal, leading to irritation and itching. If you suspect that your hearing aids are not fitting as they should, consult with your audiologist. Periodic checks with your audiologist can help you or the audiologist highlight issues before the issue gets worse. The audiologist can make adjustments or recommend a different style or size that better suits the unique shape of your ear canal. Custom-fit ear moulds are often a good investment for those who experience frequent discomfort, as they are designed to match the contours of your ears precisely.

3. You can take short breaks from wearing your hearing aids when possible. Giving your ears time to breathe and recover can minimise irritation and allow your skin to recover from any minor chafing that may occur throughout the day. 

4. Use ear protection when in dusty places or swim ear plugs when swimming or in contact with water to keep dust and water out of the ear respectively. 

Management of Itchy Ears While Using Hearing Aids.

Ear Examination:

1. Have your ears examined by your doctor or your audiologist. 

Foreign body removal:

2. Arrange to have the foreign body removed by an ear specialist trained at removing foreign bodies from the ear. Ears should be periodically cleared of wax to limit the proliferation of bacteria within. 

Earwax removal:

3. Arrange to have earwax buildup removed, and if prone to wax build-up, arrange ear-wax removal appointments periodically. 

Lubricant or Emollient Usage:

4. Follow the advice of your ear specialist, audiologist or ENT doctor on managing your ears in the days between visits for earwax removal. e.g weekly/ forth-nightly use of olive oil drops, keeping water out of ears e.t.c. Apply recommended lubricants or emollients as advised by your prescribing health professional. Using a lubricant like olive oil ear drops to lubricate any loose dry skin or wax moving around. The oil is likely to "bind" the wax/stray hair in place and stop it moving around so freely whilst also allowing the ear canal itself to gradually push it outwards. (As long as we don't go back into our ears with a cotton bud!). If you are a hearing aid user, use the ear drops at night just before bed. As you will not be wearing your hearing aids then and less likely to get oil into your hearing aid!

5. Allergies: 

Very rarely, there might be dermatitis or an allergy on contact with an ear mould. In this case, it may be worthwhile having the audiologist speak to the manufacturer about considering a different type of material entirely to remake the mould. Gold or titanium-plated ear moulds could be a possibility. Consider taking your antihistamines if you note a relation between the ear itching and seasonal allergies.

6. Look out for irritants within your hearing aid cleaning tools. Check the ingredients within your cleaning wipes or hearing aid cleaning solution. Some cleaning solutions or wipes may have ingredients that are particularly irritating to your ears. 

7. Consider seeing your doctor or women's health specialist for a means to manage hormonal fluctuations relating to symptoms including itching ears, as experienced with women in perimenopause or menopause.

8. Other skin-related conditions

Dry skin as a result of pre-existing eczema, psoriasis or similar can cause itching, and the skin is already easily irritated with or without hearing aids. Safe lubricants (vetted by your GP) can be used with particular care taken not to block the sound outlet of the RIC aids or custom ear mould. It would also be advisable to seek medical advice from the GP, ENT or dermatologist if the skin irritation can't be alleviated despite all the best measures taken.

9. Check the hearing aids

With open-fit hearing aids, too-loose domes are more likely to cause itching than a well-fitting dome. As the loose dome would have space to move around in the ear canal therefore causing itching. Consider other means of coupling your hearing aids to your ears than your current choice and discuss options with your audiologist. 

The length of the open tube or receiver length needs to be checked. As a too short tube could be pulling on the skin of the ear. A too long tube might be allowing the hearing aid to hang too loosely over the ear. Consider the dome shape as well. Would a closed dome cause less irritation than an open dome? Sometimes the receiver sizes vary with power receivers having more bulk than medium receivers. As long as the receiver covers the audiogram range of loss, a medium receiver could sit differently within the canal and cause less irritation. If all these open fit measures fail to alleviate the itching, then a custom-made ear mould may need to be considered. More on hearing aids. 

With ear moulds, itching could occur due to an allergy of the earmould or a poor fit. There could be wax buildup within the ear canal or residual debris from a previous or current infection ( both awaiting clearance via micro-suction or irrigation).

If there is moisture within the canal, or tubing, the mould may need to have a larger ventilation hole (severity of audiogram loss permitting). Moisture within the ear mould and ear canal wall could lead to itching, especially due to extra moisture and body temperature warmth encouraging the growth of bacteria and fungus in the the ear. The latter serves as another reason to keep the ear dome or mould clean with a non-irritating cleaner and dry properly every night. 

If there is a bump or area on the ear mould causing irritation, it may need to be re-sent to the manufacturer for a re-make. The re-make could be bigger or smaller. If problems persist then the new impression may require a different technique to make the ear-mould. (closed jaw vs open jaw).

Common Presenting Symptoms of Itchy Ears

Persistent itch: If you have a persistent or recurrent itch that does not seem to subside despite efforts to clean or adjust the hearing aids. This can be a sign of an allergic reaction, earwax buildup, or an infection. Paying attention to the frequency and intensity of the itch can help you and your audiologist determine the cause and appropriate treatment.

Earache, Redness and swelling: These symptoms can indicate inflammation, which may be due to an allergic reaction, irritation from the hearing aids, or an infection. If you notice these symptoms, it’s important to seek medical advice and treatment from your doctor. In some cases, the skin inside the ear may also appear very dry, excessively flaky or peeling, which can be indicative of a skin condition such as eczema or otitis externa.

Discharge from the ear: This can range from clear fluid to pus and may be accompanied by an unpleasant odour. Discharge is often a sign of an infection and requires immediate medical attention. Persistent itching combined with discharge can indicate a serious condition that needs to be addressed immediately by by seeing one's doctor.

Conclusion: Managing Itchy Ears Effectively with Hearing Aids

Managing itchy ears effectively while using hearing aids involves a combination of preventive measures, and routine management. Regular cleaning and maintenance of your hearing aids are crucial steps in preventing irritation and infections. Also, considering other areas of one's health, including sensitivity and allergies, might be helpful. Ensuring a proper fit and taking breaks to allow your ears to breathe can also help maintain comfort and reduce the risk of itching.

Consulting with your audiologist or the best related health professional to manage related co-morbidities when necessary ensures that you receive professional guidance and treatment options tailored to your specific needs.

References

Alhussaini, M.A., Ghandour, A.M., Eloseily, A.M., Fahim, D.F., Salah, T.E. and AbdElrhaman, N.H., 2024. Microbiome in the External Auditory Canal of Hearing Aided Patients with Pruritis. Indian Journal of Otolaryngology and Head & Neck Surgery, 76(6), pp.5521-5525. 

Madsen EF, Larsen J, Flink PO. Ugeskr Laeger, 1991 Jul 22, Vol. 153. 2125-8. Itching in the external ear--a side effect of ear plugs. 

Vallur, S., Raghavan, A., Jagdeeswaran, V.U. and Kumar, P.G., 2021. Evaluation and management of ear itching: Our experience. International Journal of Otorhinolaryngology and Head and Neck Surgery, 7(10), pp.1617-1623.