by Pauline Primrose-Heaney (Value Hearing Audiologist)
The skin in your ear canal is very sensitive and delicate. Sometimes, even something as seemingly insignificant as a hair can cause itching.
So as a clinician, it’s not uncommon to hear a (typically) new hearing aid user complain that their hearing aid makes their ears itch.
In most cases, as you become more accustomed to the sensation of the hearing aid in their ear, this feeling of itchiness eases and is forgotten. However, there are some instances that may need further attention to address the itching feeling.
It could be something as simple as looking at how the hearing aid fits in the ear, or it could be a physiological issue, such as an allergic reaction to the material used for the hearing aid earmould or dome.
Firstly, let’s have a look at fit issues.
Fitting Issues
One of the great things about modern hearing aids and advancements in technology is that clinicians can fit more ears more openly.
This means that most hearing aid users can be fit without an earmould, leading to more discreet fittings. The good news is hearing aids can be fitted immediately since there is no need to wait for an earmould to be made in a lab.
For most people, the result is a more comfortable fit in the ear with a more natural sound quality, as the ear is not occluded.
Instead of moulds, clinicians use domes on the end of behind-the-ear (BTE) or receiver-in-canal (RIC) hearing aids to achieve what is called an ‘open fitting.’
On the flip side, one of the most common causes of itching for an open fitting is an ill-fitting dome.
While domes come in different sizes to accommodate different ear canals, they ultimately can’t suit 100% of people. In this instance, the clinician needs to look not only at the dome size, but also at the tubing or receiver length.
- If the tubing/receiver is too short, it could pull the dome up and put pressure on the skin.
- If the tubing/receiver is too long, it can cause the hearing aid to lift up off the ear and cause itching whenever the head is moving.
- If the dome is too small, it can cause irritation as it moves around in the ear canal (similar to the sensation of a feather tickling inside the ear canal).
- If the dome is too large, it can cause irritation as it becomes uncomfortable.
Selecting the correct dome size
Selecting the correct dome and tubing/receiver length is a balance between comfort and the stability of the hearing aid on and in the ear - one can affect the other.
You may need to try a few different dome sizes to find the balance that works best for you. It’s also not uncommon for new hearing aid users to change to a different sized dome after wearing the hearing aids for a while and your ears have adjusted to the new sensation of having something in them.
For BTE hearing aids, some manufacturers not only offer different lengths, but also different depths (how deep it extends into the ear canal).
There are also some dome designs that don’t extend quite as far into the ear canal that can be used for both BTE and RIC hearing aids. For some people, having the dome sitting more externally in the ear canal can ease the itchiness.
Choosing the right receiver length
For RIC devices, the receiver is the power of the hearing aid. The part of the receiver that sits in the ear canal is much larger compared to the thin tube of a BTE hearing aid, as it is an electronic component.
The clinician will select the power that best suits the hearing loss. However, some hearing losses may fall in between 2 different receiver powers. The less powerful the receiver, the smaller it is, which can result in a very different fit and reported comfort in the ear.
So if a hearing aid user complains about itchiness and discomfort that doesn’t subside, it may be possible for the clinician to opt for a less powerful receiver - depending on the hearing loss.
Itching and custom earmoulds
For hearing aids with a more occluding dome or custom earmould, or custom hearing aids, fit issues can cause itchiness as well.
As earmoulds do occlude the ear more in comparison to a dome, they can be more susceptible to moisture build-up in the ear canal.
Moisture trapped between an earmould and the ear canal will cause an itching sensation. Additionally, this excess moisture encourages bacterial and/or fungal growth, which can exacerbate the issue beyond an itch.
Additionally, wax build-up in the ear can also trap moisture, and take longer for the ear to dry, so if you are prone to excess wax build-up, finding a way to manage wax is important.
Using a D-Dry Kit can help
This is also why it’s important to use a D-Dry for your hearing aid - more on how this works can be found here: https://blog.valuehearing.com.au/news/how-to-use-a-d-dry-kit.
Ill-fitting earmoulds are a common culprit behind itchy ears when wearing hearing aids. The clinician will work with you to identify the part of the ear canal where the itching is and modify the earmould, or perhaps take a new impression of your ear using a different impression technique.
Now, let’s investigate physiological issues.
Potential mild allergic reactions
Hearing aids can sometimes cause itchy ears for those who have sensitive skin or a mild allergic reaction to the dome or earmould.
Domes are made from medical grade silicone, so an allergic reaction to a dome is far less likely compared to a reaction to a custom earmould.
Allergic reactions to earmoulds are more common for earmoulds made from acrylic. This is due the process of curing the monomers in the acrylic material when manufacturing the earmoulds.
Fortunately, there are hypoallergenic materials such as silicone available, which can resolve most cases of allergic reaction.
Ear oils and wax might be a culprit
Aside from fit issues, there are other physiological factors that may not necessarily be the cause of, but can certainly exacerbate, itching in the ears when hearing aids are worn.
Dry ears is one such example. Ears naturally produce oil and wax - it’s part of how they maintain ear health.
Over-enthusiastic cleaning of the ears can strip the ear canals of this protection, thus drying them out and causing itchiness. Additionally, some people may not produce adequate amounts of wax/oil naturally, and have dry ears as a result.
You may notice flakes of dry skin around the ear if this is the case. Psoriasis can also cause itchy ears, with inflamed, scaly patches of skin in and/or around the ear. Wearing hearing aids may exacerbate the itching sensation. Note that using alcohol-based products to clean the ear should be avoided in these instances, as they will make the itching and dryness worse.
Commercially available products such as Miracell and Otoease can be used to soothe the skin; however, use this carefully if wearing RIC or custom aids to avoid damage to the hearing aid electronics in the ear. If itching persists, see a GP or dermatologist if necessary.
In summary
In summary, itching due to wearing hearing aids can occur, and can be caused by a number of factors. Your clinician will work with you to address the itching caused by the hearing aid, but it may be a process of trial and error in finding a solution that balances comfort and stability without sacrificing hearing outcomes.
