left ear drum in a patient with a history of chronic q-tip u | Figure 1

left ear drum in a patient with a history of chronic q-tip use. Notice the hairs and wax on the drum. He presents with chronic ear itching. Word to the wise - DO NOT USE Q-TIPS in the ear canal. Wax is supposed to be in the canal - it's protects the skin, moistens the skin, repels water and prevents infection. Removing wax from the ear canal causes itching, eczema and can lead to external otitis.

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A 2.5 years old refugee female presented with ear pain and these skin lesions, the mother stated ´´it was like raptured ear´´ otoscope examination revealed severly redden inflamed ear canal Tympanic memb. not seen, Your thoughts on management? Can use tobradex or other ear drops if TM not intact?

A right tympanic membrane (ear drum) showing a pressure equalizing tube that has moved into the middle ear space (orange arrow) instead of being extruded into the ear canal. A retraction (green arrow) is where the tube had been inserted. The ossicles are clearly seen as well - malleus (hammer - blue arrow), incus (anvil - gray arrow) and stapes (stirrup - yellow arrow). Figure 2 is the same picture without the arrows.

42 yo male, hx seasonal allergies/eczema, seb. derm, GERD, presents with chronic ear itching, fullness on RIGHT. Uses q-tips occasionally ("only on outside"), uses warm water flush PRN. Swimmer. Chronic = years. Notes it is worse when GERD is worse. Takes ppi generally which controls those symptoms. Was told by ENT has LPR and uses alginates as well. Associated (?) right tonsillar gland, he says "chronic x 2 years" pending neck U/S as he notes waxes and wanes w/above (ear/GERD). It's semifirm, fixed and minimally tender. Periodically notes severe nocturnal ear itching. He bled recently after q tipping deeper in ear. See black scab material on pictures. Bleed was why he presented, and wants to reduce overall symptoms burdwn. Hearing w/normal screening audiogram in office. Recent labs (TSH/CBC/CMP) wnl. (Ordered during his "yearly" with his PCP. No RX for sebborhea, just cleansing and OTC Ketoconazole 1% shampoo biweekly. I suspect it's a combination of chronic irritant/atopic vs. seborrheic otitis externa, with dry and inflamed outer ear canal due to over cleaning and skin barrier disruption. Suggested biweekly distilled white vinegar + decreased instrumentation. Ref. To ENT for further evaluation of the rest (fullness, LPR, weird looking canals...). Has the osteoma I see (is a swimmer), but would appreciate advice on the rest of the weirdness, what might be done / though of etc. First 4 pics are the RIGHT (AFFECTED) ear, last 2 are the LEFT. How the heck would someone even begin to restore the skin barrier in an ear this dry and irritated? I once heard of using a glycerin supp. to "paint just edges of canal," but there's got to be a better way to manage. (Old school fm doc suggested this). I also have concern this gland may be more ominous but given I'm prone to overthinking I'm awaiting the u/s to characterize it prior to ENT eval. Please heavily critique my thought process / DDX and plan. Or just say hi!

21YM referred for impacted ear wax. found this embedded deep in ear channel. object made of hard black rubber, perforated on one end, blunt on other end. patient does not remember putting any foreign object in his ear! Ear drum and hearing normal.

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