Ear Canal Injury

What the ear canal is and why it injures easily

The ear canal is about 2.5 cm (1 inch) long in adults. The outer third has cartilage, hair and wax glands. The inner two-thirds is bone covered by very thin skin with almost no padding, which is why even light scratching can tear it and why it is so painful. The eardrum sits at the end, and beyond it are the tiny hearing bones and the inner ear, which controls balance.

Causes

• Cotton swabs and cleaning tools: the most common cause. They scratch the skin and push wax deeper.
• Fingernails while scratching an itchy ear.
• Hairpins, keys, pens and earbuds.
• Children inserting objects: beads, small toys, food, and button batteries, which can cause chemical burns within hours. See foreign body in the ear.
• Ear irrigation or syringing done with too much force.
• Burns: hot water, welding sparks, chemicals.
• Blunt head trauma: a fracture of the temporal bone can tear the canal.
• Barotrauma or a slap to the ear: these mainly injure the eardrum rather than the canal.

Symptoms

• Sharp pain, worse when you touch or pull the outer ear or chew
• A little bright red blood, or a dark crust later
• A blocked feeling if blood or swelling fills the canal
• Muffled hearing from blood or swelling, which clears as it heals
• Itching as the skin heals

Signs of deeper injury include real hearing loss, ringing (tinnitus), spinning dizziness, nausea and a feeling of fluid in the ear. These suggest a hole in the eardrum or damage to the middle or inner ear.

Scratched ear canal vs perforated eardrum

More detail is on our perforated eardrum page.

How doctors assess an ear canal injury

A doctor looks into the ear with an otoscope to see where the injury is, whether the eardrum is intact, and whether an object remains. They may gently clean out blood. Tuning-fork tests and a hearing test (audiogram) check for middle or inner ear damage. If there was a head injury, a CT scan of the temporal bone looks for a fracture. Leaking clear fluid can be tested for cerebrospinal fluid.

Treatment and home care

Minor scratches and cuts

• Leave it alone. Do not put swabs, fingers or tissue into the canal. The ear cleans itself.
• Keep it dry for about 1 to 2 weeks. Use a cotton ball coated in petroleum jelly in the outer ear when you shower, and avoid swimming.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
• Do not use home drops, oils or hydrogen peroxide unless a doctor says the eardrum is intact.

Medical treatment

• Antibiotic ear drops if the cut is large, dirty or becoming infected. Only drops safe for a perforated eardrum are used if there is any doubt.
• Removal of objects with suction or small instruments under a microscope. Button batteries are an emergency.
• A wick (small sponge) if the canal is swollen shut, so drops can reach the skin.
• Specialist (ENT) care for deep cuts, burns, eardrum damage, hearing loss or fractures.

Complications

• Infection: a damaged canal can develop otitis externa (swimmer's ear), with worsening pain, swelling and discharge.
• Hematoma: a blood blister in the canal that may need draining.
• Narrowing of the canal after burns or repeated injury, which can trap wax and water.
• Eardrum perforation and hearing loss after deep injuries.

Preventing ear canal injuries

• Do not put anything smaller than your elbow in your ear. Clean only the outer ear with a washcloth.
• If wax is a problem, use over-the-counter softening drops and see a clinician for removal. See ear wax impaction.
• Keep small objects and button batteries away from young children.
• Wear ear protection when welding or grinding.

Frequently asked questions

How long does a scratched ear canal take to heal?

Most small scratches heal in 3 to 7 days, and deeper cuts within about 2 weeks. The thin skin of the canal repairs quickly as long as it is kept dry and left alone. Pain that grows after the first few days, or new discharge, suggests infection.

Is it normal for a scratched ear canal to bleed?

Yes, a small amount of bright blood is common because the skin is thin and close to the bone. It usually stops within minutes. Bleeding that will not stop, heavy bleeding, or bleeding after a head injury needs prompt medical care.

Can a cotton swab damage your eardrum?

Yes. Pushing a swab too far, or being bumped while using one, can puncture the eardrum and sometimes injure the hearing bones. Sudden pain with hearing loss, ringing or dizziness after using a swab should be checked by a doctor the same day.

Should I put drops in a cut ear canal?

Not without advice. If the eardrum has a hole, some drops can damage the inner ear. A doctor can look in the ear and prescribe antibiotic drops that are safe if needed. Most minor scratches heal without any drops at all.

Why does my ear canal itch after an injury?

Itching is a normal part of skin healing. Resist scratching, because it reopens the wound and invites infection. If itching persists for weeks, it may be eczema of the ear canal or a fungal infection, which a doctor can treat.