These troublesome outer ear problems, which in medical jargon are grouped under the term otitis externa diffusa, can be caused by highly diverse factors. They can be triggered by viruses, bacteria, fungal infections and allergic reactions. In the case of inflammation caused by a bacterial infection (primarily by staphylococci), the initial itching generally turns to severe pain when the ear canal skin swells up. However, itching is the main symptom of dry, flaky forms of otitis externa, which often manifest them- selves as eczema of the pinna. Exogenous disruptions, such as earrings, piercings, ear protectors, earphones etc. that destroy the natural antibacterial protection provided by the layer of earwax, are frequently partly responsible for their appearance. That said, in most cases outer ear complaints are actually the result of excessive hygiene. For many people nowadays the need for cleanliness is so strong that ENT doctors are already talking of “ear canal hypochondriacs”. Those cleanliness fanatics attack their ears every day with Q-tips, thus destroying the protective environment of the ear canal skin and giving eczema and bacterial infections a helping hand. Other causes are possible changes in the pH value by means of soaps, shampoos, hairsprays or foreign bodies, which can cause irritation and inflammation of the ear canal. Endogenous factors that aid the incidence of eczema are an innate tendency towards pathological skin changes and a weakened immune system owing to allergies or diabetes.