Gout of the ear – if you have this, you almost certainly have chronic gout





This page about gout of the ear was last reviewed, or updated, on 9 March 2012. 

Gout settling in the ears is an unusual phenomenon in the world of gout. It is a very rare event if the ears get attacked first before anywhere else. But it’s quite common for the ears to get attacked after gout flares elsewhere, or simultaneously with attacks elsewhere. The left or right ear? Gout has no particular preference. And sometimes it goes for both at once, or one after the other, switching its attack within 24 hours.

Tophi are more likely to develop here than in other gouty areas, albeit in a much smaller way.

Unlike other places, there are no juicy joints in the external ears to attract a gout attack, and gout doesn’t go for the area where the visible ear connects to the head, but what probably promotes gout MSU crystal deposition in the ears - which over time leads to tophaceous gout, (tophi) - are the same factors as those for the big toes.

Except that the big toes have joints which have pressure put on them, which isn’t put on the ears. So why does gout go for the ears? The ears are a body extremity. Therefore they are a colder body part, with slower blood circulation in a less venous area (no larger veins). These are all factors which attract gout attacks.

Chronic gout is that stage of gout where it been around for some years. By this stage, gout has done a number of attacks in different areas with increasing frequency and length, and has now, for reasons still not really understood, widened its field of action. In this case to attack the ears, after visiting most likely, the big toes, or hands, fingers, feet, ankles or elbows. A tophus (one), the chalky-like lumps of accumulated gout crystals, or tophi (more than one) have developed somewhere.

The new gout drug, Krystexxa, now approved in the U.S. and the EU, has shown some success against tophi, because it is capable of reducing the uric acid level drastically. 

If you’ve had a gout attack, remember to keep your ears warmly wrapped up in winter.

NO DOUBT ABOUT GOUT

Doctors find one small consolation in gout of the ear. It is much easier to remove the milky, pre-hardened tophi liquid from the ear for examination (the procedure called aspiration or arthrocentesis) to see if there are gout crystals, than it is from any of the joints, especially the big toe joints. This confirms that you are dealing with gout as long as the crystals are correctly identified. Gout will have been probably already identified if you get tophi in the ear (s), but perhaps not.

EAR GOUT PAIN 

Sometimes gout sufferers feel twinges or pain in their ears before a gout flare in another body area or before an ear gout attack. It’s obviously a signal that one is due to occur, and an alert for taking preventative gout medications immediately.

Or if you are not already on a course of preventative and lowering uric acid medications, see your doctor. Because there is no joint to inflame and because the crystal deposits are small, it’s possible that an ear gout attack is virtually painless. Perhaps the neutrophils of the immune system, whose attack on the MSU crystals in other gouty areas is one of the causes of pain and inflammation, hardly notice them and ignore them. On the other hand, some ear gout attacks are very painful.

TAKE IT SERIOUSLY 

Although small tophi in the ears may seem like minor gout, I should emphasise (emphasize) that tophi, any tophi, is a sign of chronic gout. The tophi stage is a more advanced stage of gout, which develops anytime between two and 40 years after a first attack, if gout treatment has not been successful. Ten years and above is an approximate average.

IT ISN'T YEARS FOR EARS

There is only one real answer..... and that is to get your uric acid level down to the level at which ear tophi shrink slowly -  over around four months to a year - and the crystals dissolve.They don’t disappear overnight.  Does this happen for many gout sufferers? Yes it does, especially if they have no other serious medical conditions.

WHERE DO GOUT CRYSTALS GET DEPOSITED? 

The ears, or rather those parts of them we see (the external ears), are mainly made from cartilage. If they were muscle, gout would not attack them. (Why gout crystals don’t get deposited in muscle is one of gout’s remaining mysteries). Cartilage, along with joints, tendons, membranes, bursae and tissues, is one of gout crystals’ favourite (favorite) spots elsewhere. 

Gout of the ear eventually means tophi deposits, if treatment is unsuccessful. Tophi’s favourite (favorite) spot is on the curved outer ridge – the helix. Tophi display like an array of tiny whitish pearls on the edge of the helix or under its fold – five or more is possible, but there’ll probably be fewer than five. So these are not the quail’s egg on the fingers or the golf ball on the elbow. 

Elsewhere on the external ear, gout crystals can be deposited on ear areas such as the antihelix, tragus, and concha, in fact just about anywhere on it. More rarely, gout crystals can be deposited in the ear lobes.

Because there isn’t much flesh or fat on the ears, gout of the ear, displays another characteristic which is less common than in other gouty areas. The hardened tophi approaches the surface of the skin, and may poke through in the form of small white rounded globules, the size of a grain of rice, or a sunflower seed. 

GOUT OF THE EAR TREATMENT 

If you get milky pus in your ear after a gout flare or flares, you need to have the area lanced and the pus squeezed out. You don’t want tophi gout settling in the ears because solid tophi hardens into cartilage (it becomes mixed in with it), and so it is much more difficult to remove surgically, or perhaps by a lowered uric acid level, at a later date.

There isn’t any specific treatment for gout of the ear. As with gout in all body areas, the aim of all types of treatment is to lower serum (blood) uric acid levels to below the level at which gout crystals dissolve and tophi shrinks, wherever they are located. This level is thought to be below 6.0 mg/dL (men) and around 5.5 mg/dL (women), but precisely it is a personal matter between you and your gout. You may need to go lower. 

Because the deposits of tophi in the ears are smaller than elsewhere, you should be able to get rid of them more quickly as long as you can reduce your uric acid sufficiently. 



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Read how a gout-of-the-ear-sufferer deals with tingling sensations on the ears' rim. See the contribution from - A visitor from the United States. (2nd contribution down)

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