Ear Wax…A Sticky Situation
Why do we have ear wax? Earwax is a normal product of our ears. It is a mixture of cerumen (wax), oil, sweat, and dead skin cells that is produced in the outer 1/3 of the ear canal. Although many consider ear wax to be a nuisance, it serves two important purposes: it lubricates the ear canal and acts as an antibacterial agent.
There are two types of earwax: wet and dry. Wet wax is common in Western Europe, and dry wax is more common in Asia. Researchers have identified at least one gene (the ATP-binding cassette CII gene), that determines the type of ear wax we produce. Individuals vary greatly in the amount and consistency of wax produced, which affects their predisposition to the canal becoming plugged. Some are rather prolific “wax producers,” and others remain relatively wax-free with little maintenance.
So how much wax should we have? Too little earwax increases the risk of infection; however, too much wax can also increase chance of infection and cause hearing problems. So you want just enough. Two populations are known to have a high incidence of excessive/impacted cerumen: individuals with mental retardation and the elderly.
What can go wrong?
- Wax can occlude the ear canal, causing hearing impairment, and a feeling of fullness. This is called an “impaction”.
- Wax can trap bacteria in the ear, causing an infection. Symptoms are typically pain and hearing loss.
- It can obscure vision when the doctor looks in your ears, possibly hiding a dangerous process (such as cholesteatoma – a erosive cyst of the eardrum).
- Wax can cause hearing aids to malfunction.
How do you know if there is an excessive build-up of wax?
If your ear(s) feel plugged or itchy, but there is no pain, you may have a wax problem. There may also be hearing loss in the affected ear. If this is the case, see a physician – either your internist or an ENT doctor.
What is the best way to remove earwax? There are several different methods to remove ear wax, including: ear drops, irrigation with water, or with instruments and suction.
It is okay to use a cotton tipped applicator only to clean the very outside of the ear, however, one should never put the applicator, or anything else for that matter, into the ear canal. Follow the old adage, “don’t put anything smaller than your elbow into your ear.”
Over the counter drops that help remove wax are largely water, oil and peroxide solutions (e.g. Debrox). These drops are generally safe to use, as long as one does not have a perforation of the eardrum. These drops can effectively remove small to moderate amounts of wax, but are generally ineffective in more severe impactions.
Irrigation is a technique where a stream of water is used to flush the wax out of the canal. While irrigation is an accepted method, it has many disadvantages compared to ear wax removal under direct vision. Irrigation is can be quite painful, and may cause infections, vertigo and perforations of the eardrum. It should never be performed if you have a hole in the eardrum.
What about ear candling? These hollow candles are placed into the ear canal and ignited. Although the intent is to create negative pressure which draws wax from the ear, ear candles have been scientifically proven to be ineffective, and carry the obvious risk of burning the ear canal. Studies show that these candles can even deposit debris, wax and soot into the canal causing greater problems than wax build-up.
The best method to remove earwax is by a physician using a microscope to directly visualize and remove the wax. This is done only by an ear specialist called an “otologist”, or an ENT physician. Under direct microscopic vision, wax is removed with a cerumen spoon, suction, or both. It can be safely performed on all individuals, including those with eardrum problems.
Recommendations for Optimal Aural (Ear) Hygeine
First, realize that wax isn’t all that bad. It keeps your ear from becoming dry and itchy, and helps to prevent infection.
It is generally safe to put a few drops of clean baby oil or olive oil into the ear on a regular basis. Another recommendation is an over-the-counter drop such as Debrox on occasions when the ear feels slightly plugged with wax. Warning: DO NOT use drops of any kind if the eardrum is not intact.
We recommend regular cleanings by a physician using microscopic vision and following these guidelines:
- No wax – do nothing.
- Small amount wax – do nothing unless it is obscuring visualization of the eardrum.
- Moderate amount of wax – take it out with instruments and suction using a microscope. Recheck in 6 months.
- Large amounts of hard wax – take out as much as can be easily removed with microscope. Have the person use drops and return in a few days to a week for further cleaning. Recheck in 3 months.
Ear wax exists for good reason, but too much can be a problem. It is best to have your ears examined regularly by a physician. If wax build-up is a problem, see an ENT doctor to have the wax removed in the most effective manner possible.
Dr. Kato is the founder of The Ear Institute in Palm Desert. Her top priority is improving the quality of life of her patients. Dr. Kato can be reached at: 760-565-3900.
Resources: 1) Fairey A, Freer CB, Machin D. Ear wax and otitis media in children. Br Med J. Clin Res Ed 1985:291:387-8 2) Okuda I, Bingham B, Stoney P, Hawke M. The Organic Composition of Earwax. J Otolaryngol. 1991 Jun 20(3):212-5. 3) Petrakis NL. Earmarks of Art History: Cerumen and Medieval Art. Am. J. Otol 21:5-8, 2000; 4) Roeser, R. J. and B. B. Ballachanda (1997). “Physiology, pathophysiology, and anthropology/epidemiology of human earcanal secretions.” J Am Acad Audiol 8(6): 391-400.5) Yoshiura, K., A. Kinoshita, T. Ishida, et al. (2006). “A SNP in the ABCC11 gene is the determinant of human earwax type.” Nat Genet 38(3): 324-30.
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