Ear Wax

Under ideal circumstances, a person should never need to clean his or her ear canals.

The skin on the outer part of the ear canal has special glands that produce ear wax, also known as cerumen. We have this natural wax to protect the ear from damage and infections. Normally, a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying with it unwanted dust or sand particles.

Ear wax is helpful to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax is formed in the outer third of the ear canal.

Cerumen varies in form, color, and appearance from person to person.

• It may be almost liquid, firm, and solid, or dry and flaky.
• The color of ear wax varies depending on its composition.
• Glandular secretions, sloughed skin cells, normal bacteria present on the surface of the canal, and water may all be in the earwax.

The ear canals are considered to be self-cleaning. This means that ear wax and sloughed skin cells typically pass on their own from the inside of the ear canal to the outer opening. Old earwax moves from the deeper areas of the canal out to the opening. At the opening of the canal, the ear wax usually dries up and falls out of the canal.

You can have excessive earwax build up and harden by:

• Narrowing of the canal resulting from infections or diseases of the skin, bones, or connective tissue
• Production of a less fluid form of cerumen (more common in older persons due to aging of the glands that produce it).
• Overproduction of cerumen in response to trauma or blockage within the canal.
• Things that you put in your ears to clean them like swabs, Q-tips, hairpins, or keys.
• Hearing aids
• Earphones that are placed inside the ears

Excessive wax in the ears can cause different symptoms and signs, including:

• Earache
• A sense of fullness in the ears
• Hearing problems
• Ringing in the ears (tinnitus)
• Cough
• Itching
• Discharge from the ear canal

When wax plugs the ear canal it can affect your hearing. Researchers estimate that hearing can be improved by 10 decibels when the plug is removed.

In January 2017, the American Academy of Otolaryngology-Head and Neck Surgery released new practice guidelines to treat impacted earwax. This guideline was endorsed by several other medical organizations including the American Academy of Pediatrics (AAP).

This guideline discusses four ways to care for and manage impacted earwax, which include:

1. Observation, since many impactions or blockages may clear on their own
2. Softening agents are known as cerumenolytics. These are oils or ear drops that soften or break up the wax to help in removal.
3. Irrigation, or ear syringing. This is clearing the wax using a stream of warm water into the ear canal. This can sometimes be done at home. This method is not suitable for people who have frequent ear infections or who have a perforated eardrum or surgically inserted ear tubes.
4. Physical removal using a suction device or instrument. This should always be done by a doctor or other healthcare professional.

Ear candling involves placing a hollow candle (made from a fabric tube soaked in beeswax) in the ear canal and burning it to create a suction force for the removal of wax from the ears.

According to the American Academy of Otolaryngology-Head and Neck Surgery, ear candling or ear coning is not considered a safe option for ear wax removal.

• Studies have shown that the procedure does not create a vacuum that can remove the wax effectively, and the wax left inside the candle is from the candle itself, not from the ear.
• The procedure also carries health risks that include burns to the ear canal, the development of new blockage of the canal from the candling wax, ear infection, and perforation of the eardrum.

Many people will respond to treatment with natural and home remedies, for example:

1. Use a few drops of warmed olive oil, mineral oil, almond oil, baby oil, or glycerin ear drops or sprays in the ear to soften the wax.
2. Use hydrogen peroxide drops.
3. Over-the-counter (OTC) products are available for wax removals, such as Debrox or Murine Ear Drops.
4. Syringe bulbs or irrigation home kits

If the ear still feels blocked after using these drops, call a doctor for an exam. If you try OTC earwax softeners, it is imperative to know that you don’t have a punctured (perforated) eardrum before using the product. If you have a punctured eardrum and put softeners in the ear it may cause a middle ear infection (otitis media). Similarly, simply washing the ear with a punctured eardrum may start an infection. If you are uncertain whether or not you have a hole in your eardrum, consult a healthcare professional.

Some people may also be hypersensitive to products designed to soften earwax. Therefore, if pain, tenderness, or a local skin rash develops, the use of these drops should be discontinued.

When the wax has accumulated so much that it blocks the ear canal (and interferes with hearing), a healthcare professional may need to wash it out (known as lavage), remove it by suctioning, or remove it with special instruments. Alternatively, a doctor may prescribe ear drops that are designed to soften the wax (such as trolamine polypeptide oleate-ear drops [Cerumenex]).

Most attempts to clean the ears by using cotton swabs only result in pushing the wax further into the ear canal. Wax is not formed in the deep part of the canal near the eardrum, but only in the outer part of the canal near the external opening. So when a doctor sees wax pushed up against your eardrum, he or she knows that it often is because you have been probing your ear with things like Q-Tips, bobby pins, or twisted napkin corners. These objects only serve as ramrods to push the wax deeper into the ear and can lead to problems.

The skin of the ear canal and the eardrum is very thin and fragile and is easily injured. The ear canal is more prone to infection after it has been stripped clean of the "good," coating-type wax. Doctors see many perforated eardrums as a result of the above efforts. If you have symptoms or signs of impacted earwax consult with your doctor.