Ear Wax: Friend or Foe?

Why do we have Ear Wax?

The normal ear canal is lined with skin, with an average of 24mm in length and has the capacity to hold up to 2ml of fluid.  It is the outer one-third of the external auditory canal that is cartilaginous, and is the site of the earwax (cerumen) production.  The normal flora of the external auditory canal includes yeast, fungus and pseudomonas.  It is the dark and moist environment of the ear canal that makes it susceptible to fungal, bacterial and yeast infection.

Scientists have found that earwax is part of our heritage.  Dry earwax are typically found in East Asians and Native Americans, which is light-colored and flaky, while earwax found in Caucasian and African groups is darker and wetter.

 

The body’s natural defense against ear canal infections is the production of acidic cerumen that prevents infection by raising the pH of the ear canal, thereby making the environment less hospitable to bacterial and fungal overgrowth.  Swimming, excessive sweating, or removal of cerumen alters the acidic nature of the ear canal and infections may develop.  This disturbance of the pH of the ear canal allows bacteria and fungus to proliferate.
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How do I best manage earwax?

It is always best to leave the ear canal alone.  If you are concerned about wax build up, it is always recommended to consult your GP and/or Audiologist.

How do I best manage earwax when I wear hearing aids?

This is a tricky question.  Hearing aids can indirectly act as a cotton bud.  As you insert the device into your ear, it can push the wax further down the ear canal.  If you are concerned about wax build up, it is always recommended to consult your GP and/or Audiologist.  We do strongly recommend cleaning your hearing aids on a daily basis.

Why do you suggest seeing a GP and/or audiologist prior to wax removal?

We need to assess your ear health in order to recommend the right treatment.  Exostoses (surfers ear), bacterial/fungal infections, middle ear perforations – are things we need to consider when treating ear canals.  In some cases a fallen dome from a hearing aid can cause the blockage within the ear canal, choosing the wrong treatment in this case can cause the dome to be pushed further within the ear canal.

 

 I am prone to wax build up – What should I do?

There are a number of cerumenolytics (topical drops and sprays) that are available from your local chemist – some are better than others.  A popular product on the market is “Clean Ears Spray”.  This product works by softening the wax or dead skin with liquid, this may result in wax breaking down and falling out of the ears within a couple of days. Or, it may soften the wax enough to allow the GP to irrigate the ears to remove the remaining pieces of wax. We do not recommend using this spray if you have a Tympanic Membrane (TM) perforation.

Always follow the advice from your GP and/or Audiologist.

Therapeutic Options for Cerumen Impaction: Advantages and Disadvantages.
OptionAdvantagesDisadvantages and Potential Complications
IrrigationEffectiveTM perforation; pain; vertigo; EAC trauma; otitis externa; severe audio-vestibular loss.

 

Manual removal (via suction or curette).EffectiveSpecial skills required; skin laceration; pain; patient cooperation required (especially with children).

 

Topical preparationsEasy applicationOtitis externa; allergic reactions; pain or vertigo if TM is not intact; transient hearing loss.

 

What do we recommend?

If the ear canal is completely occluded, we normally recommend topical treatments such as CleanEars.  Avoid using hearing aids when using the spray.  If the spray has not completely removed the wax, your GP may irrigate the ear with water to flush out remaining wax.  If wax is too stubborn you may need to see an ENT to have the wax suctioned out.  It is always best to contact your health care professional prior to making an appointment to see how they treat wax.

What about ear candling?

Ear candling, also called ear coning or thermal-auricular therapy, is an alternative medicine practice claimed to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal.  It is claimed that the ear candle creates a vacuum that suctions the wax out of the ear canal.

Is it effective?

A study performed by Seely et al (1996) found that in all instances, after candling, there was no reduction in the amount of ear wax found in individual’s ear canals. In fact, after candling, some participants had candle wax deposited in their ear canals.

Is it safe?

The concern we have with ear candling is having the hot wax accidentally making its way into the ear canal which can cause trauma to the ear canal and can even perforate the eardrum.

Tips for managing ear wax:

  • Avoid using cotton buds.
  • When visiting the GP get them to inspect your ear canal.
  • If you wear hearing aids and have issues with ear wax, best to follow the advice given by your GP and/or audiologist.
  • Leave the ear canal be. The earwax acts like a cleaning agent – Let it do its job.

 

References:
Engelhaupt, E. (2014). What your earwax says about your ancestry. Science News. Retrieved 23 January 2017, from https://www.sciencenews.org/blog/gory-details/what-your-earwax-says-about-your-ancestry

Lorig, K. (2001). Patient education: a practical approach. Sage.

Roland, P. S., Smith, T. L., Schwartz, S. R., Rosenfeld, R. M., Ballachanda, B., Earll, J. M., … & Krouse, H. J. (2008). Clinical practice guideline: cerumen impaction. Otolaryngology–Head and Neck Surgery139(3_suppl_1), S1-S21.

Seely DR, Quigley SM, Langman AW. (1996) Ear candles – Efficacy and safety. Laryngoscope 106: 1226–1229.

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5 Comments to “ Ear Wax: Friend or Foe?”

  1. Peter says :Reply

    I have used Murine ear wax drops leaving in at least 15 minutes, then gently pump warm water in, with good effect.

    1. Thank you Peter,
      Hopefully others will benefit from this advice. They just need to make sure there is no ear drum perforation before applying the water. And as you say – gently does it.

  2. Brian Dearle says :Reply

    What is the best way to clean the hearing aid ear piece. I generally give it a wipe over with a tissue although that is often not very effective.

    Cheers

    1. Hi Brain, Thank you for the comment. You would need to remove the dome and roll that in a tissue. You would also need to brush the wax filter while holding it upside down to have gravity take call of the bush-offs. Maybe a topic for a video?….

  3. moz says :Reply

    I appreciate, cause I discovered just what I used to be
    looking for. You have ended my 4 day long hunt! God Bless you man. Have a great day.
    Bye

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