Author: Southern California Ear, Nose & Throat

Earwax – The Inside Story

  • The ear is a delicate and intricate system that includes the skin of the ear canal and the eardrum. Most of the time, our ears take care of themselves, and common efforts to keep the ears clean may actually damage our ability to hear. So special care should be given to protect this part of our bodies. The most important thing you can do is to never stick a Q-Tip or any other object in your ears.
     
    Why the Body Produces Earwax
     
    Earwax (medical name: cerumen) is healthy in normal amounts and functions as a self-cleaning agent with protective, lubricating, and antibacterial properties. The lack of earwax may result in dry, itchy ears. When we say that the ears are “self-cleaning,” we mean there is a slow and orderly movement of earwax and dead skin cells from the eardrum to the ear opening. Assisted by chewing and jaw motion, old earwax is constantly being moved from the ear canal to the ear opening where it usually dries, flakes, and falls out.
     
    Earwax is not formed in the deep part of the ear canal near the eardrum. It is only formed in the outer one-third of the ear canal. So, when a patient has wax blockage against the eardrum, it is often because he or she has been probing the ear with cotton-tipped applicators, bobby pins, twisted napkin corners, or other objects. These efforts only push the wax deeper in the ear canal and can permanently damage the eardrum.
     
    When the Ear Canal Should be Cleaned
     
    Most of the time, the ear canals do not have to be cleaned. However, sometimes it really is necessary. The ears should be cleaned when so much earwax accumulates that it causes symptoms or prevents examination of the ear by your doctor. This condition is called cerumen impaction and may cause one or more of the following symptoms:
     
    ·     Earache, fullness in the ear, or a sensation that the ear is plugged
    ·     Partial hearing loss, which may be progressive
    ·     Tinnitus, ringing, or noises in the ear
    ·     Itching, odor, or discharge
    ·     Coughing
     
    Recommended Ear Cleaning Method
     
    To clean the ears, gently wash the external ear with a soft cloth, but do not insert anything into the ear canal.
     
    For most cases of earwax blockage, you can apply home treatments commonly used to soften wax. These include placing a few drops of mineral oil, baby oil, glycerin, or commercial drops such as Comfort Ear™ Natural Moisturizer in the ear canal. If the wax buildup does not respond to these treatments, you can try detergent drops such as hydrogen peroxide or carbamide peroxide (available in most pharmacies) to remove the excess wax.
     
    Irrigation or ear syringing is often used for cleaning and can be performed by a doctor or at home using a commercially available irrigation kit. Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water, saline, or wax-dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Avoid having your ears irrigated if you have diabetes, a hole in the eardrum (perforation), a tube in the eardrum, skin problems such as eczema in the ear canal, or a weakened immune system.
     
    Manual removal of earwax is also effective. This should be performed by an otolaryngologist using suction or special miniature instruments and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have skin problems affecting the ear canal, diabetes, or a weakened immune system.
     
    Why You Should Never Use Cotton Swabs to Clean Your Ears
     
    Wax blockage is one of the most common causes of hearing loss—and it is often the result of attempts to clean the ear with cotton swabs. These attempts just push the wax deeper into the ear canal, causing a blockage.
     
    The outer ear is the part of the ear that can be seen on the side of the head plus the ear canal that leads to the eardrum. The ear canal is shaped a little like an hourglass, narrowing part of the way down. The skin of the outer part of the ear canal has special glands that produce earwax. This wax traps dust and dirt particles and keeps them from reaching the eardrum. Usually the wax accumulates a little bit, dries out, and then comes out of the ear, carrying dirt and dust with it.
     
    Ear Candling is Also Not Safe
     
    Ear candles are not a safe option for wax removal and may result in serious injury. Ear candles are 10- to 15-inch long, cone-shaped, hollow candles, typically made of wax-impregnated cloth. Users are instructed to insert them into the ear canal and light the exposed end. Not surprisingly, some of the most common injuries are burns, obstruction of the ear canal with wax from the candle, and perforation of the membrane that separates the ear canal from the middle ear.
     
    The U.S. Food and Drug Administration (FDA) became concerned about safety issues associated with ear candles after receiving reports of patient injury. There is no scientific evidence supporting the safety of these devices or their effectiveness in producing the results claimed for them. As a result, the FDA has taken several actions to limit their use.
     
    When You Should Consult a Doctor
     
    If the home treatments discussed here are not satisfactory—or if so much wax has accumulated that it blocks the ear canal and hearing—it may be time to see a doctor. A doctor may prescribe eardrops designed to soften wax, or (s)he may wash or vacuum it out. Occasionally, an otolaryngologist (ear, nose, and throat specialist) may need to remove the wax under microscopic visualization.
     
    If you suspect that there may be a perforation of the eardrum, consult a doctor before you try any over-the-counter remedies. Putting water, eardrops, or other products in the ear when there is an eardrum perforation may cause pain or infection.
     
    What You Can do to Prevent Excessive Earwax
     
    There are no proven methods for preventing cerumen impaction. However, there are things you can do to make it less likely. First and foremost is not inserting cotton-tipped swabs or other objects in your ears. If you tend to have repeated wax impaction or use hearing aids, consider seeing your doctor every 6 to 12 months for a checkup and routine preventive cleaning. To help maintain the normal flow of earwax, you can also use a moisturizing eardrop such as Comfort Ear™ Natural Moisturizer on a daily basis.

Hearing Screening for Children

Early Screening is Important
 
Hearing loss is the most common birth disorder among American children. Approximately 3 out of 1,000 children in the United States are born deaf or hard-of-hearing. This is important because studies have shown that early correction of hearing loss is crucial to the development of speech, language, cognitive, and psychosocial abilities. Treatment is most successful if hearing loss is identified within the first few months of life. Unfortunately, 25% of children born with serious hearing loss are not diagnosed until they are 14 months old.
 
Test as Early as Possible
 
Ideally, a child’s hearing will be tested in the hospital shortly after birth. If your child is not screened before leaving the hospital, testing should be done within the first month. If test results indicate a possible hearing loss, it’s important to get a second evaluation by an otolaryngologist within the first three to six months.
 
Early Screening may be Mandatory
 
Health organizations across the country—including the American Academy of Otolaryngology–Head and Neck Surgery—have emphasized the importance of screening newborns for hearing loss. As a result, many states have passed Early Hearing Detection and Intervention legislation. Other states regularly screen the hearing of most newborns, but do not have legislation that requires it. Check with your local authority or hospital for screening regulations in your area.
 
How Children are Screened
 
Two tests are used to screen infants and newborns for hearing loss.
 
Otoacoustic emissions (OAE)
This test involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” is produced when sound is emitted through the earphone. If no echo is detected, it could indicate hearing loss.
 
Auditory brain stem response (ABR)
ABR is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.
 
If either test indicates potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.
 
Signs of Hearing Loss in Older Children
 
Hearing loss can also occur later in childhood. Parents, grandparents, and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:
·     Not reacting to unexpected loud noises
·     Not being awakened by loud noises
·     Not turning his/her head in the direction of your voice
·     Not being able to follow or understand directions
·     Poor language development
·     Speaking loudly or not using age-appropriate language skills
 
If your child exhibits any of these signs, discuss them to your doctor as soon as possible.
 
What You Can Do if Your Child has Hearing Loss
 
Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss. Potential causes include ear infection, excessive earwax, congenital malformations, or a genetic predisposition for hearing loss.
 
If your child’s hearing loss is permanent, hearing aids may be required to amplify the sound reaching your child’s ear. In some cases, ear surgery may be able to restore or significantly improve hearing. With certain types of very severe hearing loss in children who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, the implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.
 
Preventing Delay in Language Development
 
Research shows that if a child’s hearing loss is remedied by six months of age, it will prevent subsequent language delays. If your child is deaf, you need to decide whether he or she will communicate primarily with oral speech and/or sign language and seek early intervention to prevent language delays. Other communication strategies such as auditory verbal therapy, lip reading, and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently. The important thing is to get a definitive diagnosis as early as possible and take the appropriate action quickly.