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Ear Wax Fascination

My kids have the most wild ear wax and I am not ashamed to say I have a bit of fun with this. I've used candles on them, Elephant ear flushes, home solutions for loosening up the #wax, but some techniques are better than others and certainly some are safer than others.


I am always a bit excited to see impacted ear wax in the clinic because this is one of the most fun procedures, at least on a slower day (have you seen the tick tock videos!?!). However, much of this can be done at home. Here's what I teach my clients.



#Cerumen, or ear wax, is a combination of glandular secretions and desquamated epithelial cells which cleans, protects, and lubricates the external ear canal. Simple use of our jaw helps expel excess wax from our ears, which makes you wonder when you wake up with ear wax on your pillow if potentially you were grinding your teeth at night (which may relate to #parasites).


Some individuals though have some sort of compromise with this process or maybe they are utilizing Q-tips creating an impaction in the ear. About 10 percent of the time we see this in children and in about 5 percent of health adults. Impaction is much more common in older adults, up to about 57 percent of those in nursing homes and in about one-third of those who are mentally challenged. These impactions can cause hearing loss, itching, pain, cough, or even ringing in the ear (#tinnitus) and sensation of imbalance.


Hearing loss in the older client can also cause impairment cognitively so these symptoms are significant, and the impaction should be addressed. As well as with children with fevers or anyone with communication limitations, these impaction should be removed when discovered.


Clinicians may offer #irrigation, manual removal, or suggest agents to loosen and soften the wax for expelling at home. Cotton-tipped swabs, ear candling, and olive oil drops or sprays are not recommended as they are not found to be effective or have significant risks, such as accidental burns. Cameras and all sorts of ear wax removal tools can be purchased online but this is intimidating even for me. Rupturing the tympanic membrane is serious so I really don't recommend these at home.


What Does Ear Wax Tell Us about Your Health?


Earwax is a natural substance that protects the ear canal and eardrum. It can help encapsulate debris and remove it from the ear. Those creepy crawlers that we all pretend don't find us in the night are caught in this substance if they dare to enter the ear canal. I've found many bugs, some rather larger, and also backs to earrings and threads when assessing clients ears.

The ears are also relatively self-regulating. Talking and chewing, even the unique shape of the ear, causes earwax to naturally move up and out the ear taking any debris and dead skin cells along with it.


Ear wax can be off-white, yellow, bright orange, dark orange, brown or black. Fresh ear wax is more off-white and the older it becomes the darker yellow and orange, even amber it becomes because it will pick up more and more debris. Pale orange is also older, with less debris. Near black indicates impaction so that the ear wax has hung around for a while. Gray is more indicative of dust or other particles in the ear. Sometimes we see streaks of blood which can happen when people dig at their ears with their keys or anything else they try to fit in there (think yeast). Green and yellow are often indicative of ear infection.


Our genetics really dictate the level of stickiness. East Asian descendants often have more dry and flaky ear wax for example. Younger children also have softer ear wax that is lighter in color, whereas adults have harder, darker ear wax. Individuals who have had head and neck radiation may have drier cerumen and require more careful debridement.


Interestingly, with greater stress comes a greater abundance of ear wax. When this happens, individuals may struggle to move their wax out fast enough with natural methods such as talking and chewing and they may then suffer impaction.


Eczema, seborrheic dermatitis, and ectodermal dysplasia can increase the frequency of impaction and the risk of otitis externa (external ear infection or swimmer's ear). Others have a narrow ear canal or angle in more unique ways which can make irrigation or manual removal of ear wax a greater challenge.


Risks to Cerumen Removal


The golden rule of ear wax care is to simply leave your ears alone. Let your normal physiologic movement do its work. Inserting anything into the ear, including your fingers, cotton swabs and especially any pointy tool or instrument can cause trauma and can push any wax further into the canal, causing blockages.


Ear candles are quite fun, I admit it, but there are a plethora of case scenarios in which the fire fell into the ear canal and one published case of an individual catching their bed on fire. While I have personally found them very effective, the thought of that flame falling into my daughter's ears just isn't worth the fun.


Gently wash your outer ears with mild soap and water. Let this rinse into the ear canal to clear away any wax that has fallen away from the walls into the canal. It is safe to rinse this wax away because it has performed its function. Any external wax can then be wiped away and this is all that is needed for most.


If the ears are producing an abundance of ear wax, then drops to thin the wax may be helpful. Debrox is an example, although half hydrogen peroxide and half filtered water can also be used, as can a few drops of almond oil. Sometimes you'll find these drops with glycerin too. These are often inserted at night and allowed to work overnight, for a few nights in a row. Adding warm water to the ear after a few days of treatment typically rinses out just by tilting one's head over a bowl.


Of course if you have an eardrum perforation or ear tubes, drops and irrigation should not be used. Even in our own office, clients with blood clotting disorders or on blood thinners are higher risk so I wouldn't consider doing these at home. Clients who are immunocompromised or have uncontrolled diabetes are also higher risk, especially with irrigation.


Irrigation


After using a wax softening agent, irrigation can help get that more stubborn wax out of the ear canal, either at home or in the clinic. We can assure the tympanic membrane is intact prior to irritation, which is important for preventing infection. Several techniques are available with none being superior to any other.


Syringes and electronic irrigators are options with the syringe being most common. Gentle upward and backward traction should be placed on the external ear to help straighten the external auditory canal. The irrigation fluid should be body temperature and administered gently to avoid trauma, bleeding, and pain. The canal should also be checked intermittently for clearance of the cerumen and potential complications. Some may pass out, particularly if the water is too cold and tympanic membranes do rupture in about one in 1,000 irrigations. This risk can be reduced by mixing vinegar and isopropyl alcohol (half & half) and instilling this after treatment.


Admittedly while we are happy to do this for you and charge you for it, if you are using one of the ear wax softening agents for a few days prior to irrigation with a bulb syringe at home, your outcomes and even satisfaction aren't much different than if we were to do it here. Jet irrigators really shouldn't be used at home though, as they really can cause damage to the ear.



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