Doctor, Please Explain
Earwax
Insight into the proper care of the ears
• Why does the body produce earwax?
• What is the recommended method of ear cleaning?
• When should a doctor be consulted?
• and more…
Good intentions to keep ears clean may be risking the ability to
hear. The ear is a delicate and intricate area, including the
skin of the ear canal and the eardrum. Therefore, special care
should be given to this part of the body. Start by discontinuing
the use of cotton-tipped applicators and the habit of probing
the ears.
Why does the body produce earwax?
Cerumen or earwax is healthy in normal amounts and serves to
coat the skin of the ear canal where it acts as a temporary
water repellent. The absence of earwax may result in dry, itchy
ears. Most of the time the ear canals are self-cleaning; that
is, there is a slow and orderly migration of ear canal skin from
the eardrum to the ear opening. Old earwax is constantly being
transported 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, but in the outer part of the canal. So when a patient
has wax blockage against the eardrum, it is often because he has
been probing the ear with such things as cotton-tipped
applicators, bobby pins, or twisted napkin corners. These
objects only push the wax in deeper.
What is the recommended method of ear cleaning?
Under ideal circumstances, the ear canals should never have to
be cleaned. However, that isn’t always the case. To clean the
ears, wash the external ear with a cloth, but do not insert
anything into the ear canal.
Most cases of ear wax blockage respond to home treatments used
to soften wax. Patients can try placing a few drops of mineral
oil, baby oil, glycerin, or commercial drops, such as Debrox® or
Murine® Ear Drops in the ear. These remedies are not as strong
as the prescription wax softeners but are effective for many
patients. Rarely, people have allergic reactions to commercial
preparations.
Detergent drops such as hydrogen peroxide or carbamide peroxide
may also aid in the removal of wax. Rinsing the ear canal with
hydrogen peroxide (H2O2) results in oxygen bubbling off and
water being left behind—wet, warm ear canals make good
incubators for growth of bacteria. Flushing the ear canal with
rubbing alcohol displaces the water and dries the canal skin. If
alcohol causes severe pain, it suggests the presence of an
eardrum perforation.
Why shouldn’t cotton swabs be used to clean earwax?
Wax blockage is one of the most common causes of hearing loss.
This is often caused by attempts to clean the ear with cotton
swabs. Most cleaning attempts merely push the wax deeper into
the ear canal, causing a blockage.
The outer ear is the funnel-like part of the ear that can be
seen on the side of the head, plus the ear canal (the hole which
leads down to the eardrum). The ear canal is shaped somewhat
like an hourglass—narrowing part way down. The skin of the outer
part of the canal has special glands that produce earwax. This
wax is supposed to trap dust and dirt particles to keep them
from reaching the eardrum. Usually the wax accumulates a bit,
dries out, and then comes tumbling out of the ear, carrying dirt
and dust with it. Or it may slowly migrate to the outside where
it can be wiped off.
What are the symptoms of wax buildup?
• Partial hearing loss, may be progressive
• Tinnitus, noises in the ear
• Earache
• Fullness in the ear or a sensation the ear is plugged
Are ear candles an option for removing wax build up?
No, ear candles are not a safe option of wax removal as they may
result in serious injury. Since users are instructed to insert
the 10” to 15”-long, cone-shaped, hollow candles, typically made
of wax-impregnated cloth, into the ear canal and light the
exposed end, some of the most common injuries are burns,
obstruction of the ear canal with wax, or perforation of the
membrane that separates the ear canal and the middle ear.
Even though ear candling is an ancient practice with the intent
to treat a wide variety of ear maladies including cerumen
impactions, ear infections, hearing loss, tinnitus, Ménière’s
disease, sinusitis, headaches, inhalant allergies, and many
other conditions, the FDA has never cleared or approved
marketing the products as a medical treatment.
Are ear candles approved by the U.S. Food and Drug
Administration?
The U.S. Food and Drug Administration (FDA) became concerned
about the safety issues with ear candles after receiving reports
of patient injury caused by the ear candling procedure. Although
there are proponents who argue in favor of the use of ear
candles, the FDA is unaware of any controlled studies or other
scientific evidence that support the safety and effectiveness of
these devices for any of the purported claims or intended uses
as contained in the labeling.
Based on the growing concern associated with the manufacture,
marketing, and use of ear candles, the FDA has undertaken
several successful regulatory actions, including product
seizures and injunctions, since 1996. These actions were based,
in part, upon violations of the Food, Drug, and Cosmetic Act
that pose an imminent danger to health.
When should a doctor be consulted?
If the home treatments discussed in this leaflet are not
satisfactory, or if wax has accumulated so much that it blocks
the ear canal (and hearing), a physician may prescribe eardrops
designed to soften wax, or he may wash or vacuum it out.
Occasionally, an otolaryngologist (ear, nose, and throat
specialist) may need to remove the wax using microscopic
visualization.
If there is a possibility of a hole (perforation or puncture) in
the eardrum, consult a physician prior to trying any
over-the-counter remedies. Putting eardrops or other products in
the ear with the presence of an eardrum perforation may cause an
infection. Certainly, washing water through such a hole could
start an infection.
