Cerumen in the Ears

I thought I would write something about one of the most common issues that I deal with in my office on a daily basis: Wax plugging the ears. While this is not a glamorous or attractive topic of conversation, excessive wax in the outer ear canal affects many people. It can cause problems as simple as mild hearing loss, or more complex including painful infection of the outer ear.  Also while many people have ideas on how to clean ears and remove the excessive wax, some of the techniques are ineffective and occasionally can lead to more serious problems. First of all left me explain and define a few things.  The official medical term for the wax that accumulates in the outer ear canal is cerumen.  Cerumen comes in two definite forms–soft and wet or firm hard and dry.  Interestingly, like so many parts of our body, the type of wax that we produce is based on our genetics. If the wax in the ear canal is analyzed, approximately 60% of it comes from skin cells that are shed or peeled away from the outer layer of skin.  The remainder of the mixture is a combination of secretions from glands in the ear canal.  The glands produce mixtures of short and long chain fatty acids as well as other skin secretions such as perspiration and even cholesterol. The main purpose of cerumen is actually to carry shed /expelled skin cells from the deep parts of the ear canal near the eardrum out to the surface.  The outer ear canal is the only blind pouch opening in our bodies that is lined with normal skin cells.  The skin of the ear canal is just like skin anywhere else where the outer layers die and peel away.  The wax migrates from deep in the ear canal to the opening acting like a very slow river pushing the dead skin out. That is the normal state of the outer ear canal but like so many things in our body, problems can arise.  The most common one that I see is an overproduction of wax that is often associated with inability of the wax and dead skin cells to detach from the underlying surface.  This, as you can imagine, leads to plugging of the ear with wax which is officially called cerumen impaction.  One study suggested that approximately 5% of adults have cerumen effectively plugging their ear canals. Most people have had this problem at least one time in their life.  Many have tried to take care of it themselves using ear cleaning liquids or even kits.  I personally have suggested ear cleaning recipes for many of my patients to try at home. Most commonly, I suggest putting olive oil or almond oil in your ear approximately every 2 weeks.  This helps soften the wax and allows the skin cells to detach and the ear wax comes out naturally. For people with more serious or frequent wax plugging problems I recommend these 3 steps: 1) With an eyedropper place 5-8 drops of hydrogen peroxide in the ear 2) After approximately 3 minutes, flush the ear with a baby bulb syringe using a mixture of warm water and white vinegar at body temperature. Let the liquid run out with the ear facing downwards 3) If moisture is left in the ear a few drops of rubbing alcohol can be used to evaporate the moisture. Please note that this is a suggestion and not always a cure and this should never be done if there is a history of a perforation or hole in the eardrum Of course I could not discuss wax in the ears without saying something about cotton swabs most commonly known as Q-tips.  I personally do not think Q-tips are always dangerous or evil and should never be placed in someone’s ears.  I think they can be used after showering or bathing to absorb the excess water in the outer ear canal with good results.  However when they are used to try to remove cerumen from the ear canals usually they just push it in farther.  EAR CANDLING SHOULD NEVER BE DONE, BUT THAT IS ANOTHER TOPIC.  As an ENT specialist trained in ear surgery, I frequently remove ear wax in my office under an operating microscope.  This allows me exceptional magnification and vision so that removal of the wax with small instruments and suctioning can be done without damaging the delicate ear structures.