FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

EAR WAX REMOVAL WITHOUT INJURY

Question: I have a terrible problem with wax buildup in my ears. Everyone says that I shouldn't use Q-tips, bobby pins or similar things to dig in my ears, but what can I do to get rid of the wax?

Answer: Earwax is referred to by those of us in the medical professions as cerumen, but everyone knows what that brown "stuff" looks like. It is produced by specialized oil glands within the skin lining the outer segment of the ear canals. As the wax is produced, it slowly migrates outward. Under ideal conditions, as the wax migrates outward toward the opening of the ear canal, it dries and flakes away without ever producing a buildup. Many people believe cerumen has no value. These folks may think its an evolutionary oddity, like the appendix, that appears to serve no useful function for us humans. Well, this just isn't the case. Cerumen coats and waterproofs the outer portion of the ear canal. It also has antibacterial properties. Because of these qualities, its presence significantly reduces the risk of infection within the ear canal -- what we doctors call otitis externa or you may know as "swimmer's ear."

Some individuals have difficulty with their ear canals becoming blocked by wax, a condition we doctors call impacted cerumen (gosh, but we do love those important sounding terms!). This can occur because of a high rate of cerumen production or because it becomes hard and doesn't migrate out of the canal. People of all ages can have either problem; however, children more often have an overproduction of wax and older individuals are more likely to have trouble with hard wax blocking their ears.

A blocked ear canal is a health concern for several reasons. The blockage can produce an annoying or uncomfortable sensation. Impacted cerumen also makes it more likely that small amounts of water will be trapped within the ear canal, and thereby, cause irritation. One of the most common but subtle disorders is a decrease in hearing. A blocked ear canal produces the same degree of hearing loss as is produced by plugging your ear with your finger. Fortunately this, as opposed to other causes of hearing deficit, is easily corrected.

So, how should you get the wax out of your ears since you shouldn't "dig" in them with fingers or objects? A spray of water from an "ear syringe" is the best choice. These simple and inexpensive devices are available at any drug store. A gentle stream of body temperature water should be directed down the ear canal. Usually six ounces or so will clean out most "blocked" ear canals. It may be necessary, if the wax is particularly hard and dry, to soften it overnight with the application of a few drops of mineral oil or a specially formulated wax-softening product before irrigation. You should see your family doctor or an ENT specialist if the blockage is not removed after two attempts, the second of which is preceded by an attempt to soften the wax.

And, I almost forgot an important point. You shouldn't use cotton-tipped applicators to clean inside your ear canals because there is some risk of irritating the skin there or of irritating the eardrum itself. The most common complication, however, is that the applicator acts as a "ramrod" and pushes hardened bits of wax further into the ear, thereby converting it into a solid "chunk" that can't fall out on its own. Often this type of cerumen impaction can't be corrected without a doctor visit.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.