Cleaning Of Ear Wax
Ok! We all know that ear digging feels Super “Shiok“!
Did you know that our ear canal is a self-cleaning organ, and dead skin, hair & earwax are constantly moving out from our ear canal?
The common use of cotton buds for cleaning ear wax tends to push wax deeper into the ear canal. This may lead to a complete obstruction in some patients.
What is Ear Wax (Cerumen)?
Ear Wax, also known as cerumen, functions as a natural barrier preventing physical damage to the external ear canal from water, insects, trauma, infection and other foreign bodies. It is composed of secretion from sebaceous and ceruminous glands in the ear canal and admixed with sloughed skin, normal skin flora, water and the occasional depilated hair.
Fun fact of the day:
The uppermost of the skin (skin epithelium) moves from the inner to the external part of the ear and serves to remove excess wax from the ear canal.
The concern arises when this innate system is hampered or insufficient.
What are the Causes for Earwax to Buildup?
1.) Obstruction/ Narrowing of the ear canal
- Ear canal disease is one of the causes of the impedance of clearance of wax. Ear canal disease can be secondary to bone damage such as osteoma (benign bone growth); or skin conditions including infection of the external ear canal and eczema.
- Ear canal that is tortuously narrowed either due to normal anatomical variations or repetitive injury and infections of the soft tissue ear canal has a higher risk of Ear Wax impaction.
2.) Ineffective ear-wax migration
- The glands lining the ear canal shrinks as we progress with age. This produces more solid, less fluid-consisted wax. The wax clearance mechanism becomes inefficient.
- The common use of cotton-tipped applicators (eg Cotton buds) tends to push wax deeper into the ear canal, this may lead to a complete obstruction in some patients.
- Prolonged use of earplugs, hearing aids and swim moulds can potentially obstruct ear canal and contribute to the accumulation of ear wax.
3.) Excessive ear wax
- Excess ear wax can occur as a result of injury to the ear canal or water retention.
Are There Any Symptoms?
Most people are asymptomatic (no symptoms displayed) despite the accumulation of wax in the ear.
In some, symptoms surface when wax becomes hardened and hard to remove.
Patients may experience ear pain, feeling of pressure in the ear, hearing loss, itch, dizziness or ringing sound in the ear.
Who Will Benefit from Ear Wax Removal?
1.) Symptomatic patients
Patient with symptoms arising from wax accumulation who underwent wax removal experienced IMPROVED symptoms.
2.) Patients with an inability to express symptoms
This category of patients includes young children and patients with cognitive impairment. Ear Wax removal is advisable in these instances as its benefits in relation to hearing improvement has been well-evidenced.
3.) Asymptomatic patients
However, patients without symptoms are not advised to undergo routine Ear Wax removal as the Ear Wax mostly clears without intervention. Also, Ear Wax can serve as a protective layer.
Pearls of wisdom:
- Consider consulting a doctor if you experience symptoms indicating excess wax such as troubled hearing, earache, ear block sensation or tinnitus.
- Avoid attempts to remove Ear Wax using cotton bud sticks as this pushes the Ear Wax deeper into the canal leading causing further obstruction.
- Excess ear wax can be managed by Ear Waxolytic ear drops, irrigation or manual extraction. A doctor will be able to advise on the appropriate method based on a patient’s medical history, expectation and preference.
What are the Ear Wax Removal Options?
1.) Cleaning Ear Wax by Cerumenolytic agents
Safe option in patients without infective, eardrum perforation, ear surgical histories. Unlike, other methods of ear wax removal, this is a convenient and effective option.
Patients who opt for this choice of treatment should follow-up with a doctor for examination as prolonged retention of cerumenolytic drops behind the Ear Wax can lead to irritation of the skin lining of the ear canal.
However, some patients have reported transient hearing loss, dizziness, ear pain, and external ear canal infection. It is advisable to use cerumenolytics not more than 3-5 times a day for this reason.
2.) Cleaning Ear Wax by Irrigation
Ear irrigation is one of the most widely used methods to remove Ear Wax. This involves using flushing of water to remove the build-up of ear wax. Under the gentle force of water, the ear wax is dislodged and flushed out from the ear. This procedure is not advisable for patients who have a history of the hole in the eardrum or ear infection.
A common side effect of ear irrigation is the retention of water behind any wax that was not completely removed. As a result, this might result in an infection of the ear canal. Irrigation may also lead to perforation of the eardrum, hearing loss, ear pain, giddiness and tinnitus.
3.) Manual Removal of Ear Wax
The procedure needs to be performed by an experienced clinician with appropriate equipment. Manual removal requires sufficient visualization with an otoscope or a binocular microscope.
Instruments used include curettes, forceps, hooks, suction. It is a preferred option for patients with perforation eardrum or patients at high risk of sustaining an ear infection.
Manual removal procedures are most effective for removing Ear Wax in the ear canal.
The method can be associated with ear pain, bleeding, laceration and perforation of the eardrum.
4.) Ear Toilet (Aural Toilet)
Toilet?! It is not as unglamorous as it sounds. Ear Toilet is an ear cleaning procedure using “micro-suction” or “mini-vacuum” tube to remove earwax in a safe manner.
With direct visualisation through a binocular microscope, this enables our doctors to clean the ear canal with greater precision and reduced patient discomfort.
This method allows 2-handed working which further minimizes the risks of human error.
5.) Ear Candling
This involves lighting one end of a hollow candle and putting the other end in the ear. Ear candling is not FDA recommended for ear wax removal, as it is not safe and can cause injuries or burns.
If you are experiencing an Ear Infection or Excessive ear wax build up in your ears, it is highly recommended to visit a doctor at as soon as possible.