What is ear wax? Safe ear hygiene practices regarding ear wax

[Naveed Yaseen]

The skin on the outer part of the ear canal has special glands that produce ear wax, also known as cerumen. The purpose of this natural wax is to protect the ear from damage and infections. Normally, a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying with it unwanted dust or sand particles.

Ear wax is helpful to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of ear wax may result in dry, itchy ears, and even infection.

What does ear wax look like?

Cerumen varies in form and appearance from person to person. It may be almost liquid, firm and solid, or dry and flaky. The color of ear wax varies depending upon its composition. Glandular secretions, sloughed skin cells, normal bacteria present on the surface of the canal, and water may are present in ear wax.

Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of the skin lining the ear canal from the eardrum to the outer opening of the ear. Old earwax is constantly being transported from the deeper areas of the ear canal out to the opening where it usually dries, flakes, and falls out.

When should ear wax be removed?

Under ideal circumstances, a person should never have to clean their ear canals. However, we all know that this isn’t always the case and sometimes removal of ear wax is necessary. Excessive ear wax may build up in the ear canal for many of reasons including:

* narrowing of the ear canal resulting from infections or diseases of the skin, bones, or connective tissue;

* production of a less fluid form of cerumen (more common in older persons due to aging of the glands that produce ear wax); or

* overproduction of cerumen in response to trauma or blockage within the ear canal.

When wax has accumulated so much that it blocks the ear canal (and interferes with hearing), a physician may have to wash it out (known as lavage), vacuum it, or remove it with special instruments. Alternatively, a physician may prescribe ear drops that are designed to soften the wax [such as trolamine polypeptide oleate-ear drops (Cerumenex)].

The patient may first try an over-the-counter product (OTC) if they need to remove ear wax, such as Debrox or Murine Ear Drops. If the ear still feels blocked after using these drops, a physician should be consulted. If the person does try OTC ear wax softeners, it is imperative to know that he or she does not have a perforated (punctured) eardrum prior to using the product. Putting ear wax softeners in the ear in the presence of a perforated eardrum may cause an infection in the middle ear. Similarly, simply washing one’s ear in the presence of a perforation may start an infection. If a person is uncertain whether or not he or she has a perforation (hole) in the eardrum, consult a physician. Some individuals may also be hypersensitive to products designed to soften ear wax. Therefore, if pain, tenderness or a local skin rash develops, the use of these drops should be discontinued.

Is it OK to use Q-tips?

Never put anything smaller than your elbow in your ear! Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal near the external opening. So when a doctor sees that a patient has wax pushed up against the eardrum, he or she knows that it is often because the patient has been probing his or her ear with such things as Q-Tips, bobby pins or twisted napkin corners! Such objects only serve as ramrods to push the wax deeper into the ear and can lead to problems.

The skin of the ear canal and the eardrum is very thin and fragile, and is easily injured. The ear canal is more prone to infection after it has been whipped clean of the “good,” coating-type wax. Doctors see many perforated eardrums as a result of the above efforts. Some doctors recommend the use of two drops of mineral oil in each ear one day per week at bedtime to help liquefy ear wax in people who have a history of recurrent problems with ear wax. This should only be done if the individual has an intact eardrum and no other known problems with their ears.

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