Wax In … Wax Out

May 13, 2018 11:50 PM

Wax In - The most common subject that any hearing health care worker gets asked about is ear wax.  Usually with a negative connotation. Something along the lines of “yuck…ear wax”.  

First and foremost what we need to realize is; Earwax is good!  Normal amounts of ear wax produce  numerous benefits. There is the obvious one of trapping and preventing small particles from reaching the eardrum. The substance also serves to moisturize and lubricate the sensitive skin of the ear canal. An invisible, yet very important function of ear wax is infection protection. The antimicrobial functions of ear wax are due primarily to the Ph balance, the lipid content and the enzyme lysozyme.

The proper name for ear wax is cerumen (Sir-oo-men). Cerumen is a naturally-produced secretion.  It is made up of a mixture of water-soluble viscous secretions, sebum from sebaceous glands and less viscous secretions from modified apocrine sweat glands. The consistency  varies from light and oily, to thick and sticky, The bulk of it is environmental detritus and shed skin. There is no wax. 

The removal of cerumen should be left to natural processes. The technical name for these mechanics are desquamation, and epithelial migration, which conveniently will also be the subject of a future article. For now, we’ll just say it migrates laterally, dries up, and falls out. Simple.

Wax out - Occasionally though, there is occasion to manually remove the cerumen from your ear canal(s). Some legitimate reasons are for procedures, or observation of the ear canal or ear drum.  The most common though is from a benign condition called cerumen impaction. Simply put, a plugged ear canal. Usually, a person cannot tell that they have cerumen impaction. But there are some physical signs, such as popping or crackling sounds with jaw movement. Infrequently the impaction can cause pain or discomfort.  Cerumen impaction can cause episodic hearing loss.  This can range from barely perceptible to moderate in severity, and is easily remedied by removal of the offending mass.

There are three procedures for removing cerumen. 

1] Curette: which is a small loop or scoop. 

2] Lavage: which simply means rinse out 

3] Otoendoscopy: A tiny vacuum system. 

 Of these three systems, notably absent is the cotton swab, commonly know as the Q-tip. “A cotton swab can be carefully used to about the depth of the cotton on the swab.” says Dan Rochel of Hearswell in Isanti “It cannot remedy impaction, it can only plug your ear up by stuffing wax down further.”

 The only method that should be used on a home remedy basis is the lavage method, often sold in pharmacies.  They consist of a solution that you put into your ear; and a bulb syringe to rinse it out. The most common brand name is Debrox. These should be used only with recommendation of a hearing health care professional, and should never be used if there is a damaged ear drum. The method of viewing into an ear canal for inspection is called otoscopy. “We use a video-otoscope, so our patients can see what we see” says Rochel. At Hearswell, video otoscopy, and cerumen management are part of the standard clinical practice. If you have questions about ear wax, or other hearing related issues, Give them a call.