Published in Panorama
Dealing with Ear Wax
It is estimated that more than 30% of any general population suffers from ear wax related problems, reveals Dr Sunil Narayan Dutt, ENT Specialist and Departmental Coordinator, Canadian Specialist Hospital, Dubai. Ear wax can cause pain and hearing loss when wax completely blocks the ear canal. This prevents sound waves from easily reaching the ear drum. Even a small amount of wax, if wedged between the ear drum and the ear canal wall, can reduce the ability of the ear drum to conduct soundwaves. Some people tend to form very hard wax and this can cause pain by exerting pressure on sensitive ear canal walls. It is therefore necessary to take precautions to avoid wax related problems, emphasizes Dr.Dutt.
Why ear wax? What precise role does it play?
Wax is naturally formed in the ear canals. Wax is a mixture of the products of several glands in the ear canal, known as sebaceous and ceruminous glands. It contains various amino acids, fatty acids, lysozymes and immunoglobulins and is to some extent bactericidal (kills bacteria) being especially potent against dividing bacteria. The primary purpose of ear wax is to protect your ear canal and ear drum from such foreign materials.
What gives rise to excess wax or wax that becomes troublesome?
There is a natural migration of skin debris and the secretions including wax in the ear canal. Normally, this starts from the centre of the ear drum and radially spreads towards the outside. When this natural mechanism is injured or impeded, wax starts accumulating. Injury may be with ear buds, hair pins and grips, match sticks or even accidental trauma. Ear canal infections and skin diseases may impede wax migration. Children may put in tiny objects into the ear canal (beads, toy parts etc) that may impede wax.
What are the problems associated with ear wax?
Problems with wax include pain, infection and deafness (up to 20 decibels. Many patients who present with ear wax problems are regular users of cotton buds. Ear buds, safety pins and hair pins, when used carelessly, can push wax and skin debris into the deeper parts of the ear canal where wax is not formed. In such a situation, there would be further impaction of the hardened wax with skin debris mi8grating from the ear drum and the deep canal skin. Impacted wax can give rise to extremely painful conditions such as wax granuloma and keratosis obturans. Curvature of the ear canal and the diameter of the canal may add to the pathology and hence symptoms.
What are the symptoms of ear was?
Build up of ear wax may manifest with pain in the ears – one or both, difficulty in hearing, ringing noise in the ears or a feeling of something blocking the ears.
Who are the people at risk of developing ear wax problems?
It is usually those who have ‘dry wax’ in the ears that develop problems. Young children and the elderly have problems with wax as the wax migration is not so mature in the very young and gets defective as you grow older. People with skin diseases certainly have a risk of ear canal infection and hence wax accumulation.
Can previous ear surgery give rise to ear wax accumulation?
Ear surgery by itself does not lead to excess wax production. But it may take some time for the natural migration to recuperate after ear surgeries. It really depends on the type of ear surgery performed.
Is there a heredity component to the problem?
Most certainly. There are two distinct forms of wax. Dry wax is yellowish or grey and is usually brittle. Wet wax is yellowish brown and is wet and sticky. There is a monofactorial inheritance with the wet type inherited as autosomal dominant and the dry type autosomal recessive. Approximately 40% of the population has dry wax and it is usually this group that has problems.
How exactly does hearing loss happen with accumulated wax?
The external ear (appendage called ‘Pinna’) and the ear canal contribute to nearly 15 to 20 decibels (a unit of the loudness of sound: for example, whisper’ is about 20 decibels; normal conversation is at about 40 decibels) of sound perception. Hence, complete blockage of the ear canal by wax can cause a significant hearing impairment, more so if it is on both sides.
How do pain and infections happen on account of excess wax?
When skin and wax that need to normally migrate do not do so, there is accumulation of skin debris and secretions. This is a good medium for bacterial infections. Skin and bone involvement with infections produces pain.
Is it possible that some folks have problems with ear wax throughout their lives? If yes, why?
As mentioned before, if you have dry wax, you are likely to have problems intermittently. Also, people with chronic skin diseases (dermatitis, eczema, psoriasis) may have ear problems on and off.
Some people are known to develop “problem wax”, suddenly for no reason. What is “problem wax”, who gets it and why?
Some patients have wax accumulated in the deep part of the canal pushed in by ear buds for example, along with skin debris which can increase in size and in addition to infection and pain, can cause bone erosion (a condition called keratosis obturans). This is a serious condition requiring surgery.
Is it possible for people to have excess wax only in one ear and not the other? Why is this so?
In most people, wax problems are bilateral (both sides). Occasionally, we may have patients with wax problems with one ear only….with ear infection, skin disease, ear trauma and so on. Very often, the problem starts with one ear and slowly the patient develops problems with the other ear too.
Does excess ear wax affect the performance of hearing aids in people who have them?
Absolutely. As mentioned earlier, wax in the ear canal causes up to about 20 decibel hearing impairment and this would affect the amplification provided by a hearing aid and hence its performance may leave much to be desired. Besides, constant use of conventional hearing aids may further aggravate the wax problem and also lead to infections. This can become a vicious cycle.
Is it possible to prevent problems from ear wax? If yes, how?
There are some dos and don’ts that I generally advise my patients. Listed below are some of them.
1. Use wax-solvents or warm olive oil if you perceive wax accumulation.
2. Use ear buds judiciously only for the opening of the ear canal and the bowl of the auricle (ear appendage).
3. Using a hair-dryer to dry the ear after a bath or swim is a good technique.
4. Use cotton-wool pads dipped in vaseline to prevent water from entering the ears during a shower/bath.
5. While swimming, use swim-plugs (may be custom-made) with a swim-hat to prevent water entering the ears.
6. Do visit your specialist if symptoms of itching, pain, discharge or deafness develop.
1. Do not use very hot oils or coconut oil for wax dissolution. Hot oils scald the skin and ear-drum; coconut oil desiccates easily.
2. Do not use ear-buds injudiciously; definitely not into the depths of the ear-canal.
3. Do not use match-sticks, hair-pins/grips, safety-pins, pens/pencils in the ear canal.
4. Do not self-medicate with persistent symptoms. See your specialist; the problem may be unrelated to wax and may be more serious.
5. Do not attempt to remove wax from your child’s ear. You may make matters worse. See a specialist.