The good, bad and the ugly of ear wax

You may have heard the saying, "you should not put anything in your ears that is smaller than your elbows." But how many of us actually listen to that? And how can you clean your ears safely?

First, a quick anatomy lesson. The outer ear includes the pinna, or the fleshy external part of the ear made of cartilage, as well as the ear canal going to the eardrum. The middle ear, composed of the eardrum, creates vibrations based on the sound waves going into the ear. The inner ear is responsible for converting vibrations into nerve impulses into the brain, for us to hear. The inner ear also plays a role in our balance.

So what is ear wax and why do we need it?
The ear canal is covered with skin. The wall of the ear canal is sensitive to touch because there is a cranial nerve that passes just below the back canal wall surface. The outer two thirds of the ear canal has cartilage with glands that produce ear wax. Ear wax contains enzymes that help prevent bacteria and fungus from growing in the ear. It also traps dust and dirt particles that enter the ear. 

Wax is healthy for you and it should be there! It only needs to be removed for the following reasons:

1. When a doctor needs to move it out of the way in order to see the eardrum to rule out an infection or other problems going on.
2. When there is a giant blockage of ear wax that is causing hearing loss or pain.

When excess ear wax is pushed further into the ear canal or hardens, it can become impacted. This affects about 10 percent of children, five percent of healthy adults, and 57 percent of older adults in nursing homes, according to the American Academy of Otolaryngology — Head and Neck Surgery.

The removal of ear wax
Most people reach for the Q-tips. I would caution against this. In fact, Q-tips were not made to clean the ear canal itself, only parts of the external ear. It often will just push the wax deeper into the ear canal, causing ear pain and further blockage, which is harder to remove. Usually ear wax on its own will accumulate, dry and then fall out of the ear, carrying dirt and dust with it.

The use of ear candles has received a lot of attention recently, but I strongly advise against using these as they are not safe, nor effective. There is a risk of burning the ear canal and possibly causing a hole in the eardrum. Rarely, if a child is not able to cooperate in the clinic for ear wax removal, and the ear wax is causing significant hearing loss, we may remove it under sedation in the operating room. 

If your doctor recommends removing the ear wax, I recommend using over the counter ear wax removing solutions, like Debrox or mineral oil. Debrox has a diluted form of hydrogen peroxide and is safe in the ears for short periods of time. This is safe for children to use as well. Lay on your right side, pull the ear lobe backwards and apply three to four drops into the ear canal. Then press the front part of the ear a few times to make sure the ear drops work further into the ear canal. Stay on your side for a few minutes, then repeat on the other ear. Consider doing this at night or before showering. You can do this every two weeks for adults to help lubricate the ear canal and prevent the hardening and impaction of ear cerumen.

If you or your child has ear tubes, I would check with your ENT (ear, nose and throat) specialist before using Debrox or mineral oil.

If your ears feel plugged or painful despite using the ear drops, it's time to schedule an appointment with your primary care provider. They will evaluate your ears and, if there is excess ear wax, they will irrigate out the ears with water. If this is not effective, you may be referred to an ENT provider to safely remove the ear wax under the guidance of a microscope.