What is ear wax?
Ear wax is a normal secretion, produced by the ceruminous glands in the outer one-third of the ear canal, mixed with desquamated skin and hair.
Whilst many people obsess in having wax-free ears, ear wax does provide protection to the surrounding skin. It acts as a water repellent, and being slightly acidic, ear wax discourages bacterial and fungal growth too.
As the ear canal epithelium migrates outwards, the wax should move out too, until it reaches the opening of the ear canal and sloughs off, thus providing a natural cleaning system.
When does it cause problems?
Some people produce unusually large amounts of wax, which can prove difficult to clear naturally, resulting in ‘blocked’ ear canal. More commonly, impacted wax is the result of patients trying to clean their own ears. Cotton wool buds are the usual culprit, which are inserted into the external ear canal, pushing any debris deeper into the meatus.
Whilst many people are asymptomatic, impacted wax remains a common presentation to GP’s. Patients may complain of hearing loss (usually mild, unless the meatus is totally obstructed), and occasionally of local irritation, discomfort, tinnitus or dizziness. Water may also get trapped behind the wax, predisposing to an otitis externa.
Structural changes (eg exostoses or otitis externa) may interfere with the normal migratory process, and those people with very narrow ear canals may also develop problems as the meatus blocks more easily.
Longer-term, hearing impairment due to wax impaction can lead to stress, particularly in the elderly, leading to social isolation and depression.
Wax Softeners
If, on inspection, the wax looks hard, then a softener such as warm olive oil drops or sodium bicarbonate ear drops can be used for a couple of weeks, facilitating its normal migration out of the ear canal. The patient should be advised to lie with the affected ear uppermost for a few minutes after a generous amount of the softening agent has been introduced.
There are several other proprietary preparations containing mixtures of organic solvents (eg urea, glycerol and hydrogen peroxide), but these can irritate the skin of the external ear, are more expensive and usually no more effective as the simple solutions.
For some people, a wax softener may be all that is required to aid its natural removal. This is a particularly useful method in young children who would not tolerate any further interference. In those with recurrent collections of excessive ear wax, olive oil drops can be helpful on a more regular basis.
ENT Doctor London is one of UK’s leading Nose Surgeon London clinics, and can be contacted on 0207 580 6970.
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01 6th, 2009 |