Ear wax is produced in the outer ear1, and plays a vital part in cleaning and protecting the ear. The ear is usually a low-maintenance organ. From time to time, however, there may be an excessive build-up of ear wax, and this can be problematic.
So, What is Ear Wax?
Ear wax is a normal product of the ear which protects the skin of the ear from water and infection. It is mostly made up of cerumen2, a yellowish-brown, waxy substance produced by the apocrine3 ceruminous glands in the outer ear canal. Chemically, cerumen contains esters (the products of condensation reactions between alkanoic acids and alkanols). Ear wax esters have long aliphatic4 chains of carbon molecules, which ensures that they are insoluble in water.
Ear wax protects the tissues of the ear, and helps prevent infection by trapping irritants such as micro-organisms, dead skin cells, sweat, oil, hairs and dirt from the atmosphere. Part of the ear canal is lined with fine hairs called cilia that help to catch particles that enter the ear and then propel them (now trapped in earwax) towards the ear opening where the wax can be washed off. The action of the jaw during talking and chewing also serves to 'massage' the wax out of the canal.
Ear wax is also slightly acidic, which discourages bacterial or fungal growth in the moist, dark environment of the ear canal. Without ear wax, it would be almost impossible to avoid ear infections.
Problems with Excess Ear Wax
Sometimes, ear wax builds up and becomes mixed with hairs and flakes of dead skin, eventually becoming a wax plug and giving rise to symptoms such as mild deafness, a sensation of 'fullness' within the ear, earache, tinnitus (ringing in the ear) and dizziness. Although even quite a large accumulation of wax in the ear canal need not impair hearing, sudden deafness can ensue when water runs into the ear during washing, causing the wax to swell.
On most occasions, wax in the ears is relatively harmless and is easily treated. However, a sufferer will often not realise that their ears are blocked by wax, and assume that their symptoms are the result of some other cause such as advancing age.
Diagnosis and Treatment of Excess Ear Wax
When you present yourself to your doctor or nurse5 with one of the above symptoms, she/he will examine your ear using an instrument called an otoscope. Once the diagnosis is made, depending on the depth of the wax plug, she/he will either syringe the ear on the spot or will recommend that you return home and soften the wax for a few days first. This will involve using either olive oil or an over-the-counter wax-softening preparation. Olive oil is usually recommended as some people have allergic reactions to proprietary wax softeners. Olive oil is also cheaper and works just as well.
Once the wax is softened sufficiently, the GP or nurse will then use an ear syringe to squirt warm water into the ear canal and allow the wax to float out. The great improvement in hearing that follows syringing of the ears can really be quite startling!
Over-the-Counter Wax Softeners
Wax-softening drops, such as 8% sodium bicarbonate, almond oil or olive oil ear drops, can be purchased from pharmacies. The preparation should be warmed to body temperature before use. The patient, lying with the affected ear uppermost, should use the dropper to put in a few drops, remaining in this position for two to three minutes to allow the drops to soak into the wax, plugging loosely with cotton wool. This should be repeated two or three times a day for five to seven days.
Note that you should never poke anything (such as cotton wool buds, screwed up tissue paper or hair grips) into the ear as this will, at best, impact the wax plug onto the ear drum and, at worst, damage the ear drum itself6.
A Note about 'Candling'
Candling is an 'alternative' method for drawing wax from the ear, which seems to have gained popularity in recent years. The patient is required to lie on his/her side and a 'candle'7 is inserted into the ear canal. The candle is then lit and is said to create a vacuum in the ear canal that draws out the ear wax.
This method is both hazardous and ineffective. Hot candle wax can burn the external ear, and if any gets into the ear canal it can cause a painful burn, infection, or even a perforation of the ear drum. There is also the possibility of the individual setting their hair or clothing alight.
The over-arching principle here still applies:
Never insert anything into the ear canal.