Normally, the ear is a self-cleaning and, therefore, low maintenance organ. However, from time to time there may be an excessive build-up of ear wax, and this can be problematic.

The human ear consists of three different parts: the outer ear (which you can see); the middle ear and the inner ear. The outer ear consists of the pinna or auricle and is separated from the middle ear by the ear drum.

In order to keep itself clean, the ear produces a waxy secretion called cerumen ¹. Part of the ear canal is lined with fine hairs called cilia that help to trap particles that enter the ear, and to propel wax toward the ear opening where it can be washed off.

Sometimes, the wax builds up and becomes mixed with hairs and flakes of dead skin and eventually gives rise to symptoms. These symptoms include a gradual loss of hearing and a sensation of fullness inside the ear. It is possible that even quite a large accumulation of wax in the ear canal does not impair hearing, but sudden deafness ensues when water runs into the ear during washing. This causes the wax to swell.

On most occasions wax in the ears is relatively harmless and is easily treated.

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 contains cerumen, produced by the apocrine² ceruminous glands in the external auditory canal. The ear wax you see is a combination of this and other components such as dead skin cells, sweat, oil, hairs and dirt from the atmosphere. A major component of ear wax is keratin, derived from dead skin cells. Cerumen is a yellowish - brown waxy substance which protects the tissues, and helps prevent infection by trapping micro-organisms, dirt and other irritants. Chemically, cerumen contains esters (the products of condensation reactions between alkanoic acids and and alkanols). Ear wax esters have long aliphatic ³ chains of carbon molecules, which ensures that they are insoluble in water. 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.

Wax is constantly travelling towards the outer ear where, in extreme cases, it can be seen to exude. The actions of the jaw, during talking and chewing serve to 'massage' the wax out of the canal.

Symptoms of a wax plug

The symptoms of a wax plug within the ear can include:

Mild deafness, a sensation of 'fullness' within the ear, earache, tinnitus (ringing in the ear), dizziness.

Often a sufferer will not realize 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

When you present yourself to the General Practitioner or Nurse Practitioner ⁴ 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, 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 an 'Over The Counter' (OTC) wax-softening preparation or, alternatively, olive oil. Usually use of olive oil will be recommended as some people have allergic reactions to proprietary wax softeners and, besides, olive oil is cheaper and works just as well.

'Over The Counter' Wax Softeners

OTC 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. Lying with the affected ear uppermost, use the dropper to put in a few drops. Remain in this position for two to three minutes to allow the drops to soak into the wax, and then plug loosely with cotton wool. This should be repeated two or three times a day for 5-7 days.

Note that one should never poke anything, like cotton wool buds, screwed up tissue paper or cotton buds into the ear as, at best, this will impact the wax plug onto the ear drum and, at worst, damage the ear drum itself.⁵.

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!

A Note about 'Candling'

Candling is an 'alternative' method for drawing wax from the ear, which seems to have gained popularity in recent years. Here, the patient is required to lay on his/her side and a candle is inserted into ear canal. The candle is then ignited and is said to create a vacuum in the ear canal that draws out the ear wax.

This method is both hazardous and ineffective.

It is hazardous as hot wax can burn the external ear, and if any gets into the canal it can cause a painful burn, infection, or even a perforation of the ear drum. There is also the possibility of setting one's hair or clothing alight.

The over-arching principle here still applies:

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