What is ear wax?
Wax is an important and is a natural secretion found in the outer ear. It keeps the ear canal lubricated and also protects the ear canal against dust, dirt and bacteria, which helps to prevent infection.
Wax, or cerumen as it is also known, is composed of epithelium (skin cells), dust and oily secretions from the sebaceous and ceruminous glands in the ear canals. These secretions lubricate the ear canal and prevent it becoming too dry. The composition of wax varies from individual to individual depending on diet, age and environment.
What should you do about ear wax build up?
If wax is not causing you any problems, it is best left alone. The ear is self-cleaning and the wax should clear naturally on its own, so it is unnecessary to try to remove the wax yourself. If wax is noticed on the outer ear, a wipe with a clean flannel may be all that is needed. Sometimes, however, wax may build up, particularly if it is very dry or if the person has a narrow or hairy ear canal. Wax may also build up if it has been pushed down the canal by cotton buds, hearing aids, hair clips or other implements. Cotton buds can also irritate the ear canal, stripping it of its natural oils and causing it to feel itchy. When water gets into the ear canal during swimming or showering this may cause the wax to expand, giving a sensation of ‘blockage’ in the ear and increasing the perception of tinnitus.
If wax build up is causing deafness, problems with hearing aids, or is uncomfortable, it may need to be removed. Some people with tinnitus feel that their tinnitus is more troublesome when their ears are full of wax.
How can you treat ear wax at home?
Most people tend to use ear wax softening drops as the first option for wax removal. These may soften the wax enough to aid the natural expulsion from the ear. There are many ear drops on the market. Some proprietary drops may be harsh to use, particularly if the person has a sensitive skin or any skin condition such as eczema or psoriasis. Sodium bicarbonate ear drops can also be effective but again some people find them very drying.
Rather than use such ear drops, many people find that olive oil is easily available, comfortable to use and does not need to be warmed before use. Two or three drops, twice a day for one to two weeks is usually sufficient, and the wax will often then come out by itself.
When introducing drops into the ear, it is best to use a dropper and lay with your head on one side for a couple of minutes to allow the drops to move along the ear canal, then tilt the head to the other side to assist the wax to move outwards. After this period, tissue may be used to soak up any excess from the outside of the ear. Some people find it easiest to instil the ear drops when they are in bed, first thing in the morning and last thing at night.
If you often get a build-up of ear wax, using a couple of drops of olive oil once a month or so may help prevent the build-up.
What clinical methods are used to remove ear wax?
One of the most frequent ways to remove wax in general practice is by ear irrigation, or syringing as it is commonly known. This procedure cannot be carried out if the person has had any ear surgery, recent infections or a perforation of the ear drum. It is also not advisable to carry out the procedure if the patient has any dizziness problems or very troublesome tinnitus.
During this procedure, the person sits in a chair and the ear is rinsed with warm water from an electronic irrigator. The wax and water is collected in a cup-shaped receiver which the patient holds under their ear. In the past clinicians used a large metal syringe; however the new electronic irrigators, which have controlled pressures, are gentler and safer. Ear syringing does make some noise but this is not excessive or uncomfortable. Most people who have irrigation find it to be a fairly pleasant procedure.
Wax can also be removed by micro-suction. This procedure is most commonly carried out in private clinics although some primary care clinics can also now offer this. During this procedure the clinician looks through a microscope and suctions the ear with a small instrument. It is a noisy procedure and although some patients may find the procedure slightly uncomfortable it should not be painful.
Wax may also be removed by a clinician using a headlight and instruments.
Never try to remove the wax yourself with an instrument or device as you will most probably push it further down the ear canal or cause damage.
If any method being used is uncomfortable, tell the clinician at once.
To summarise:
Wax is a natural secretion and if it is not a problem it is best left alone
Do not use cotton buds, hair grips, a pencil or other items to try to remove the wax
Consider ear wax softening drops or olive oil as the first option unless you are experiencing pain or discharge
Visit a clinician who will advise whether wax removal is necessary and what type of procedure is most appropriate for you depending on your medical history