Ear Canal Cleaning

What is ear wax?

The skin on the outer one third of the ear canal has special glands that produce ear wax, also known as cerumen, which acts to protect the ear from damage and infections. As it accumulates and dries up, it falls out of the ear canal, carrying with it unwanted dust, pollen and sand particles, etc. This wax, a natural water repellent, also helps to keep the ear canals from becoming dry, which may result in itchy ears, and possible infection.

(A smart bet would be that earwax will never be a subject in romantic poetry or added for emphasis in an emotional movie scenes, as are tears. To illustrate this, the second chapter in Louis Carroll’s classic, Alice in Wonderland, is entitled The Pool of Tears. Wonderful sounding, isn’t it? Brings up images of intense emotions, doesn’t it? Sounds a lot better than -The Pool of Earwax- doesn’t it? The point is, tears and wax both serve the same purpose, that is to remove foreign material and add a layer of protection to these organs.)

What does ear wax look like?

Cerumen, or ear canal wax, varies in form and appearance. It may be quite watery, firm or dry and flaky. The colour also varies depending upon its composition from near white to dark brown. It may also contain glandular secretions, sloughed off skin cells, normal bacteria and water.

The ear canals are considered to be self-cleaning, that is wax and debris within typically pass, on their own, from deep inside to the outer opening, where it usually dries up and falls out.

Excessive ear wax can cause different symptoms, including: reduced hearing; feeling of fullness; earache, itching, coughing and; ringing or odd sounds within the ear.

Under ideal circumstances, a person should never have to clean their ear canals. However, sometimes removal of ear wax is necessary. Excessive ear wax may build up in the ear canal for many of reasons including:

narrowing of the ear canal resulting from infections or diseases of the skin, bones, or connective tissue;
production of a less fluid form of cerumen (more common in older persons due to aging of the glands that produce ear wax); or
overproduction of cerumen in response to trauma or blockage within the ear canal.

How should ear wax be removed?

Is it OK to use Q-tips? No. No it is not OK to use Q-tips!

Most attempts to clean the ears by using cotton swabs often result in pushing the wax further into the ear canal. Wax is only formed in the outer part of the canal, near the opening, so when a doctor or those who test hearing see that wax has been pushed down closer to the eardrum, the culprit is usually Q-Tips, bobby pins or twisted napkin corners. Such objects only serve as ramrods to push the wax deeper into the ear and can lead to problems.

The skin of the ear canal and the eardrum are thin and fragile; easily injured. The ear canal is more prone to infection after it has been stripped clean of the ‘good’ coating of wax and there are many instances of perforated eardrums as a result of the above efforts.

There are many types of home treatments in an attempt to clean the ears, from mineral oil and hydrogen peroxide to pharmacy over-the-counter OTC products. The debate is ongoing, but published research more or less disproves the effectiveness of these methods.

Over-the-counter drops that help remove wax are all basically oil and peroxide solutions Brand names include Debrox and Murine. Hydrogen peroxide is present for the mechanical effect; it does not dissolve ear wax (Burkhart et al 2000). Plain water was more effective and faster than hydrogen peroxide or olive oil in dissolving ear wax (Chalishazar & Williams 2007), and as effective as the over-the-counter products, namely Murine and Ceruminex (Roland et al 2004).

If the person does try OTC ear wax softeners, it is imperative to know that he or she does not have a perforated (punctured) eardrum prior to using the product. Putting ear wax softeners in the ear in the presence of a perforated eardrum may cause an inner ear infection (otitis media), so too can rinsing with water. Some individuals may also be hypersensitive to OTC products designed to soften ear wax.

And now a few words about ear candling: I suppose I could ask, in what other hole in you body would you put a lit candle, but for the sake of evidence-based research, I’ve added the following to this article.

A 2007 paper in the journal Canadian Family Physician concludes:

“Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk. No evidence suggests that ear candling is an effective treatment for any condition. On this basis, we believe it can do more harm than good and we recommend that GPs discourage its use.”[8]A

A 2007 paper in American Family Physician said:

“Ear candling also should be avoided. Ear candling is a practice in which a hollow candle is inserted into the external auditory canal and lit, with the patient lying on the opposite ear. In theory, the combination of heat and suction is supposed to remove earwax. However, in one trial, ear candles neither created suction nor removed wax and actually led to occlusion with candle wax in persons who previously had clean ear canals. Primary care physicians may see complications from ear candling including candle wax occlusion, local burns, and tympanic membrane perforation.”[9]

The Spokane Ear, Nose, and Throat Clinic conducted a research study in 1996 which concluded that ear candling does not produce negative pressure and was ineffective in removing wax from the ear canal.[1] Several studies have shown that ear candles produce the same residue when burnt without ear insertion and that the residue is simply candle wax and soot.[10][11][12]

If you suspect that something is out of the ordinary with your ear, the best approach is to have your doctor investigate. If you are subjected to recurring problems of wax buildup, or believe that this has occurred, many hearing centres perform ear canal debridement (cleaning).

The three main methods of clearing wax, whether at your doctors or in a hearing clinic, are rinsing (through the use of a special syringe), by a curette (a plastic probe with a small loop at the end) or suction (not unlike at a dentist’s office).

The single best way to greatly reduce the possibility of wax buildup in your ears is to not use cotton swabs, or any other ‘device’ to clean you ears.

The only ‘cleaning’ I recommend is with a tissue: wrapped tightly around a finger tip, it removes the wax that would be visible by others: the relative size of the canal opening, as compared to the finger, means that it can’t pack wax down deep, where it becomes a problem.

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