Ear Wax
Ear Wax Removal
The nature, function and make-up of earwax/cerumen shows that this sticky secretion is not only of considerable clinical importance, but also a source of fascination!
The removal of earwax and subsequent improvement of hearing can be one of the most important clinical experiences.
Earwax often blocks hearing aid moulds causing unnecessary difficulties to those whose hearing.
(For appts at a private Ear Clinic please see the section Private Ear Nurse Clinics)
One must never consider it an ordinary, unimportant routine treatment. The removal of cerumen/wax can be difficult, and the procedure has to be explained.
As Ear Nurse Specialists we do not advocate syringing of the ear for wax removal. Serious damage to hearing can occur sometimes with ear syringing, and it is thought to cause tinnitus in some people. The Ear Nurse Specialist removes wax under direct microscopic vision, with the use of instruments, or suction. There is a high amount of knowledge and expertise required and to be carried out safely, one must be suitably trained and qualified nurse or doctor.
Please Note: The Ear Nurse Specialist Group supports the view of safe practice for aural procedures. Otology is a specialty area of nursing requiring credentialled expertise. Be aware of unqualified personnel!
Where, how and why wax is secreted?
The outer third of the ear canal contains " cerumen" and " sebaceous" glands. Earwax in secreted for protection of the delicate hearing mechanism within, and to keep the ear canal acidic, therefore deterring infection.
What is earwax?
Earwax is a mixture of secretions from the ceruminous and sebaceous glands, together with flakes of skin, dust and other debris. The cerumen glands are thick sweat glands of a special type. The secretions can be activated by emotional stimulation (fear) and when touching the skin (over zealous cleaning of the canal).
Evaporation occurs allowing the sticky substance to entrap dust, bacteria, fungi and flakes of skin before being expelled by 'migration' - a process whereby the skin layer of the eardrum is continuously migrating- thus moving up the ear canal aided by jaw movement. Thus dispelling the excess earwax.
Earwax often becomes drier with increasing age. Although the quality and quantity of earwax is similar for both sexes, wax impaction iseems to be more common in males.
Symptoms of wax impaction
These can include deafness, tinnitus, earache, fullness in the ear and vertigo. Some people have jaw or facial pain.
Wax retention will occur whenever there is an obstruction and in some people this can be caused by anatomical abnormalities (eg tortuous canal, exostoses, (bony outgrowths in the ear canal), surgically created mastoid cavity) hairs (particularly male), and hearing aid moulds.
In children, it is usually a narrow canal, and in both age groups, the use of cotton buds for cleaning may cause impaction.
Cotton Buds are neither necessary nor appropriate as they push wax in further and may rupture the eardrum.
Cotton buds interrupt the normal self-cleansing process of the outer ear. Irritation of the skin by cotton buds may predispose to Otitis Externa, (canal infection ) which can lead to shrinking of the skin and wax glands. This in turn makes the ear feel dry and itchy, perpetuating the desire to 'clean the ear"!
The repeated insertion of a hearing aid mould may also cause wax accumulation / impaction of the upper part of the canal. This may cause feedback, and nearly 1/3 of all hearing aid malfunctions is due to wax.
General Information
Wax is normal, and is only removed if causing a problem, ie impacted, and painful, or if the eardrum needs to be seen for a very good reason. No child should be forced to have wax removed. Ear syringing is not advised in children.
Sometimes tympanometry is carried out to test the mobility of the eardrum, and if this is normal, - let the wax stay. If the canal is blocked, use olive oil, or 3% Peroxide, for a few days, and then check again. Some children who have a serious wax impaction problem may require a general anaesthetic for removal. The most important thing with children is to avoid an unpleasant confrontation, which will result in fear of all future treatment.
