Ear wax - when too much causes problems

The build-up of wax in the ear can be annoying but can also muffle incoming sound making hearing or understanding difficult. It is not quite certain the purpose of ear wax but believed it is useful in lubricating the ear preventing dryness and irritation and catching debris, such as dead skin and dust, shaving cream and shampoo, and even small insects, from entering deeper into the ear canal. Accumulation wax may be associated with a sensation of blockage but not all people who feel their ears are blocked will have a problem related to wax.

Wax accumulation has several consequences

• it can prevent  view of the tympanic membrane (the ear drum)
• it can cause hearing loss and hence may interfere with hearing assessment
• if in contact with the ear drum may can cause discomfort and occasionally vertigo
• it can contribute to infection

Wax removal can help to solve these problems and potential complications.

Ear anatomy

The ear is divided into 3 main areas; the external outer ear, middle ear and the Internal (inner ear).

The External (outer) ear consisting of an auricle (what we know as the ear) that sits on each side of the head), the external auditory canal and the eardrum. Sound waves are gathered by the auricle and channel them inward.

The middle ear receives the sound waves as vibrations and conveys them to the inner ear where receptors for hearing and equilibrium are housed.

The Internal (inner) ear, also called labyrinth of the ear, contains organs of the senses of hearing and equilibrium. Information is received and is sent through to the brain for processing. In the brain the electrical impulses are translated into sounds which we recognise and understand.

Ear wax

Ear wax, called cerumen, is secreted by specialised sweat glands, called ceruminous glands, a type of apocrine gland, found near the external opening. Hair within this section helps with the cerumen to trap any debris from entering the ear. The oily wax substance has antibiotic properties to prevent the accumulated debris from bacteria growth. Ear wax can be wet (honey-coloured and sticky) or dry (grey and flaky) depending on your ancestry.

The ear usually cleans itself naturally without any help from us. It is when the wax and debris enter deeper into the canal and dry that problems arise.

What can cause excess ear wax?

• Hereditary - like hair and eye colour, the amount of wax produced can be influenced by your genes. Interesting, research findings on an individual’s ear wax reveal chemical compounds in earwax differ between the races, and the molecules that produce an odour are generally higher in Caucasians than in East Asians
• Stress, anxiety, medication or physical activity that increases or decreases your ‘flight or fight response
• Ageing
• Narrow or small ear canals can make it difficult for wax to leave the ear
• Inserting cotton buds into the ear to clean ear, but will often push wax deeper into the ear
• Hearing aids - in older people hearing aids may prevent the natural removal of wax
• Wearing ear plugs or ear phones for extended periods of time preventing the natural flow of wax from the ear

Symptoms of excess ear wax

• Difficulty hearing
• A feeling of congestion in ear
• Dizziness
• Earache
• Ringing in the ear
• Itchiness in the ear
• Exudate coming from the ear

Other symptoms could mean more serious issues - warranting an urgent trip to medical help. These include: high fever with vomiting, pain, spinning sensation with loss of balance, complete loss of hearing. Not removing ear wax from ears may lead to infection.

Treatment for excessive ear wax

Ears should clean themselves without any help from fingers or cotton buds - which will often cause more problems as they may push wax further into the ear, but for those who have an excess of wax certain treatments may help.

If you feel you have a blockage in your ear it is best to visit your doctor who will use an otoscope to look in the ear(an otoscope is a medical device that allows the doctor to see deeper into your ear). This is usually a painless process. The doctor may suggest a softening agent inserted overnight to loosen the wax build up. He may need to irrigate the ear and syringe the wax out, or use a medical instrument to remove the wax.

Ear wax removal drops

A variety of topical medications are available that can be applied directly into the ear canal with the aim of softening the wax to aid natural expulsion or mechanical removal. These liquids used are typically administered in drop or spray form.

Liquids used to remove/soften wax are of several kinds:

• Oil-based compounds, which soften the wax by dissolving (for example, olive or almond oil)
• Water-based compounds, which improve water miscibility (for example, sodium bicarbonate) or just water
• A combination of the above
• Non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol

Softening agents are designed to detach and dissolve wax from the ear. They are easily purchased from your pharmacy and are simple to use. Just by adding a few drops to the ear and placing a cotton ball in the ear to prevent escape.

Choose a product with natural ingredient for sensitive, allergy prone skin. These products are designed without harsh, irritating ingredients.

Ear Cleansing Spray

Ear Cleansing Sprays are a gentle and effective way to help prevent ear wax from building up. They work with the ear’s natural cleansing process by gently washing away excess wax using a pH balanced isotonic saline solution. The design of these units prevents over insertion into the ear (unlike cotton buds and finger nails) and are easy to use; keeping the head upright, pump 3 to 5 sprays into the ear. Gently tilt the head to drain. Use 2 to 3 times a week to help prevent wax build-up.

It is always advised to seek medical advice before applying self-help products. 

References

1. Tortora Gerald J., Derrickson Bryan, 2006 Principles of Anatomy and Physiology 11th edition, John Wiley & Sons, Inc.
2. https://www.mayoclinic.org/diseases-conditions/earwax-blockage/symptoms-causes/syc-20353004
3. https://www.webmd.com/a-to-z-guides/ear-wax#1
4. https://www.huffingtonpost.com/2014/03/11/earwax-facts-didnt-know_n_4849245.html
5. https://blog.asha.org/2013/01/08/nothing-smaller-than-your-elbow-please/
6. http://audiclean.com/beta/new/Audiclean-Ear_Wax_Remover.html 
7. http://www.laboratoiredelamer.com/?lang=en
8. http://www.bmj.com/content/351/bmj.h3601 Ear wax
9. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012171/full Ear drops for the removal of ear wax