New guidelines were just released a week ago for the management of cerumen (ear wax). A panel of very respected health care providers, including ear-nose-and throat specialists, audiologists, internists, pediatricians, family practitioners, geriatricians, and nurses, was convened to look into the incidence and prevalence of ear wax, how often it becomes a problem to treat, and various methods of treatment for it.
The bottom line is that your grandmother was right – don’t put anything smaller than your elbow in your ear. For people who need something that sounds more scientific, read on!
Here is my summary of the data: [I’ve only interjected my opinion once – imagine that!]
1. About 12 million people a year in the U.S. seek medical care for impacted or excessive cerumen, leading to nearly 8 million cerumen removal procedures by health care professionals.
2. Earwax is not really a “wax” but a water-soluble mixture of secretions produced in the outer third of the ear canal, plus hair and dead skin, that serves a protective function for the ear. Cerumen is a natural product that should not be routinely removed unless it becomes impacted.
3. Cerumen impaction occurs when enough earwax accumulates to cause symptoms (pain, fullness, itching, odor, tinnitus, discharge, cough, or hearing loss), or to prevent proper medical assessment of the ear. The problem affects 1 in 10 children, 1 in 20 adults, and more than one-third of the elderly and cognitively impaired.
4. Removing cerumen from the ears is a favorite hobby of many people – who employ cotton-tipped applicators, hair pins, and other such implements. This unnecessary manipulation of the ear canal, far from ‘fixing’ this problem (that doesn’t exist), can, in fact, result in further impaction and other complications to the ear canal, such as infection, bleeding and pain.
5. Cerumen is a beneficial, self-cleaning agent, with protective, lubricating (emollient), and antibacterial properties.
6. Cerumen becomes a problem when:
a. the patient wears hearing aids because it may cause feedback, reduce sound intensity, or damage the hearing aid;
b. it blocks 80 percent or more of the ear canal diameter and may cause hearing loss.
7. Appropriate options for cerumen impaction are:
(1) cerumenolytic (wax-dissolving) agents
(2) irrigation or ear syringing, and
(3) manual removal with special instruments or a suction device, which is preferred in general, and in particular for patients with narrow ear canals, eardrum perforation or tube, or immune deficiency.
[I have to interject here. I am quite opposed to ear syringing and would not recommend it.]
8. Inappropriate or harmful interventions are cotton-tipped swabs, oral jet irrigators, and ear candling.
“Clinical Practice Guideline on Cerumen Impaction” will appear as a supplement to the September 2008 issue of Otolaryngology – Head and Neck Surgery, the peer-reviewed scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) and the American Academy of Otolaryngic Allergy. The guidelines will also be presented in a seminar during the 2008 AAO-HNSF Annual Meeting & OTO EXPO in Chicago, September 21 – 24, 2008.
Reporters wishing to receive the full text of the guidelines should contact Jessica Mikulski at 703-535-3762 or 703-657-9715, or via email at email@example.com. Beginning September 1, 2008, the guidelines will be posted on the AAO-HNS website at http://www.entnet.org.
I suspect that many ENTs would prefer to leave ear wax in, so they can sell a hearing aid. My ear canals are narrow and twisting, so it is much more to remove wax. I have been to numerous ENTs who claim that a tiny amount they removed is all the wax there was, and try to sell me an expensive set of hearing aid. But a retired doctor has told me on every occasion that the wax is still there.
Sujana S. Chandrasekhar MD
I think (and hope) that you are mistaken. Tortuous ear canals do make removal of cerumen more challenging, and make wax buildup more likely, but hearing aids are not prescribed for the small amount of hearing loss from wax. It may be that your ENTs are identifying a sensorineural hearing loss, for which they are prescribing hearing aids.