EAR WAX

EAR WAX

An existing hearing loss can be exacerbated by the presence of ear wax. Ear wax can significantly reduce the transmission of sound by blocking the ear canal, blocking the sound

from exiting the hearing aid, or causing damage to internal components of the hearing aid.

What Is Ear Wax?

Ear wax is a normal product of the ear. Ear wax is primarily composed of keratin (dead skin) with a mixture of cerumen, sweat, dust, and other debris. The amount and consistency of ear wax vary from person to person. Ear wax can vary in color from yellow to orange or reddish-brown to dark brown or almost black. It may be nearly liquid or thick, sticky or dry, or soft or hard. Wax type is genetically inherited, although the appearance of wax may vary from time to time in the same person. Cerumen type has been used by anthropologists to track human migratory patterns, such as those of the Inuit. There are two main types, wet and dry. Dry flaky wax is common in persons of Asian descent and Native Americans. Dry wax contains by weight about 20% lipid. Wet wax is common in people of Western European descent (Caucasians) and people of African descent. Wet wax can be either soft or hard, with hard wax being more likely to be impacted.

Why Do We Have Ear Wax?

Various hypotheses have been advanced as to the purpose of ear wax. It has been proposed that wax provides protection against foreign objects, assists in cleaning the ear canal, acts as a lubricant, acts as an antibacterial and antifungal agent, and promotes a healthy immune response. Debris is removed from the ear canal by a “conveyor belt” process of epithelial migration that is aided by jaw movement. Cells of the tympanic membrane migrate outward from the umbo to the walls of the ear canal. The speed of cell migration accelerates as the cells move outward to the entrance of the ear canal. The cerumen in the canal is also carried outward, taking with it any dirt, dust, and particulate matter that may have gathered in the canal.

Wax can also act as a lubricant, preventing drying and itching of the skin in the ear canal (asteatosis). In wet-type cerumen, the lubricating effect is due to the presence of cholesterol, squalene, long-chain fatty acids, and alcohols produced by the sebaceous glands. Cerumen can provide protection against some strains of bacteria.

Removal of Ear Wax

If wax is hard and impacted in the ear canal, it may cause damage to the skin as it is removed and thus should be first softened. Wax removal is often more difficult for older people because their wax tends to be drier and harder. Ear wax can be softened by applying a few drops of mineral oil, baby oil, or glycerin in the ear for several days in a row. Oil should

be administered at night time so that it can be absorbed into the wax and skin overnight. If oil is administered in the morning, the oil will likely get into the hearing aid when inserted and possibly disable the hearing aid.

SYRINGING WITH WATER

Syringing with water can be done by a client at home, by a trained audiologist, by a family doctor, or by another qualified person. Water pressure may, however, push the wax deeper into the canal (possibly touching the eardrum), whereas significant amounts of water may remain in the ear canal after syringing. When hydrogen peroxide (H2O2) is used, oxygen bubbles off, leaving water in the ear canal. A problem with wet, warm ear canals is that they make good incubators for growth of bacteria. In these instances, the ear canal may be flushed with isopropyl alcohol to displace the water and dry the skin but should be used sparingly to avoid excessive drying and itching.

PLASTIC SCOOPS

Small, flexible plastic scoops are commonly used by audiologists trained in wax removal. A good hands-free magnifier and light source are required. The basic technique is to gently scoop built-up wax from the canal. Care must be taken to minimize discomfort or trauma to the ear canal and to avoid contact with the tympanic membrane. This method is not recommended if wax is deeply impacted. Hairs in the ear canal may be embedded in the wax and can leave small amounts of blood in the canal when they are pulled out with the wax.

SUCTION

Suction is an effective way to remove wax and debris; however, there is a risk of damage to the ear canal and/or tympanic membrane. This method can be uncomfortable for the client, both physically because of the suction and acoustically because of the high SPLs. Suction should be used only by a qualified practitioner such as an otolaryngologist.

COTTON SWABS

Using cotton swabs to clean the ears is not recommended. Swabs tend to push wax deeper in the canal and may stimulate the production of more wax. Swabs irritate the skin of the ear canal and may damage the ear drum.

EAR CANDLING

Ear candling or coning is an ineffective and potentially dangerous method of cleaning the ears. A hollow candle is placed at the entrance of the ear canal and lit, supposedly sucking out ear wax. Despite many claims that ear candling is effective for wax removal, it has been proven that the substances appearing within the cone originate from the melted candle, not from the ears. The suction supposedly created by the candle’s flame is insufficient to remove wax and there is a substantial risk of burns, infection, obstruction of the ear canal, and perforation of the eardrum. Ear candling is not recommended at any time, and federal health warnings have been issued.

Cleaning Hearing Aids

Hearing aids should be cleaned regularly as a preventive measure. A thorough cleaning every 6 months is usually sufficient to reduce repairs due to wax damage. Some clients require deep cleaning of their hearing aids every month or even more frequently, whereas others may never have a problem with wax.

A vacuum chamber with a suction tip for cleaning hearing aids is essential for any hearing care practice. The vacuum chamber loosens and removes small particles of dust and wax, whereas the suction tip removes more recalcitrant debris. Care must be used when using a suction tip because the receiver can be easily damaged.

Prevention: The Use of Wax Guards Wax guards are the first line of defense against wax damage in a hearing aid. Different kinds of wax guards have been developed, including covers, metal springs, vented plastic plugs, and vented plastic baskets. One of the most effective is the vented plastic basket type, which is also the simplest for clients to change on their own. When clients cannot change the wax guard themselves, encourage them to bring their hearing aids in for regular cleaning and to change the wax guards.