Ear Wax: Good and Bad

We make ear wax, also known as cerumen. Many people are annoyed by wax buildup, but it has a purpose! Wax grabs all the dust, dirt, and other debris that gets into our ears. It also moisturizes the ear canal ~ without it our ears become itchy. It even has special properties that prevent infection. That's all good stuff, so don't be too frustrated with a little wax!

Why do we have ear wax?

Most often the wax moves from the inner part of the ear canal to the outer edge of the canal on its own.

It's amazing to me how our bodies are put together so perfectly: it is designed so the wax is made deep in the canal, then skin cells and wax migrate to the outer edge of the canal, taking with them debris!

Some people naturally make dry ear wax, others make wet wax. This can be due to genetics and other factors. The important thing to remember with this is how your wax tends to build up and how to best keep it from building up.

When is ear wax a problem?

If wax builds up it can cause pain, itching, ringing in the ear, dizziness, decreased hearing, and infection.

Inappropriate cleaning with hard and/or sharp objects (such as cotton swabs or paperclips) can increase the risk of infection or even perforation of the ear drum.

Even special cotton swabs made "safe for ears" can push wax deeper and cause a solid collection of wax plugging up the canal.

How can parents help babies and kids keep their ears clean?

Routine bathing with clean warm water allowed to run into the ear followed by a gentle wiping with a cloth is all that is needed most of the time.

No, water in the ear doesn't cause ear infections. It can contribute to swimmer's ear, but ear wax buildup also can contribute to that.

If you've been told your child makes excessive Ear wax:

Ear wax removal drops and a bulb syringe are a safer way to remove wax when needed.

Ear drops made for wax removal with carbamide peroxide can be put in the ear as long as there is no hole in the ear drum or tubes.  The oily peroxide acts to grab the wax and bubble it up. Then rinse with clean warm water and a soft cloth (see syringe tips below). If there is excessive buildup, daily use of drops for 3-5 days followed by weekly use of the drops to prevent more buildup is recommended. (For particularly stubborn wax, using drops 2-3 times/day for 3-5 days initially can help.)

Make your own solution of 1:1 warm water:vinegar and gently irrigate the ear with a clean bulb syringe.

Mineral oil or glycerin drops can be put in the ear. Let a few drops soak for a few minutes and then rinse with warm water and a soft cloth.

Occasional use of a syringe to gently irrigate the ear can help.

How to use a bulb syringe:

• First, be sure it's clean!

Fungi and bacteria can grow within the bulb ~ you don't want to irrigate the ear with those!  While they can be boiled, they are also relatively inexpensive and easily available, so frequent replacement is not a bad idea.

• Use only warm fluids

Warm the fluid to body temperature or just above body temperature.

Cold fluids may make the person dizzy and possibly nauseous!

If using drops first, put the bottle in warm water or rub it between your hands a few minutes (as if rubbing hands together to warm them, but with the bottle between the hands).

Don't overheat the fluid and risk burning the canal!

• Have the child stand in the tub or shower.

This just helps decrease the mess!

• Pull up and back gently on the outer ear to straighten out the canal.

• Aim

Aim the tip slightly up and back so the water will run along the roof of the canal and back along the floor.

Do NOT aim straight back or the water will hit the eardrum directly and can impact hearing.

• Go slow

Don't push the water too fast ~ a slow gentle irrigation will be better tolerated.

If they complain, recheck the angle and push slower.

If complaining continues, bring them to their doctor's office to let us do it to be sure there isn't more to the story. Sometimes there's an infection that makes the canal exquisitely tender and needs to be treated. And beads, rocks, and other objects have been known to sneak into ears...

• Refill the syringe and repeat as needed until the wax is removed.

• Clean and dry

Use a soft cloth to grab any wax you can see and dry the ear when done.

Some people like to use a hair dryer set on low to dry the canal. Just be sure to not burn the skin!

What if you can't get it out?

If wax continues to be a problem, we can remove it in the office with one of two methods:

Curette Method

First we inspect the ear canal carefully with an otoscope (or as I call it ~ my magic flashlight).

If wax is identified and deemed in need of removal, we can use a curette to remove the wax. A curette looks like a spoon or a loop depending on provider's preference and wax type. We place the curette behind the wax and pull it out.

This is often the fastest method in the office, but is not always possible if the wax is too flaky or impacted into the canal leaving no room for the curette to pass behind the wax.

It should only be done by trained professionals... don't attempt this at home!

Irrigation Method

If the ear wax is plugging up too much of the canal, the canal is very tender, or if the wax is particularly flaky and breaks on contact with the loop, we will let the ear soak first, then irrigate with warm water.

This process takes longer but is better tolerated by many kids and they think it is fun to "shower their ear".

We often must follow this with the curette to get the softened wax completely out.

ENT.

Sometimes I recommend having an Ear Nose and Throat specialist remove the wax.

Very narrow ear canals might require special equipment an ENT has available.

If a child has tubes in the ears, I do not attempt to remove wax. In this situation I send them to their ENT to clean them out if they think it's necessary.

My biggest tips:

• Never use cotton tipped swabs, pipe cleaners, pencils, fingernails, or anything else that is solid to clean the ear!

Note: I still don't recommend them if the package says "safe." They aren't!

• Don't put liquid in the ear canal if there is a hole in the ear drum (tubes are included in this).

Pus draining from the ear is a sign that there might be a hole.

• Ear candles are not a safe solution.

Burns are too big of a risk!

• Don't do things that cause increased pain or bleeding.

Many parents attempt to clean ears with Q-tips, ear buds, pipe cleaners, or other unsafe objects. Remember to never use anything smaller than your finger in your ear.

The ear canal is very sensitive, especially if wax buildup has been there a while and has caused an infection of the skin in the canal. Anything put into the ear can increase any pre-existing pain.

If the skin is friable from prolonged wax and/or infection there is often bleeding with cleaning. If you notice this at home, your child should have the ears evaluated in our office. We will look for holes in the ear drum, scratches on the skin in the canal, and signs of infection needing antibiotic.

• Stop cleaning regularly.

Most of the time ear wax does not cause problems, so it doesn't need to be removed.

Some people who suffer from itchy ears can help themselves by NOT cleaning their ears so much!

• Earwax usually can be left alone.

Only try to clean it out if there are signs of problems with it (ear pain, ringing in the ears, decreased hearing, etc).

If kids don't tolerate removal with the methods above, bring them in for us to take a good look. There might be more to the story that needs to be addressed.

• Bring your child in to the office to have us assess and treat if:

1. Significant ear pain persists

2. Pus or bleeding from the ear is noticed

3. You suspect something is in the ear

UPDATE:

In January of 2017, the American Academy of Otolaryngology-Head and Neck Surgery Foundation issued updated AAP-endorsed guidelines regarding wax buildup. Check out this list of Do's and Don'ts from the guidelines.