“Never put anything smaller than your elbow in your ear!”
The Outer Ear and Canal
The outer ear is the funnel-like part of the ear you can see on the side of the head, plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass—narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax.
This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off. The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.
Should you clean your ears?
Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he been probing his ear with such things as cotton-tipped applicators (Qtips®). These objects only push the wax in deeper. Also, the skin of the ear canal and the eardrum is very thin and fragile and is easily injured.
Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears.
Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out.
Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn’t always so. If you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.
Ear wax blockage may respond to home treatments used to soften wax if there is no hole in the eardrum. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops, such as Debrox®, or Murine® Ear Drops in the ear. Some patients may run into problems with recurring wax buildup either secondary to an over production of wax, narrow ear canals, or a combination of these or other factors. In these situations regular use of ear drops may be helpful.
Common regimens include:
Debrox® or Murine® Ear Drops 5 drops in each ear at bedtime 1-2 nights per month
Mineral oil applied with an ear dropper, 5 drops in each ear at bedtime 1-2 nights per month
If using the above regimens, it is not necessary to “irrigate” or wash your ear. The drops will dissolve small amounts of wax and prevent a major accumulation or “impaction” of wax. Some over the counter ear cleaning systems have a small bulb to irrigate or wash out the ear. Patients should know that rinsing the ear canal with hydrogen peroxide (H2O2) results in oxygen bubbling off and water being left behind—wet, warm ear canals make good incubators for growth of bacteria. If you attempt to flush your ear canal to remove wax, it is recommended that you add a few tablespoons of white vinegar to the water to acidify it, and afterwards apply several drops of rubbing alcohol to wick away moisture and help dry the ear.
When should I see my doctor?
If you are uncertain whether you have a hole (perforation or puncture) in your eardrum, consult your doctor prior to trying any over-the-counter remedies. Putting eardrops or other products in your ear in the presence of an eardrum perforation may cause an infection and pain. Certainly, washing water through such a hole could start an infection. In the event that the home treatments discussed above are not satisfactory or if wax has accumulated so much that it blocks the ear canal, and hearing, your doctor may prescribe eardrops designed to soften wax, or he or she may wash or vacuum it out. Occasionally, your ENT doctor may need to remove the wax using microscopic visualization.
Other Possible Causes of Hearing Loss
Middle ear infection (otitis media)
External ear infection (otitis externa)