Summary

Ear wax blockage is a condition in which the natural wax found in our ears deposit in large quantities and block the ear canal. This leads to hearing loss and a host of other symptoms. It also increases the risk of infection and complications arising from the same. Treatment for the condition is quite simple and it heals fairly soon. In this article, we will learn more.

Introduction: What is Ear wax?

Our ears naturally produce a substance called cerumen (pronounced ‘seh-roo-men’) that looks and feels like wax; however, it is not wax. So, what exactly is this substance and why is it required?

There are two types of glands in the ear canal that together help create earwax.

• Sebaceous glands: These tiny glands attached to the hair follicles inside the ear secrete an oily, lubricating substance called sebum. Sebum lubricates the skin inside the ears and prevents them from drying out.
• Ceruminous glands: These are modified sweat-glands. They secrete antimicrobial proteins and peptides that protect the ears.

Cerumen largely contains sebum which consists of dead skin-cells, hair, keratin, alcohol esters, cholesterol, wax esters, long-chain fatty acids (both saturated and unsaturated), and squalene.

How does ear wax look like?

Ear wax is of 2 types:

• Wet: This is found in most races or communities of the world. The wax is watery which makes it easy to come out and prevents ear wax blockage.
• Dry: Certain races and communities of the world such as those from East or South East Asia have naturally dry wax. If they accumulate, they can get hard and cause ear wax blockage.

Healthy earwax comes in a wide range of colours such as light-yellow, bright-yellow, light brown, dark brown and orange. However, if you notice that the wax coming out of your ears is any of the below colours, you must rush to a doctor.

• Green: This means, there is an infection in the ear.
• Black: This means, there is ear wax blockage.
• Brown with red streaks: This means there is an injury inside the ear and if the discharge is runny (watery), it means, the eardrum has ruptured.

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Also Read: HOW DO I KNOW I HAVE HEARING LOSS?

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Functions of Ear wax

Cerumen is an important substance in the body and performs several functions.

• Firstly, it acts as a waterproof lining for your ear canal. Considering that there can be significant exposure to water while bathing, swimming or when one gets drenched in the rain, a waterproofing material is required to prevent water from getting inside the ear as that can cause infection. If water gets trapped in the ears, it can lead to infections such as Dermatitis, Otitis Media and Ear Eczema. Over time, this can lead to conductive hearing loss.
• Traps dirt and dust: In the same way, it also helps trap dirt, dust and chemicals encountered when one is outside the house, inside the house while cleaning it, and at workplaces (depending on the nature of the industry).
• Protects against bacterial and fungal infections: Like water and dust, even microbes can enter the ear and cause deadly conditions. But now that the wax is there, they get trapped in the same and eventually perish.
• Carries dead skin cells and other debris out of your ears: Like every other part of the body, the skin cells inside the ear go through regular cycles of birth and death. The dead cells (called dander) and all kinds of dirt, dust, chemicals and water tapped by the wax come out of the ear along with the wax.
• Prevents your ears from drying out: Conditions like eczema cause the ears to dry out and cause itches and rashes. Over time, it can lead to hearing loss. Ear wax prevents such a situation.

What is Ear wax blockage?

Every time we chew, yawn, talk, or work actively, some of the ear wax comes out naturally. This is nature’s mechanism to ensure wax doesn’t accumulate or build-up in the ears. However, in-spite of this, in some people, or sometimes, wax starts accumulating in the ear. It becomes hard and starts blocking the ear canal. The condition is called ‘cerumen impaction’, simply called ‘ear wax blockage’. There is hearing loss as a result, and most often, people use small objects to pry the wax out. While some of the wax may come out this way, the rest gets pushed deep inside, which worsens the problem. It can also lead to other complications.

Ear wax is a fairly common problem. At least 10% of children and 5% of adults develop this condition at least once. Also, the best part of the condition is it rarely develops in both ears at the same time. This way, the person does not suffer from total hearing loss.

Causes and Risk Factors

• Genetic: some people naturally produce more ear wax than others
• Have a lot of ear hair: this traps the wax, helping accumulate it
• The person has a misshapen or abnormal ear canal(s). This prevents the wax from draining out naturally.
• Use of hearing aids, earplugs, earphones or earbuds
• Some skin conditions like eczema
• The person tries to use cotton-swabs, pins, pens, pencils or other items into the ears to remove the wax. This only helps push the wax deeper which makes it harder to remove.
• Being over 55 years of age
• The child has some developmental issues or disabilities
• The person has naturally dry or hard ear-wax

Symptoms

• A sudden, partial and temporary hearing loss
• Ringing or buzzing sounds in the ear (condition called as tinnitus)
• A feeling of fullness in the ear as if something is inside the ear
• Nagging pain or ache in the ear that is moderate and not severe

The blocked ear-wax if not removed on time can cause infections. These manifest as:

• Severe pain in the ear
• Severe pain in the ear that does not subside
• There is some drainage from the ear
• Fever and chills
• Coughing
• Itchy ear
• Hearing loss that does not go away
• Foul smell from the ear
• Dizzy feeling

Complications

When ear wax is not carefully or correctly removed, it can cause various complications:

• External-ear infection, also called swimmer’s ear
• Perforated eardrum (hole in the eardrum)
• Infection in the middle-ear
• Permanent hearing loss due to acoustic trauma (injury to the eardrum)

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Also Read: The Many Causes of Hearing Impairment

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Diagnosis

The ENT specialist will use a special instrument called otoscope to look into the ear. The instrument has a light, and also offers a magnified view of the inside of the ear.

Treatment

Medical (at a clinic)

• Physical removal: the doctor will use a thin, pen-like tool made of metal that has a curved tip. The tool is called curette. By inserting the curette inside the ear and with the help of an otoscope, the doctor will remove the wax buildup.
• Ear irrigation: The doctor will flush some warm water, or sodium-bicarbonate, or some ear-drops inside the ear, and gently remove the wax out.
• The doctor will use a suction device to mildly suck the wax out

Home-care

• Wax softening: One can use mineral oil, baby oil or glycerine to soften the wax and allow it to come out on its own eventually. The doctor may also prescribe hydrogen-peroxide or carbamide-peroxide based ear-drops that will soften the ear wax, after which it will come out naturally over a day or two.
• After the wax softener has been used for a couple of days, one can buy an over-the-counter (OTC) bulb-type syringe. This can be filled with water at room temperature. Using this, the water can be injected into the ear, and the wax flushed out.
• OTC kits that combine ear-drops with an irrigation system help irrigate the ear and flush the wax out.

 At this juncture, its important to mention a treatment option that used to be popular in the past, and may still be around. This is the ear candle. It uses a special candle that is lit so that the heat generated will create suction or vacuum inside the ear and pull the wax out. However, the FDA has not approved the same because in trials it was found that neither was vacuum created nor the wax removed. Further the person suffered from burns in the ear and face, punctured ear-drum, bleeding, injuries from dripping beeswax that is used in the candle, and fire hazards. So, if you hear suggestions to try this method, reject them outright.

Also, one should not use cotton-swabs, pins, pens, pencils and stiff kerchiefs (that are rolled into a cone and the sharp end used to pull the wax out), as these can damage the ear-canal and ear-drum.

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