KidsAudiologist

Wax

Posted on: April 29, 2012

Ear wax is good stuff. Really!

Wax protects the delicate skin of the ear canal, contains antibacterial agents that help prevent infection, and is sticky catching dirt and dust. The colour and consistency of wax varies greatly between people – from thin and yellow to thick and dark red. Some people make loads of wax and others hardly any. Wax is the ears self-cleaning mechanism – since it’s only made in the outer third of the ear canal (nearest the entrance) and as the skin of the ear canal grows outwards it brings the old wax and it’s collected debris with it. Clever huh?!

So you really can just leave wax alone and abide by the old saying “never put anything in your ears smaller than your elbow”. If you are regularly seeing wax this is a good sign because it means it is moving out of the ear as it should. You can then wipe it away with the corner of a flannel or similar.

When ear wax is a problem

For most people wax is not a problem and should be left alone. For all those who have ever been nagged about not cleaning their ears by me I can only apologise – but only about the nagging, not the message – but audiologists and ENT doctors only nag because we are the ones who regularly see the results of self-cleaning. Wax will only cause a hearing problem if it is pushed down inside the ear, blocks the ear canal completely or becomes impacted. So please never try to remove wax yourself as putting anything into the ear (such as cotton bud, hair grips, paper clips, Hopi ear candles) will push the wax deeper where it shouldn’t be, risk hearing loss and injury.

Wax and hearing aids

Wearers of hearing aids do sometimes find they have a problem with wax build-up in their ears. This is because the use of earmoulds all day every day prevents wax from leaving the ear as it would normally. A build up of wax next to the ear mould will mean the child won’t hear as well as they should with their hearing aid and can cause the hearing aid to feedback causing an annoying whistling noise. It also makes it impossible to take good impressions for new earmoulds (or at worst can cause injury to the ear if we attempt to take impressions with lots of wax present). The problem is often worse for very young children and those with very small ear canals.

From a diagnostic point of view your GP, audiologist, or ENT doctor will also need to have any build-up of wax removed to be able to get an accurate hearing test and a good look at your eardrums and find out what is happening behind the wax in your ears, particularly if there is a chance of infection. Since the majority of audiologists aren’t trained to remove wax they rely on the GP or ENT doctor having done this before referral so that the poor patient isn’t sent straight back again.

Wax removal for children

There are 3 main ways to remove wax from the ears – syringing (using water), microsuction (using a tiny hoover to suck out the wax), and by manually picking it out with a probe. Which method used will depend on the age and development of the child as well as the equipment available and skills of the professional you see. Syringing can be carried out on children as long as the child has no contraindications which includes perforation (hole) of the eardrum now or in the past, ear infection, grommets in place, history of ear surgery, or young children who are uncooperative with the procedure. This means that for many children microsuction is usually the easiest and safest method. Microsuction involves lying still on a couch and having the wax ‘hoovered’ out the the ear with a tiny sucker. It is very noisy and can be a scary experience for children who have had their hearing aids taken out and can’t be reassured verbally, so it’s important to explain it fully to the child beforehand, but it it shouldn’t be uncomfortable or painful.

Your audiologist or ENT doctor may recommend using drops for a couple of weeks before appointments to soften any wax build-up to make it easier to remove. There is no evidence that one type of drop works better than another but medicinal olive oil ear drops are very gentle and safe for all ages. Warm a couple of drops in the palm of your hand before use. Put into the child’s ear at night after their hearing aid is out for the day. Often this is easiest to do with them lying and you can alternate the side each night putting the drops into the ear facing up. Do not use any eardrops if the child has a perforated eardrum (hole in the eardrum) or has grommets in their ears without advice from an ENT doctor.

Further reading

Five of the best… eardrops Daily Mail article featuring advice from John Graham, consultant surgeon at the Royal National Throat, Nose and Ear Hospital in London

NHS Evidence Clinical Knowledge Summaries – Earwax

Best Practice Statement; Ear Care, NHS Quality Improvement Scotland, 2006

Guidance Document in Ear Care, The Primary Ear Care Centre / Action on ENT, 2008 

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2 Responses to "Wax"

My son is nearly 4 and moderately deaf in both ears. One of his hearing aids has been whistling a lot and he doesn’t seem to be able to hear me as well as he usually does. He has had a cold and I think the problem is wax again (we had the same problem earlier in the year). Are ear drops likely to work or will we need a trip to ENT to have the wax suctioned again? I’m not even sure they’ll give us an appointment for that – last time just happened to coincide with a routine appointment.

When a child wears hearing aids wax doesn’t naturally clear out of the ear as it would usually. Drops can help soften the wax but because he has an earmould in there all the time it’s unlikely it will actually solve the problem. Some audiologists are trained to remove wax and in some other places audiology and ENT clinics have an arrangement where children can get wax cleared quickly during a routine appointment. After all, it wastes everyone’s time – the family and professionals – if they can’t see into the ears, take earmoulds, or complete testing during their appointment just because of some wax. Ask your clinic what the arrangements are – they may book you in for wax removal 10 minutes before your audiology appointment.

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