Dr Reddy: Hey guys, this is Dr. Reddy. I’m joined with Dr. Undavia and Dr. Smith. We’re a part of NJENT. Today we are going to discuss earwax, everything you want to know and maybe didn’t want to know about earwax. So first I’m gonna have Dr. Undavia start off with what is earwax?
Dr. Undavia: Earwax is… or maybe that just sounds like contention. Ear wax. It’s gross. But it is, first of all, it’s a very healthy substance. I actually couldn’t tell you what the chemical compounds is, it’s waxy stuff.
Dr. Smith: So it’s the medical term for it is cerumen that comes from the ceruminous gland, which secretes an oily substance that mixes with a sebum and it makes this waxy substance in the ear canal. You may run up the entire thing. The cerumen gland is a modified sweat gland, so it shares a lot of characteristics with the sweat gland, and it helps keep the ear canal healthy. So I tell most of my patients that the ear canal is a warm, dark environment, so it’s a setup for fungal infections, bacterial infections, and the acidity of the wax and the oiliness of the wax helps keep the skin in that warm, dark environment healthy so that it doesn’t get infected. and also helps keep that canal, that skin that’s in the canal healthy and lubricated so that it helps shed out the canal and so that the skin doesn’t build up within the canal.
Dr. Reddy: Yeah, so it has bacteriostatic properties. It’s antibacterial. It also helps hydrate your ears, like you mentioned, and it also helps keep your ears waterproof. So it’s an oily substance, so it helps keep your ears protected from water, essentially. So now we know why we produce earwax. Maybe you guys can touch on where is earwax actually produced? What part of the ear canal is it produced in? Dr. Smith?
Dr. Smith: The outermost part of the ear canal, so the hair bearing skin is only on the outer third of the canal. that part is where those cerumen or supporting glands are to help secrete oils for the hair within the canal. It becomes a problem when it either is produced in abundance and so patients start to get too much buildup and it starts to trap water and it frequents swimmers or it can cause problems with water being trapped in the ear. And sometimes I think is an even bigger problem is when you don’t produce enough of the wax within the ear canal. And so those patients tend to have dry skin within the ear, which leads to itching, which I think we talked about in the past, but these dry scalier ears without a lot of hair and oil glands can cause, I think, more symptoms and more problems down the road. Dr. Undavia, what is the arch nemesis of an ENT?
Dr. Undavia: The Q-tip. And the reason is… The Q-tip. is just a little bit wider than the canal is. And so you think you’re getting wax out because every time you put your Q-tip into the ear, you have a little bit of brown or orange or dark red on the Q-tip, but what you’ve really done is just push things in and then just got the tip of the iceberg. But this is an ear speculum. It’s a couple millimeters big and it fits into your ear nicely. And the ear canal is a little bit bigger than this, but the Q-tip is It barely goes in there. It barely goes in. So you can tell if the ear canal was tight and you put this in, often we see patients with the end of the Q-tip still stuck in the ear because they’re trying to get it out and it’s tight in there. But what you end up doing is just pushing the wax in. And the ear has its normal mechanisms to get this wax out. You might never notice that the wax comes out or you might occasionally get a little flick of wax. But when you do this, you push this right against the ear canal. and that’s when you start getting your symptoms.
Dr. Reddy: Yep, so what a lot of people don’t know is that Q-tips were never designed for use in the ears. If you actually look at the back of the label, there’s a warning that says, do not use in ears. And the reason is, is it pushes the wax past the outer third of the ear canal where wax is supposed to be, and it goes into the inner two thirds where wax is not supposed to be, which once it’s there, it’s hard for it to come out taken out from either the irrigation or a doctor like an ear, nose and throat doctor. So what should a patient do if they develop recurrent earwax impaction?
Dr. Smith: Yeah, perfect. So normally frequent cleanings can help with that. So either visiting your primary care doctor or your ear, nose and throat doctor and having the wax removed. patients will start to notice that they get water trapped in their ear, so the ear canal is a long, dark cul-de-sac and the wax starts to build up. The water will slosh back and forth between the eardrum and the wax. And so if you find yourself swimming, showering, and bathing, and kind of banging your head like that to try to get the water out, that’s typically a good sign that you’re starting to build up too much wax and the water’s sloshing back and forth. Or sometimes if you were using Q-tips, you might have sheared some of the skin backwards and that might be trapping some of the water too. So… If you’re starting to get either clogged sensation, fullness in the ears, water that you’d have to bang your head around to get out because normally you should be able to fill your ear canal up, turn your head over and it should just pour right out easily. So if you’re starting to get those, typically, yeah, getting the ears cleaned out either by a professional and you can also use over-the-counter remedies as well. Some of the peroxide solution over the counter, there’s like some… Debrox, which is like an oil-based peroxide that can be used. Some people would just use peroxide to try to get it out, which will hydrate the wax and make it a little softer and a little easier to come out naturally on its own.
Dr. Undavia: The downside of using peroxide on your own without seeing somebody is that if you do have a lot of wax, it’s going to make it a putty and sometimes you feel worse because it’s now laid right against your ear drum and then you feel almost like this has become critical. You need to see somebody fast. So that is what’s happening and it’s not an emergency, but we understand we can get you right in and clean it out.
Dr. Reddy: Yep. How about like those home irrigation kits? Do you guys ever recommend that?
Dr. Smith: Occasionally, if it’s someone who has it frequently to try to decrease the amount of wax they get. Sometimes I’ll have patients use peroxide solutions weekly or every couple of weeks or so to try to help flush some of this stuff out.
Dr. Undavia: This brings up a good point, sorry, about why some people have wax and some people don’t. Actually everybody has wax, but one of the main reasons why some people will hold more wax in their ear is just the shape of the canal. The other reason is some people might have more hair, but it’s really an anatomical thing and so it goes back to the question of whether you would tell your patient to use… an irrigator or something at home like candles and all that stuff. And the truth is in patients that have this ear wax problem, it’s typically because they have an anatomical feature holding the wax in. And so when you try and put the ear, like I would have to have the most perfect patient to use an irrigator at home where they know exactly what, which way the ear canal is, is angled. And if there’s a kink in it or not, and then have to put this irrigator in the exact right way. It’s just gonna, the water is gonna hit, or any device is just gonna hit the front wall and then bounce right back. You’re not gonna get the wax out.
Dr. Reddy: Yeah, so you touched on the anatomic reasons for potentially why some people are developing impacted earwax. The curved ear canal, the narrow canal, the hairy canal. Microscopically, there’s a conveyor belt system that your ears are supposed to have to shed. the dead skin that develops on your eardrum and your ear canal is supposed to come out to the outside of your ear and that conveyor belt system in some people for some reason just doesn’t work well. For example, in post-radiated patients, when they get radiation therapy to their ears for some type of cancer, it might be affected. And sometimes it can just happen randomly.
Dr. Smith: And a lot of times it’s caused by patient use or it can be headphones or… Um, you know, it was the silicone ear, ear plugs or ear molds to help protect from sound exposure. So people who are, uh, around a lot of noise with work or for, um, even for pleasure with music listening and things sometimes I’ll end up with plugging their own wax in just by, um, you know, instrumenting their ears with other things, not just Q-tips, but, um, and then there are like all these.Now I don’t know if you guys have seen patients coming in, but I’ll occasionally get pictures from patients with the over-the-counter carets with the little cameras on them. And some people are really good at careting their ear canals out as well. And little kids, sometimes their ear canals are really small and so their ear canals need to get careted and cleaned out. Typically we recommend speaking to your pediatrician before, or ENT before going and instrumenting and… to cleaning out.
Dr. Undavia: Well, what are the things that could happen if you didn’t do it?
Dr. Smith: Yeah, so it depends. Not everybody’s ear canal, as Dr. Undavia said, anatomically can be different. Some people have very straight, short ear canals and you can hit that ear drum very quickly. Some people have kind of long, tortuous ear canals and it’d be pretty difficult to get to the ear drum. But the main concern that we have about instrumenting the ear drum, whether it with Q-tips, because we’ve seen it with all devices, whether Q-tip or hairpins, pen caps. Those curettes, the over-the-counter curettes, we’ve seen perforations of the eardrum from all of these. And when the traumatic perforation occurs from a big blunt force trauma, it can be pretty traumatic to the eardrum and cause long-term problems with not being able to heal the eardrum, which leads to hearing loss, et cetera. So we typically don’t recommend instrumenting blindly into the ear canal. What’s the same? What should you put in your ear?
Dr. Reddy: Yes, nothing smaller than your elbow and your ears.
Dr. Smith: The three of us actually had a patient that put superglue in there. Yeah. Okay.
Dr. Reddy: Another question for you guys. Um, ear candling, does it work?
All: No, no.
Dr. Reddy: No, none of us, none of us, um, have seen any evidence and certainly there’s no scientific, uh, randomized clinical trials that shows any evidence of your candling works. Second question is, um, Does earwax color matter?
Dr. Undavia: Um, I would say in general, no, it should be a darker color. So it should be, um, orange, brown, even sometimes like really dark maroon. But if it’s lighter, like cream colored, I always just want to make sure there’s no infection or anything. But other than that, I haven’t noticed a big.
Dr. Smith: Yeah. Sometimes drainage and white debris can be an issue of fungal signs, but typically the color of the wax, whether it’s dark brown, light brown, orange. GLO doesn’t necessarily.
Dr.Reddy: I think I’m all earwaxed out at this point.
Dr. Undavia: You are your local cerumenologist.
Dr. Reddy: Well, I think that’s all we have for today’s episode. We are NJENT. You can find us on NJENT.com. Or you could give us a call at 609-710-NOES. That’s 6673. Take care. Take care, guys.