Wax Appeal

As an ENT specialist removal of impacted wax can be a very gratifying experience, as the patient goes from having difficulty hearing to completely normal hearing as soon as the offending wax has been removed.

Below is a poem penned by a patient and General Practitioner the late Dr Joe Lazarus, and given to me, that I think many will identify with.

“ SHARON WILLIAMS

My gratitude is most profound

For all your great decoking.

When they talk all around

And you can’t hear a sound

It’s really no matter for joking.

But your suction wax clearing

Has given me hearing

Each time my acoustics were flagging

I hear people swearing

And without really caring

I even hear marital nagging.

Joe Lazarus.”

Symptoms of wax impaction include deafness, tinnitus, reflex cough through stimulation of the vagus nerve, earache or fullness in the ear and occasionally vertigo.

Ear wax is a mixture of secretions from different types of glands within the external audiotory canal (ie. ear canal) and shedded squamous epithelium (skin cells), as well as dust and other foreign particles.

Skin is shed in the deep canal & works its way to the external surface, in the process it gets mixed with ”waxy” secretions produced by 2 different types of glands, ceruminous & sebaceous glands within the skin of the outer two thirds of the external auditory canal. Wax has a protective function as it contains various substances that can kill bacteria and by moving outwards towards the entrance of the ear canal it gets rid of trapped particles & cleans the ear canal. This outward movement of wax is aided by movement of the jaw & hairs in the outer part of the ear canal.

Putting any foreign body, for example cotton ear buds in the ear canal can injure the delicate skin & allow for infection to enter the skin causing a very painful outer ear infection. It is mistakenly believed that we need to clean our ears, in spite of the magnificent design of our bodies, making ear canals self-cleansing.  In the main cotton ear buds push the wax deeper into the canal & repeated use can over time impact the wax causing hearing loss, as sound waves are unable to get to the tympanic membrane (ear drum), impairing hearing.

Interestingly, genetic factors influence the consistency and composition of the wax, giving researchers a tool to track the migration of various racial groups from our distant past.

In the main persons of European and African origins produce a “wet” wax characterised by a moist, honey to dark brown coloured sticky wax. Whereas people of Asian / Eastern extract tend to produce dry, greyish, brittle wax.

Some people may secrete excessive quantities of wax predisposing them to greater wax accumulation and so may increase the risk of wax impaction, due to overloading the clearing mechanism. It is felt that this excessive wax production may be due to irritation.

The ear canal is not a straight canal, but has a bend in it, where the cartilaginous & the bony canal meet & in some individuals the ear canal can be more tortuous than normal, or it can be very narrow. Both of which will predispose to wax accumulation.

As we age, wax becomes dryer, possibly as a result of a reduction in the number and the activity of the wax producing glands. Wax impaction appears to be more common in males and it has been suggested that this may be due to the larger and coarser hairs in the external auditory canal preventing the natural dislodgement of wax, ie. trapping the wax instead.

Other ear issues that can alter the self-cleansing ability of the ear canal are bony ingrowths ie. exostosis and surgically created mastoid cavities. Wearing hearing aids or noise attenuators   tend to not allow the wax to work its way out by physically obstructing the ear canal.

Wax absorbs water (ie.is hygroscopic) and so showering or swimming, getting water into the ear canal, may result in sudden complete occlusion of the external auditory canal, if the ear canal was previously partially blocked.

As ear wax character & production, as well as reasons for the self cleansing system not working optimally are individual specific an individual specific approach to remove wax is employed.

The picture shows wax plugs from 2 individuals, one waxy & the other of a slighter drier consistency with more of a skin component. Also illustrated are various instruments that can be used to remove wax in the ENT ‘s consulting room.