Ear Care

Problems attributed to the accumulation of wax are one of the most common reasons for people to visit their doctor with ear trouble. Ear wax removal is the most common ear care procedure performed in primary care. In 1990 the average GP carried this out almost twice a week, nowadays in the United Kingdom the procedure is usually performed by qualified nursing staff. People presenting with excessive wax in the ears therefore take up a significant proportion of GPs’ /practice nurses consultation time and as a consequence of this and new government legislation fewer general practices offer this service. It is perhaps a wiser route to visit a specialist ear care clinic to have your ears examined and the wax removed.

Prior to visiting the doctor or the ear care clinic some practitioners advise to dose your ears with two shots of Earol Olive Oil Spray in the morning and evening for the 5 days before your visit. This is expected to soften/lubricate any compacted ear wax by the time you visit the nurse and may help the wax to be removed more easily, thus enabling the nurse to clear and examine your ears successfully in one visit.

Earwax is produced at the entrance of the external ear canal. The ear canal is divided into two parts, the outer two-thirds which is cartilage and the inner one-third which is bony. The skin lining the inner part is only 0.1 mm thick and is tightly attached to the underlying bone and membrane structure . The skin lining the outer two-thirds of the canal is 10 to 15 times thicker and contains hair follicles, ceruminous and sebaceous glands which open into these hair follicles. These glands produce two substances, sweat and sebum (an oil substance). Earwax is a mixture of the secretion of these two types of glands. Dead skin deposits are also common when the skin of the ear canal renews itself. This process also loosens hairs which also forms a component of the ear wax.

If you feel that you have excessive ear wax, you should in the first instance make an appointment with your local specialist ear care clinic, general practice or audiologist. Using the Earol spray prior to this appointment as per the patient information leaflet will help to soften any compacted wax and potentially dislodge the wax deposits. There is some evidence to suggest that Earol will soften and lubricate lubricate compacted wax within a very short time period and as such the practitioner may use the Earol spray at the clinic immediately prior to earwax removal or ear examination. It is recommended by healthcare professionals and leading audiology companies alike that a once a week dose of Earol olive oil spray for the people who produce harder drier earwax , or have irritable dry skin in the ear canal will help prevent the problem. It is expected that the earwax will then be maintained in a softer state enabling it to function better.

A common cause of excessive wax accumulation remains misguided attempts to remove wax with such instruments as cotton buds/sticks, needles and hair pins which, besides traumatising the skin, often contribute to and can impair the cleansing mechanism of the ear canal and impact the earwax deep into the ear canal. Ear wax is thus a normal secretion which becomes a problem in certain circumstances.

Earwax contains various enzymes, and lipids which create a slightly protective, effect by helping to maintain an acidic condition in the external ear canal whilst also lubricating and protecting the ear canal. Normally the wax, dust and dirt move in an external direction, the movement of the jaw contributing to this movement. The wax then passes on to the skin of the outer ear, where it is washed away during normal hygiene, having achieved its aim of removing dust and destroying bacteria and fungi. This self-cleaning mechanism sometimes fails, however, causing retention of wax which often leads to the wax drying and building-up in the ear canal.

Earwax excess and potentially compaction is a more common problem in elderly people because as a person ages the glands producing the earwax become less responsive, increasing the tendency of the wax to become drier. This may lead to wax build-up. Recent surveys examining the prevalence of excess wax, suggest that the problem it is higher in men than in women, in the elderly than in the young, and in people with intellectual impairment. Other factors that prevent the normal expulsion of wax from the ear canal (e.g. wearing a hearing aid, or using cotton buds) can further increase the chance of ear wax accumulating, while people with narrow or deformed ear canals or skin (disease) disorders of the ear canal skin or scalp are also susceptible to wax build-up. All these factors show that the development of an ear canal totally blocked by a wax plug is not always associated with personal hygiene.

A common cause of excessive wax accumulation remains misguided attempts to remove wax with such instruments as cotton swabs, needles and hair pins which, besides traumatising the skin, often contribute to and can impair the cleansing mechanism. Ear wax is thus a normal secretion which becomes a problem in certain circumstances and ears require regular care to prevent the occurrence of ear problems, in the same way as personal care is provided for teeth and eyes.

The accumulation of wax has several further reaching consequences over and above hearing impairment:

• It can interfere with the nurses’/doctors’ view of the ear drum during examination leading to you having to make a further appointment when the wax has been removed.
• It can cause a conductive hearing loss and hence may interfere with a formal hearing assessment. This again causes you to have a further appointment when the wax has been removed.
• If the earwax is so deep in the ear canal that it becomes in contact with the ear drum, it can cause discomfort, tinnitus, pain, possibly an irritable cough and occasionally vertigo.
• If water gets trapped behind the excess earwax during normal showering, bathing or swimming, it can contribute to infection.

This schematic gives a good representation of the outer and middle ear, plus shows where wax can build up.

Irrigating the ear with water will usually clear previously compacted plugs of earwax that have been softened by Earol® Olive Oil Spray. But, it often only works if the plug of earwax has been softened by using Earol®. Therefore, Earol® to soften wax 2-3 times a day for 3-5 days prior to irrigation. Ear irrigation is usually painless. Lukewarm water is squirted into the ear canal. This is usually done by a machine that squirts water at the right pressure. This dislodges the softened plug which then falls out with the water.

Note: the old-fashioned big ear syringes have largely been replaced by modern irrigation machines. This is because the machines can deliver the squirt of water at the correct pressure. There is no risk of there being too much pressure applied which may harm (a problem with the old-fashioned syringes).

Some people feel dizzy after ear irrigation, but this quickly settles. Some people develop an inflammation in the ear canal following ear irrigation. This causes itch and discomfort, but can be treated with ear drops. Rarely, ear irrigation can cause damage to the ear or eardrum.

Therefore, see a doctor or nurse after ear irrigation if you develop any ear pain, troublesome itch in the ear, discharge from the ear, or swelling of the tissues around the ear canal (which may indicate infection).

Your healthcare audiologist, nurse or doctor may recommend that you use Earol® once a week after the procedure as a preventative measure.

Your nurse, doctor or audiologist may look into your ear using a specialised device called an otoscope. This is simply a specially designed viewing device. The picture below gives a good schematic of what the otoscope does;

This is a view of wax through an otoscope.

Some people are troubled by repeated build-up of earwax and require ear irrigation every so often. In this situation, to prevent earwax building up and forming a plug, some doctors recommend using Earol® olive oil spray once on a weekly or fortnightly basis. At this moment there is no clear guidance on frequency of use to manage the ear wax as different people have different rates of production, however, if you are troubled by regular plugs of earwax, you may wish Earol® on a regular basis to see if this prevents the problem.