Ear wax

introduction

Ear wax, lat. Cerumen, is a brownish secretion of the ceruminal glands (ear wax glands) of the external auditory canal, which protects the ear from infections by having an antibacterial and antifungal effect, i.e. against fungi. The sometimes unpleasant smell also prevents insects from entering. Ear wax is also used to remove dust and dead skin cells, facilitate the removal of foreign materials and grease the sensitive mucous membrane of the external auditory canal.

Frequent cleaning or swimming can remove the protective effect of the cerumen and prepare the ground for infections and injuries. Reduced discharge of secretion, overproduction or improper cleaning can lead to a wax plug, the so-called Obturous cerumen to lead.
The approx. 1000 substances found in ear wax include primarily greasy and moisturizing substances, as well as various antimicrobial compounds based on peptides. In humans, cerumen is found in the moist and in the dry form. The moist form has a higher proportion of unsaturated fatty acids, is yellowish to light brown in color and has an oily consistency. The dry variant is widespread in East Asia, but is very rare in Europe and Africa.

Cause of the earwax plug

When ear wax is mentioned, the clinical picture of the ear wax plug (Obturous cerumen) meant. This means the complete closure of the external auditory canal with a plug made of ear wax. In addition to overproduction and reduced outflow of the Cerumen can also promote its swelling after contact with water, for example when showering, swimming or bathing, the formation of a plug. Individual factors such as a narrowed ear canal or irritating foreign objects such as earplugs or hearing aids can also be considered.

The most common triggers of an earwax plug, however, are excessive cleaning or incorrect cleaning techniques using cotton swabs, which can lead to the wax in the external auditory canal being pushed together near the eardrum.

Earwax plug

Normally, the body carries wax out of the ear canal. If this does not work or if an excessive amount of ear wax is produced for various reasons, body secretions can become lodged in the ear canal. This can clog the external ear canal.
Similar to an earplug, an ear wax plug restricts hearing. The severity of the restriction depends on the consistency and size of the plug.
a plug in the ear can manifest itself as itching or a feeling of pressure in the affected ear. Sometimes ringing in the ears or tinnitus are described. Since ear wax has a strong odor of its own, a large plug of ear wax can also attract attention because of its odor. In addition, the affected ear can cause pain.
An earwax plug can easily be diagnosed by the doctor. For this he uses an ear speculum, for example. It is a simple funnel, the tip of which can be inserted into the ear canal and easily dilates it. The use of an otoscope is more common. This is an illuminated ear speculum on a handle. Special ear microscopes can also be used.
If an earwax plug is found, the doctor can remove it. For this he uses different aids and instruments. After removing the plug, normal hearing performance should be completely restored.

Read more on the subject at: Earwax plug

Figure ear

A - outer ear - Auris externa
B - middle ear - Auris media
C - inner ear - Auris interna

1. Ear strip - Helix
2. Counter bar - Antihelix
3. Auricle - Auricula
4. Ear corner - Tragus
5. Earlobe - Lobulus auriculae
6. External ear canal -
   Meatus acousticus externus
7. Temporal bone - Temporal bone
8. Eardrum -
   Tympanic membrane
9. Stirrups - Stapes
10. Eustachian tube (tube) -
    Tuba auditiva
11. Slug - Cochlea
12. Auditory nerve - Cochlear nerve
13. Equilibrium nerve - Vestibular nerve
14. Inner ear canal - Meatus acousticus internus
15. Enlargement (ampoule) of the posterior semicircular canal - Ampulla membranacea posterior
16. Archway - Semicircural duct
17. Anvil - Incus
18. Hammer - Malleus
19. Tympanic cavity - Cavitas tympani
    

You can find an overview of all Dr-Gumpert images at: medical illustrations

Symptoms

A typical symptom of an earwax plug is the sudden or gradual onset, usually one-sided hearing loss, which often occurs after showering or manipulation in the ear canal. Depending on the nature of the wax plug, pain can also occur. Especially dry and therefore hardened Cerumen can damage the sensitive mucous membrane of the external auditory canals and lead to cracks that sometimes bleed. Small injuries also provide an ideal entry point for bacteria. There is a risk of inflammation of the external auditory canal (External otitis), which is characterized by increased pain and discharge from the affected ear.

Ear wax stinks - what's behind it?

Ear wax has a typical, unpleasant odor. This is supposed to serve as protection against insects or bacteria. The antibodies it contains, as well as the different fats, contribute significantly to the inherent odor of ear wax.
However, if the odor of the ear wax changes, caution is advised. The cause can be, for example, an infection of the ear canal. A doctor's visit is recommended.

diagnosis

For any type of hearing loss, the audiologist will various tests to find out the origin of the fault. In order to be able to differentiate between disturbed sound conduction and a disease of the sound-processing organs, there are various options Tuning fork tests at. In the case of the ear wax plug, it is based on impaired sound conduction, which can be eliminated with simple means. To do this, the doctor must use optical technology (otoscope) Ear canal inspect to find the suspected plug. The tuning fork tests as well as the subsequent examination of the ear canal are painless processes.

therapy

To restore full hearing, it is sufficient to remove excess ear wax from the external ear canal. In mild cases it is sufficient to rinse the affected ear repeatedly with body warm water.

If this does not remove the plug, so-called keratolytic ear drops can be used. These are drugs that have a horn-loosening effect and are used to loosen the upper horny layer of the skin. In ear medicine, they offer themselves to attack the detached skin flakes and other substances trapped in the ear wax plug and that Cerumen thereby making it softer and easier to wash out.

If all attempts to clean the ear canal by dissolving and washing out the ear wax fail, the doctor must try to remove the plug mechanically. This is done under optical control, which is ensured with the otoscope. A small probe, usually in the shape of a spoon or with a small metal loop, is inserted through an ear funnel placed on the external auditory canal and the plug is carefully mobilized and scraped off. Since the mucous membrane of the external auditory canal is very sensitively innervated and well supplied with blood, this can lead to pain and slight bleeding. However, the procedure is very well tolerated by most patients and can be performed without anesthetic measures.

If the wax is very soft or the mechanical evacuation is incomplete, the external auditory canal can also be suctioned with a special suction device.

Read more on the topic: Loosen earwax

How to remove ear wax

Ear wax cleans and protects the ear canals. The wax produced is continuously transported out of the ear canal. One of the reasons for this is the movement of the nearby temporomandibular joint when speaking or chewing. For various reasons, however, ear wax can build up and the ear canal clogged.
If this is the case, manual cleaning of the ear canal may be necessary.
Cleaning with cotton swabs is now generally not recommended because the risk of injury is too great. In addition, the wax is often pressed into the ear, which can create a massive plug. Therefore, a careful cleaning of the auricle with a damp cloth is usually recommended. However, this should not be pressed into the ear canal either. The back of the auricle should not be forgotten.
Careful rinsing of the ear canal helps against stubborn ear wax inside the ear canal. The water should be at body temperature. If it is too warm or too cold, dizziness can occur. For example, if you carefully put the water into the ear canal with a syringe, the wax will usually liquefy. Now it can come out of the ear and be wiped off. After that, the ear should be dried thoroughly. Ear drops that can be sold without a prescription work in a similar way.
In some cases, however, this is not enough. Then a visit to the doctor is recommended. The doctor has several methods to choose from to remove the wax from the ear. These include rinsing, suction or the use of a fine chopping technique. In addition, he often first inspects the ear to rule out diseases of the ear as the cause of the blockage.

Read more on the topic: Remove ear wax

Can you also suck off ear wax?

The suction of ear wax is done with special devices.
The devices available for sale differ greatly from professional devices such as those used by ENT doctors. Their cleansing effect is often no greater than that of properly carried out ear washing. Ear wax performs many important roles. This includes cleaning the ear canal and protecting it from infections or insects. Therefore, regular suctioning of the ears only makes sense in exceptional cases. A doctor can easily determine whether regular suctioning is necessary. In such a case, regular visits to the doctor to clean your ears are usually sufficient.

Ear spray to dissolve ear wax

There are numerous ear sprays available on the market that promise gentle cleaning of the external auditory canal without cotton swabs, either based on oil or sea salt and by adding certain (keratolytic-horn-dissolving) active ingredients that are intended to dissolve the wax.
The sprays are usually delivered in a pressure container and sprayed into the ear via an applicator. Loosened components of the ear wax can be removed after a short exposure time on the auricle with a damp washcloth. It should be said that, as already mentioned, the ear canal does not require regular cleaning.
If used too often, ear sprays can also lose the protective wax layer and spread of infections. If there are already hearing impairments or even pain from an ear wax plug, ear sprays are no substitute for consulting a doctor and professional cleaning of the ear canal.

Home remedies for earwax

There are a wide range of home remedies available for cleaning your ears. Some of them differ greatly in terms of their effectiveness, meaningfulness and security.
The ear irrigation is a proven and safe means of cleaning the ear canal. Sometimes it is recommended to do it with the addition of different oils. This has been tested for olive oil in clinical studies. No clear advantage over body temperature water could be determined. It has not yet been proven whether other oils work better.
Another way to clean the ear is by using an ear candle. These are thin, hollow candles that are inserted into the ear canal and then ignited. It is not recommended to use them to clean the ear canals. On the one hand, the cleaning effect is proven to be low and, on the other hand, there is a risk of injury to the face and ears, especially if used improperly. The American Food and Drug Administration even expressly warns against their use.

Ear candle

The ear candle is a funnel-shaped, inside hollow tube made of beeswax, which, depending on the manufacturer, is mixed with essential oils or plant components. With the user lying on the side, the thin end of the ear candle should be inserted into the external auditory canal without pressure and lit at the upper end. The negative pressure created by the combustion effect at the lower end and the warm air rising in the tube due to the slight chimney effect are said to have a cleansing effect on the ear and also to promote pressure regulation in the inner ear and sinuses.
The ear candle is said to have a relaxing effect due to the mild warmth and the crackling that occurs as it burns down. However, the assumption that ear candles can help gently clean the ear is wrong. Neither the suction effect at the lower end of the candle nor the chimney effect inside are sufficient to rid the outer ear canal of earwax. On the contrary: models without a built-in filter can even contribute to the closure of the ear canal by dripping off the wax. It can also injure the ear canal or face. Due to the risk of injury and the low benefit of ear candles compared to other methods, it is better to refrain from using candles.

Read more on the topic: Ear candle

forecast

After the ear wax has been professionally removed, a complete restoration of the original hearing can usually be expected. Occasionally it happens to minor, painful injuries to the mucous membranewhich as a rule, however, do not require any further treatment.

Often the clogging of the ear canal by ear wax is one regularly recurring problem. Unfavorable nature of the Cerumen, an unfavorable anatomical course of the outer parts of the auditory canal or an insufficient self-cleaning function of the ear are possible causes as well as improper manipulation.

A doctor should clean the ear if an ear wax plug occurs due to the risk of injury. With excessive cleaning it can also permanent itching or Infections come.

prophylaxis

Regular cleaning of the ear canal is usually not necessary. Since the ear wax, as already mentioned, represents a natural barrier against the infestation of bacteria and fungi, routine cleaning is not advisable.

How can I prevent overproduction?

Excessive ear wax production can be very troublesome. It often occurs in adolescents during puberty. The causes are not fully understood and seem to have the changed hormone balance as the cause. These changes affect sebum and sweat glands all over the body. They are natural and harmless.
Another reason for excessive wax production seems to be stress or anxiety. Ear wax is produced by special glands that are very similar to human sweat glands. In stressful situations, there is increased sweat production in order to cool the body adequately even during great exertion. In addition, the ear wax-producing glands are also increasingly addressed.
Irritation of the ear canal through, for example, ear plugs or incorrectly cleaning the ear canals with cotton swabs can stimulate the production of wax.
The amount of wax production also seems to be genetically determined. It differs from person to person similarly in the amount of sweat produced.
If the earwax produced is no longer removed sufficiently, the appearance of overproduction can arise. The causes for this are manifold. These include narrowing or obstruction of the ear canal for various reasons. This should be examined by a doctor.

What can I tell from the color of the wax?

Ear wax comes in many different shades. Both yellowish and orange-colored earwax are possible, as well as many shades of brown up to black.
Dark earwax seems to arise mainly when there is a lot of sweat production. Genetically, humans produce either dry or moist ear wax. The absolute majority of Europeans produce the wet type. In contrast, the dry type is found especially in East Asia. This is whitier and firmer. The main indication of damage is blood that has been added to the ear wax. If large amounts of fluid flow out of the ear, it may not only be ear wax, but also, for example, pus. In this case, a doctor should be consulted.

Ear wax in babies and children

Ear wax is a common problem in babies and children. Basically, however, it also fulfills the same tasks for the little ones as it does in adulthood. It represents an important barrier against any kind of infection of the external auditory canal and ensures that it is kept moist and self-cleaning. Excess production and impaired self-cleaning can also lead to the formation of a wax plug in babies and children.

Close observation and age-appropriate questioning of the child can provide information about the type of impairment. Older children usually complain of a loss of normal hearing on one side, a feeling of pressure, pain or itching, and less often even ringing in the ears.

In babies, if the excess ear wax is not already visible at the exit of the external auditory canal, attention should be paid to signs of abnormal sensations in one ear. Too much wax is never the cause of a fever, infection or trouble falling asleep. Under no circumstances should parents try to clean their baby's or child's ears themselves without medical advice. Cotton swabs intended for use by adults are forbidden, as they pose a risk of injury to the child's ear if improperly used.

After carefully inspecting the affected ear, the doctor will decide to gently remove the wax using keratolytic (horn-loosening) drops and gently rinsing it out with warm water.

Painful measures such as scraping the external auditory canal with spoons or snare tools are not recommended for babies and children due to their lack of willingness to cooperate.

If necessary, the treatment with drops and the subsequent rinsing of the ear canal must be repeated. The doctor can train parents of affected children in the application of the measures for home use. Even in infancy or childhood, however, the healthy ear does not need regular cleaning and complications can arise from excessive or improper irrigation.

Read more on the topic: Removal of wax from the baby