Cerumen is produced in glands that are located in the outer third of the ear canal. The wax helps to protect the ear canal from infection as it is slightly acidic and decreases bacterial and fungal growth. There is a natural mechanism that allows old skin and wax to migrate out of the ear. This often doesn’t succeed and the result is wax buildup.

Most ear cleaning systems rely on flushing out the ear, attempts to dissolve the wax or mechanically remove the wax. Ear buds have been on the market for years and are used to mechanically remove the wax by sweeping the bud around the inner surface of the canal. The problem is that the process is done blindly and can result in serious damage to the ear drum and middle ear structures, or by abrading the canal skin, lead to infection. There have been fatalities and deafness from their use. The most common problem with ear buds is that they tend to push the wax even further into the ear canal, resulting in wax impaction.

Another common way to clean the ear is by syringing. This is usually done in the doctor’s surgery and requires the use of a large syringe which flushes water into the ear canal and the water hits the ear drum and washes back out over the canal taking the wax with it. This too can lead to serious damage to the ear canal, ear drum and middle ear structures and can result in temporary or permanent hearing loss. It also requires a visit to the doctor’s surgery at a cost to the healthcare system. Patients often find it uncomfortable and if the water is too cold, it can result in dizziness.

There are other products on the market that attempt to dissolve the wax by placing drops in the ears and flushing them out after a short interval of time. Most of these have been shown to be no more effective than a placebo.

Ear candling has become popular in recent years, and involves a special cone shaped candle which is placed in the ear, and the outer end lit. It is supposed to draw the ear wax out. Although the patients claim it feels good, studies show that the technique is totally useless at removing the wax. The candlers open up the residual candle showing off wax inside, but the candle, when burned in the air, has the same build-up. There have also been reports of facial burns from candling.

Prevention is better than cure
Management of ear wax has been for the most part, control of the situation when it has become a problem. Removal of the wax plug is done when the build-up has caused a hearing loss or infection. What is needed is a way to control ear wax build-up on an ongoing basis.

As prevention is preferable, a system that allows for the safe and effective bathing of the external canal skin, in particular the outer third where the wax is produced, would seem beneficial. It would be necessary to protect the eardrum from not only the device, but from the force of the fluid entering the ear. This would add greatly to the customers comfort. To control the wax, the product would have to be used on a regular basis (one to three times per week) to stay ahead of cerumen buildup.

 By being proactive, and available over the counter, ear wax control would become the responsibility of the customer and would be done in a controlled and safe manner. This would help to reduce healthcare costs in an already struggling economy.

Dealing with ear wax is a problem faced by a large sector of the population. There are also those that have minimal problems, but are concerned with maintaining clean ears. The aforementioned products are aimed at these individuals. Some of the products can result in the worsening of the problem, and others are not useful until a build-up has occurred. Some have no benefit at all.

At risk groups
As the population ages, people using hearing aids will increase in numbers. Hearing aids themselves can increase the risk of wax build-up by impeding the normal migration of the wax and dead skin out of the ear canal. Wax build-up can result in impaired hearing aid performance by blocking the sound transmission directly, but also by getting into the hearing aid molds. Once the mold is blocked, the hearing aid is non functional until the wax can be removed. Hearing aids are a costly yet necessary tool for people with hearing loss. Having a hearing aid rendered useless by ear wax will affect one’s ability to communicate and participate in most daily activities. It is imperative, therefore, for this population to keep wax build-up under control. Again, being proactive and preventing wax accumulation is superior to treating the wax problem once blockage has occurred.

Another group that has issues with wax buildup are workers that are exposed to excessive noise. Ear plugs that are inserted into the ear canal can block wax migration, and push the wax deeper into the ear canal. Regular cleaning of the ear canal would lessen the risk of hearing loss from excess wax.

Overall, our society has become more conscious about hygiene. Many products are available for most areas of the body in an attempt to provide a sense of cleanliness. Products exist to clean ears once they are clogged, but to date there has been little on the market to allow for the prevention of wax buildup. A safe, user friendly device, that when used on a regular basis, washes out the wax as it is produced, would go a long way in filling that void.

Dr John MacRae
Chief of Otolaryngology at
Joseph Brant Hospital, Ontario,
Canada