One week before my daughter Maureen’s 3rd birthday she started tugging at her left ear. When I tried to see into her ear, she wouldn’t let me, so the following week I asked our pediatrician to take a look. He looked into each ear with the otoscope, and then told me, “she has external otitis – an irritation of her ear canal. It needs to be cleaned out.”
As they flushed out her ear canal I was AMAZED at what came floating out: 3 balls of fuzz the exact color of our living room carpet, 2 rolled up wads of white paper, another 2 balls of carpet colored fuzz and a small white button! Her ear itched and she kept trying to relieve the itching by sticking things into it.
The medical name for earwax is cerumen, based on the Latin word cera, which means wax. But cerumen isn’t really wax, it’s a sticky liquid secreted by the cells in the skin lining your ear canal designed to protect your eardrum by trapping dirt and dust before they can irritate or damage it.
For some people, earwax just flakes away and never causes them any trouble. Then there are the REST of us. Problems with earwax are one of the most common reasons people make appointments to see their doctor. Cerumen can build up against the eardrum, causing hearing loss, ear pain and interfering with hearing aids. Trying to remove it by sticking cotton-tipped swabs or bobby pins up your ear canal only forces it further inside your ear canal, leading to pressure, pain and impaction.
If swabs can’t do it, how do you remove earwax? By softening it first. Making cerumen more pliable makes it easier to dislodge when flushing it out. Unfortunately there isn’t any consensus of what type of eardrops are most effective. A systematic review of studies done on earwax removal using several different types of eardrops showed no difference between them.
The leading product purchased in the United States for earwax is Debrox®, a 6.5% solution of carbamide peroxide. According to a 2013 OTC survey funded by US News and World Report and Pharmacy Times, 86% of American pharmacists surveyed recommend Debrox® drops to their customers.
Carbamide peroxide reacts with earwax to release oxygen, creating foam that liquefies the cerumen and helps it to be rinsed away. Like many people, when I use Debrox® I can hear crackling and popping sounds and can feel a distinct tickling sensation in my ear.
Another eardrop product that we used to recommend for earwax was Cerumenex®, which contained triethanolamine to emulsify cerumen. Introduced in 1958, it was withdrawn in 2008 due to reports of permanent hearing loss or irritation after only one application. When further investigation proved the risk was real Cerumenex® was discontinued.
Docusate sodium (Waxsol®) drops are used to soften earwax in the UK. Docusate sodium, also known as Colace® is a stool softener that pulls liquid into hard stool to make it softer, and does the same thing to impacted cerumen. Most surfactants work just like liquid detergent. If you ever taste docusate, either as a liquid or syrup, it’s like washing your mouth out with liquid dish soap. Yuk!!
In our clinic we use a two-step process: first, docusate liquid in the ear for 1-3 days, then flush with warm water. One way you can try docusate at home is to poke a hole in the end of a capsule and squeeze out its contents into your ear canal, repeating up to three times a day for one or two days. Remove your now-softened earwax by flushing GENTLY with warm water in a bulb syringe or by tipping your head up during a warm shower. Dry afterward with a hair dryer on a low setting.
If, like me, you suffer from excess cerumen, here are some DONT’s:
DON’T clean earwax from your ear canal with a cotton-tipped swab, bobby pin or rolled napkin.
DON’T use eardrops if you have ear pain, bleeding or any discharge from your ear; instead, contact your doctor.
DON’T use a Water Pik® or similar apparatus to flush out your ears.
Don’t use cold water to flush out your ears. It can cause problems with your balance.
More information is on earwax and ear care is available at www.webMD.com.
