Earwax

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Biography

Earwax , also known by the medical term cerumen , is a yellowish wax y substance secreted in the ear canal of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides some protection from bacteria , fungus|fungi , insect s and water. at the American Hearing Research Foundation. Chicago, Illinois 2008. Excess or impacted cerumen can press against the eardrum and/or occlude the external auditory canal and impair hearing (sense)|hearing .

Signs and symptoms

Excessive earwax may impede the passage of sound in the ear canal, causing conductive hearing loss . It is also estimated to be the cause of 60–80% of hearing aid faults.

Physiology

Cerumen is produced in the outer third of the cartilage|cartilaginous portion of the human ear canal. It is a mixture of viscous secretion s from sebaceous gland s and less-viscous ones from modified apocrine sweat glands . The primary components of earwax are shed layers of skin, with 60% of the earwax consisting of keratin , 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene and 6–9% cholesterol .

Fear, stress and anxiety result in increased production of earwax from the ceruminous glands.

There are two distinct genetics|genetically determined types of earwax: the wet type, which is dominant gene|dominant , and the dry type, which is recessive gene|recessive . While Asian people|Asians and Native Americans in the United States|Native Americans are more likely to have the dry type of cerumen (gray and flaky), Black people|African and White people|European people are more likely to have the wet type (honey-brown to dark-brown and moist). Cerumen type has been used by anthropology|anthropologists to track human migratory patterns, such as those of the Inuit . Wet-type earwax is more prevalent among the Ainu people|Ainu of Japan, in contrast to Japanese people. The consistency of wet type earwax is due to the higher concentration of lipid and pigment wikt:granule|granule s (50% lipid) in the substance than the dry type (30% lipid).

The difference in cerumen type has been tracked to a single base pair|base change (a single nucleotide polymorphism ) in a gene known as " ATP-binding cassette transporter genes|ATP-binding cassette C11 gene." In addition to affecting cerumen type, this mutation also reduces sweating|sweat production. The researchers conjecture that the reduction in sweat was beneficial to the ancestors of East Asians and Native Americans who are thought to have lived in cold climates.

Cleaning

Cleaning of the ear canal occurs as a result of the "conveyor belt" process of epithelium|epithelial migration, aided by jaw movement. Cells formed in the centre of the Ear drum|tympanic membrane migrate outwards from the umbo of tympanic membrane|umbo (at a rate comparable to that of fingernail growth) to the walls of the ear canal, and move towards the entrance of the ear canal. The cerumen in the canal is also carried outwards, taking with it any dirt, dust, and particulate matter that may have gathered in the canal. Jaw movement assists this process by dislodging debris attached to the walls of the ear canal, increasing the likelihood of its expulsion.

Lubrication

Lubrication prevents desiccation , itching, and burning of the skin within the ear canal (known as asteatosis ). The lubricative properties arise from the high lipid content of the sebum produced by the sebaceous glands. In wet-type cerumen at least, these lipids include cholesterol , squalene , and many long-chain fatty acid s and alcohol s.

Antimicrobial effects

While studies conducted up until the 1960s found little evidence supporting antibacterial activity for cerumen, more recent studies have found that cerumen has a bactericidal effect on some strains of bacteria. Cerumen has been found to reduce the viability of a wide range of bacteria, including Haemophilus influenzae , Staphylococcus aureus , and many variants of Escherichia coli , sometimes by as much as 99%. The growth of two fungus|fungi commonly present in otomycosis was also significantly inhibited by human cerumen. These antimicrobial properties are due principally to the presence of saturation (chemistry)|saturated fatty acids, lysozyme and, especially, to the slight acidity of cerumen ( pH typically around 6.1 in normal individuals).

Treatment

Movement of the jaw helps the ears' natural cleaning process. The American Academy of Otolaryngology discourages earwax removal unless excess earwax is causing health problems.Bryner, Jeanna. , LiveScience , 29 August 2008. Retrieved on 7 September 2008. While a number of methods of earwax removal are effective, their benefits as compared to each other is not yet determined. A number of softeners are effective; however, if this is not sufficient, the most common method of cerumen removal is syringe|syringing with warm water. A curette method is more likely to be used by otolaryngology|otolaryngologists when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. Cotton swab s, on the other hand, push most of the earwax further into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibres of the swab.

Softeners

This process is referred to as cerumenolysis and is achieved using a solution known as a cerumenolytic agent, which is introduced into the ear canal. It usually makes the wax come out, Ear Care and Wax Build Up and if it doesn't, it facilitates removal by syringing or curettage.

Commercially or commonly available cerumenolytics include:

Any of a number of types of oil

Carbamide peroxide (6.5%) and glycerine

A solution of sodium bicarbonate in water, or sodium bicarbonate B.P.C. (sodium bicarbonate and glycerine)

Cerumol ( arachis oil , turpentine and 1,2-Dichlorobenzene|dichlorobenzene )

Cerumenex ( Triethanolamine , polypeptide s and oleic acid|oleate-condensate )

Exterol, Otex (UK brand name) ( urea hydrogen peroxide and glycerine)

Docusate , a detergent, an active ingredient found in laxative s

A cerumenolytic should be used 2–3 times daily for 3–5& nbsp;days prior to the cerumen extraction.

A review of studies found that topical preparations for the treatment of earwax were better than no treatment and that there was little difference between oil based and water based preparations (including plain water).

Ear irrigation

Once the cerumen has been softened, it may be removed from the ear canal by irrigation. This may be effectively accomplished with a spray type ear washer, commonly used in the medical setting or at home, or with a bulb syringe at home. Ear syringing techniques are described in great detail by Wilson & Roeser, and Blake et al., who advise pulling the external ear up and back, and aiming the nozzle of the syringe slightly upwards and backwards so that the water flows as a cascade along the roof of the canal. The irrigation solution flows out of the canal along its floor, taking wax and debris with it. The solution used to irrigate the ear canal is usually warm water, normal saline (medicine)|saline , sodium bicarbonate solution, or a solution of water and vinegar to help prevent secondary infection.

Patients generally prefer the irrigation solution to be warmed to body temperature, as dizziness is a common side effect of ear washing or syringing with fluids that are colder or warmer than body temperature. Sharp et al. recommend 37 °C, while Blake et al. recommend using water at 38 °C, one degree above body temperature, and stress that this should be checked with a thermometer. Any other temperature may cause vertigo (medical)|vertigo , just as used when testing the caloric reflex test .

A syringe or spray type ear washer should be used to gently stream water into the ear. For children the rate and speed should be lower. After irrigating, the head is tipped to allow the water to drain. Irrigation may need to be repeated several times. If the water stream hurts, then the flow should be slower. It is better to irrigate too gently for a long period than irrigate too forcefully attempting to remove wax quickly. This procedure can be done at home in the shower using an ear irrigation syringe with a right angle tip. After the wax is removed, the ear can be dried by tipping the head and gently pulling the ear upwards to straighten the ear canal.

Curette and cotton swabs

Earwax can be removed with an ear pick /curette, which physically dislodges the earwax and scoops it out of the ear canal. In the west, use of ear picks is usually only done by health professionals; a modified curette having a safety stop to prevent deep insertion for self-use is available. Curetting earwax using an ear pick is common in East Asia . As the earwax of most East Asians is of the dry type, it is extremely easily removed by light scraping with an ear pick, as it simply falls out in large pieces or dry flakes, often on its own.

It is generally advised not to use cotton swab s (Q-Tips or cotton buds), as doing so will likely push the wax farther down the ear canal, and if used carelessly, perforate the eardrum . Abrasion of the ear canal, particularly after water has entered from swimming or bathing, can lead to ear infection. Also, the cotton head may fall off and become lodged in the ear canal. Cotton swabs should be used only to clean the external ear.

Vacuuming

Vacuuming of the ear may be done by professionals http://www.youtube.com/watch? v=EgYgHU9fwEc http://www.youtube.com/watch? v=ME0gAP_zixc or by home-vacuum kits. However, home "ear vacs" were ineffective at removing ear-wax, especially when compared to a Jobson-Horne probe.

Complications of removal

A postal survey of British general practitioners found that only 19% always performed cerumen removal themselves; many delegated the task to practice nurses, some of whom had received no instruction. It is problematic as the removal of cerumen is not without risk. Irrigation can be performed at home with proper equipment as long as the person is careful not to irrigate too hard. All other methods should only be carried out by individuals who have been sufficiently trained in the procedure.

The author Bull advised physicians: "After removal of wax, inspect thoroughly to make sure none remains. This advice might seem superfluous, but is frequently ignored." This was confirmed by Sharp et al., who, in a survey of 320 general practitioners, found that only 68% of doctors inspected the ear canal after syringing to check that the wax was removed. As a result, failure to remove the wax from the canal made up approximately 30% of the complications associated with the procedure. Other complications included otitis externa (swimmer's ear), which involves inflammation or bacterial infection of the external acoustic meatus, as well as pain , vertigo (medical)|vertigo , tinnitus , and perforation of the ear drum. Based on this study, a rate of major complications in 1/1000 ears syringed was suggested.

Claims arising from ear syringing mishaps account for about 25% of the total claims received by New Zealand 's Accident Compensation Corporation ENT Medical Misadventure Committee. While high, this is not surprising, as ear syringing is an extremely common procedure. Grossan suggested that approximately 150,000 ears are irrigated each week in the United States, and about 40,000 per week in the United Kingdom. Extrapolating from data obtained in Edinburgh, Sharp et al. place this figure much higher, estimating that approximately 7000 ears are syringed per 100,000 population per annum. In the New Zealand claims mentioned above, perforation of the tympanic membrane was by far the most common injury resulting in significant disability.

Ear candles

Ear candling , also called ear coning or thermal-auricular therapy, is an alternative medicine practice claimed to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal . According to medical researchers, it is both dangerous and ineffective. Advocates say that the dark residue that shows after the procedure is extracted earwax, proving the efficacy of the procedure. Studies have shown that in fact the same residue is left whether or not the candle (which is made of cotton fabric and beeswax and leaves a residue after burning) is inserted into an ear. The American Academy of Otolaryngology states that ear candles are not a safe option for removing ear wax, and that no controlled studies or scientific evidence support their use for ear wax removal. The Food and Drug Administration has successfully taken several regulatory actions against the sale and distribution of ear candles since 1996, including seizing ear candle products and ordering injunctions.

History

The treatment of ear wax was described by Aulus Cornelius Celsus in De Medicina in the first century:

Uses for earwax

In medieval times earwax, and other substances such as urine , were used to prepare pigment s used by scribe s to illustrate illuminated manuscript s.

The 1832 edition of the American Frugal Housewife said that "nothing was better than earwax to prevent the painful effects resulting from a wound by a nail skewer"; and also recommended earwax as a lip balm|remedy for cracked lips .

Before waxed thread was commonly available seamstresses would use their own earwax to stop the cut ends of threads from fraying.Beaudry, Mary C., Retrieved 2012-01-03

In other animals

Many types of whale s have a build-up of earwax which increases with time; the size of the deposit is sometimes the only way to determine the age of whales that do not have teeth.

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