New guidelines for dealing with earwax

Sep 2 2008

Ear Nose and Throat (ENT) specialists in the U.S. have come up with new guidelines for dealing with earwax.

They say around 12 million Americans each year visit a doctor for the removal of earwax and according to the the American Academy of Otolaryngology (AAO) for this reason practical clinical guidelines are needed so doctors understand the harm versus the benefit of such procedures.

Earwax or cerumen is a naturally occurring substance produced in the outer third of the ear canal.

It is not really a "wax" but a water-soluble mixture of secretions including hair and dead skin, that provides protection for the ear and unless it has become impacted, it should not be routinely removed unless the ear needs to be assessed for some reason.

When it does become impacted it can cause symptoms including pain, fullness, itching, odour, tinnitus, discharge, cough and hearing loss.

The problem affects 1 in 10 children, 1 in 20 adults, and more than one-third of the elderly and cognitively impaired.

Dr. Peter Roland, Chair of the Cerumen Impaction Guideline Panel, says unfortunately many people feel the need to manually 'remove' cerumen from the ears and this can result in further impaction and other complications to the ear canal.

Normally excessive earwax migrates out of the ear canal automatically, helped by the motion of the jaw as in chewing, and carries along with it dirt, dust and other small particles in the ear canal.

Recognizing that patients may seek care from many different types of health care providers, the guidelines are intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction.

Key features of the new guidelines are that:-

• Cerumen is a beneficial, self-cleaning agent, with protective, lubricating, and antibacterial properties.

• Doctors should examine patients with hearing aids for impacted earwax because it may cause feedback, reduce sound intensity, or damage the hearing aid.

• Earwax may cause reversible hearing loss when it blocks 80% or more of the ear canal diameter.

• When it comes to removing impacted earwax wax-dissolving agents including water, saline, and other agents of comparable efficacy, should be used to irrigate or syringe the ear 15-30 minutes prior to the manual removal of the wax with special instruments or a suction device.

• Cotton-tipped swabs, oral jet irrigators, and ear candling are say the guidelines, inappropriate and potentially harmful interventions and inserting cotton-tipped swabs or other objects in the ear canal is strongly advised against.

Dr. Roland says those at high risk such as hearing aid users, should consider seeing a doctor every 6-12 months for routine cleaning as the complications from impacted earwax can be painful and ongoing, including infections and hearing loss.

Dr. Roland hopes the new guidelines will give doctors the tools they need to spot an issue early and avoid serious outcomes.

The guidelines were created by a multidisciplinary panel of clinicians representing the fields of otolaryngology, audiology, family medicine, geriatrics, internal medicine, nursing, and pediatrics.