Some may wonder why I'm paying homage to a topic as mundane as earwax by devoting an entire column to it. Those who have witnessed earwax (also called cerumen) being removed from an infant's ear know why.
For those still in the dark, it's a procedure the child, parents and clinicians hate.
Earwax is a natural substance made in the ear canal. Its purpose is to clean, protect and lubricate the ear canal. It should be left alone except if it causes problems due to impaction or prevents an examiner from seeing the ear drum to determine if there is an ear infection.
Impacted wax fills part of the ear canal and may cause temporary hearing loss, a sense of fullness, itching and other symptoms.
There are three safe ways of removing earwax: using drops to dissolve the wax, washing it out and manually removing it.
Several different types of drops dissolve the wax, all equally effective. I favor a product containing hydrogen peroxide such as Debrox or a generic version.
Irrigation should occur at a doctor's office, and an ear syringe is frequently used for this purpose. Home use of a waterpik may result in complications and thus is not recommended. Manual removal of wax also should be done in an office by trained personnel. A variety of methods, including cerumen spoons and suctioning, may be used to take out the earwax. Q-tips and other cotton swabs should not be used as they tend to push the wax further into the ear canal, worsening the impaction and making removal more difficult.
Folk medicine lore may still recommend ear candling (placing a burning candle next to the ear to liquefy the wax so that it runs out of the ear), but current guidelines discourage this method as dangerous and ineffective.
Earwax problems, quite common in children and adults, often run in families. Indeed, a short time ago, an earwax gene was reported to have been found. Young children seem to suffer unduly when wax is removed from their ears, because they are usually not able to cope with discomfort.
This procedure needs to be performed often, since their ear canals are small and even a little amount of wax often prevents adequate visualization of the ear structures. I often recommend parents put in earwax-dissolving drops once or twice a week in ears that tend to become impacted.
However, this is not always effective or pleasant, and children may refuse to have these drops instilled. In this case, the wax should be removed by a clinician in an office setting.
The opinions expressed are solely the writer's. Robert A. Dershewitz, M.D., Sc.M., FAAP, is a pediatrician at Healthy Kids Care Center in St. John and is affiliated with The Community Hospital in Munster.
