At Santa Cruz Ear, Nose and Throat Medical Group, we receive a lot of questions about how to properly care for ears and what to do about excessive earwax. What most people don’t realize, however; is that wax plays an important part in your overall hearing health!

Did you know that earwax has protective, antibacterial and lubricant properties that actually protect your ears and keep debris away from the eardrum? What’s more, inserting cotton-tipped applicators and ear cleaning or wax-removal tools can potentially push wax further down the canal, causing harm to your ear canal or eardrum. Removing earwax can also make your ear canals dry and itchy because of the natural lubrication it supplies.

Is it ever okay to clean your ears?

Wax blockage is one of the most common causes of hearing loss. But despite the wide array of over the counter wax removal tools, the American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) states: “Unfortunately, many people mistakenly believe that earwax should be routinely removed for personal hygiene. This is not so. In fact, attempting to remove earwax with cotton-tipped swabs, bobby pins, or other probing devices can result in damage to the ear including trauma, impaction of the earwax, and changes in hearing. These objects only push wax in deeper, and can block the ear canal entirely.”

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How to avoid earwax build up

Often caused by attempts to clean the ear with cotton swabs, most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage. Usually the wax accumulates, dries out, and then naturally falls out of the ear, carrying dirt and debris with it. Or it may slowly migrate to the outside where it can be wiped off.

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When should ears be cleaned?

Ideally, the ear canals should never need to be cleaned. However, that isn’t always the case. Ears should be cleaned when enough earwax builds up to create symptoms or to prevent an ear evaluation. Known as cerumen impaction, the condition can cause one or more of the following symptoms:

Pain or fullness in the ear, or plugged sensation
Mild hearing loss
Tinnitus or ringing in the ear
Itching and/or discharge
Coughing

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What is the recommended method of ear cleaning?

If your ears tend to produce a great deal of earwax, you can use a softening agent to prevent build up and impaction. Placing a few drops of mineral oil, baby oil, glycerin or over the counter drops like Debrox and Murine can soften wax by allowing it to come out on its own more easily. Or you can leave wax removal to the professionals and schedule wax removal every six to 12 months with your otolaryngologist or hearing care professional. NOTE: If you have tubes in your ears, a hole in your eardrum, diabetes, or a weakened immune system you should contact your physician before attempting to remove wax yourself.

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Swimmer’s Ear

Swimmer’s ear (known as acute otitis externa) is a painful condition resulting from inflammation or infection. When water gets trapped in the ear canal, from baths, showers, swimming or moist environments, bacteria or fungal organisms can easily spread. Because this condition often affects swimmers, it is known as swimmer’s ear. Swimmer’s ear frequently affects children and teenagers, but those with eczema (a condition that causes the skin to itch) or excess earwax are also prone to the condition. Your doctor can prescribe treatment to reduce the pain and treat the infection.

What causes swimmer’s ear?

When water is trapped in the ear canal it causes bacteria that normally occupy the skin and ear canal to multiply, causing an infection of the ear canal. Swimmer’s ear requires treatment to reduce pain and eliminate any effect it may have on hearing, as well as to prevent the spread of infection.

Additional factors that may contribute to swimmer’s ear include:

Excessive bacteria sometimes present in hot tubs or polluted water
Excessively cleaning ear canals with cotton swabs
Contact with certain chemicals (e.g. hair spray or hair dye). Putting cotton balls in your ears when using these products avoids this
Damage to the skin of the ear canal after water irrigation to remove wax
Other skin conditions affecting the ear canal (e.g. eczema or seborrhea)

What are the signs and symptoms?

The most common symptoms of swimmer’s ear are itching and pain inside the ear). Other signs and symptoms may include:

Sensation that the ear is plugged or full
Drainage
Fever
Decreased hearing
Intense pain that may spread to the neck or head
Redness and swelling of the skin around the ear
Swollen lymph nodes around the ear or in the upper neck

If left untreated, complications from swimmer’s ear may result in chronic otitis externa (continued infection) and hearing loss. However when the infection clears up, hearing usually returns to normal.

How is swimmer’s ear treated?

Treatment of swimmer’s ear includes thorough cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mild acidic solutions containing boric or acetic acid are effective for early infections.

Before using eardrops, be sure your eardrum is intact. Check with your otolaryngologist if you have ever had a perforated or punctured eardrum, or if you have had ear surgery.

For more severe infections, your doctor may prescribe an antibiotic to be applied directly to the ear. Or if the ear canal is swollen shut, a sponge or wick may be placed in the canal so the antibiotic drops can enter the swollen canal more effectively. Pain medication may also be prescribed. If you have tubes in your eardrum, a non-ototoxic (do not affect hearing) topical treatment should be used.

Follow-up appointments are important to monitor recovery, clean the ear again and to replace the ear wick as needed. With proper treatment, most infections clear up in seven to 10 days.

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Surfer’s Ear

Exostosis, commonly referred to as surfer’s ear, is the medical term for an abnormal growth of bone within the ear canal. The name is derived from the fact that the most common cause of exostosis is frequent exposure to cold water, causing the condition to affect surfers at a higher rate than the general population.

Excessive exposure to wind and cold water causes the bone surrounding the ear canal to thicken and constrict the ear canal. At times, the ear is blocked to the point “occlusion” (complete blockage) that can lead to a substantial conductive hearing loss. An exostosis growth is not limited to surfing, however; it can result from any activity that exposes you to cold, wet and windy conditions such as skiing, kayaking, sailing or diving.

Most patients are in their mid-to-late 30s when they develop an exostosis, but those with significant cold-water exposure, like surfers, can develop the condition earlier. Exostosis is not necessarily harmful, but the ear canal construction from the bony growth can trap cerumen (earwax) and other debris, which may lead to repeated ear infections.

Management

Some exostoses do not require any treatment, but once diagnosed it is a good idea to protect the ears from cold-water exposure using earplugs and/or a neoprene headband or hood. This could help slow the growth of the exostoses.

Water blockage may often be successfully managed using “Vosol” eardrops after water exposure. These displace moisture and help dry the ear canal, reducing the risk of ear canal infection. If exostoses are causing persisting problems with ear water blockage or ear infections, it is best to remove them.

Surgery

Hearing loss, pain and ear infections may become chronic and severe requiring surgery. Surgery usually requires an incision behind the ear and removing the exostoses using a drill. Water avoidance for at least eight weeks following surgery is recommended.

Preventing Exostoses

It may be possible to reduce the progression of exostoses by avoiding very cold water or wind. If you can keep your ears warm and dry when surfing there is a good chance it won’t become as bad. Custom earplugs when swimming or surfing can be very helpful. Something tailored to the ear that does not interfere much with hearing and balance is ideal.

If you’re still unsure how to properly care for your ears or you think your hearing health may be declining, schedule an appointment with one of our hearing specialists to get to the bottom of your issues!

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