While we were being taught about ear wax in pharmacy school at the University of Technology (at that time it was known as CAST), the sophisticated students among us insisted on calling it 'woks' but our lecturer insisted on 'keeping it real' by getting us to say, 'wax' (like tax).

Ear wax (also called cerumen) is something we all have to deal with. We have often heard the advice, 'never stick anything in your ears which is smaller than your elbow' and this caution may seem extreme, since cotton-tipped swabs are safe if used correctly, that is, to clean the outer portion of the ear, as well as the exact opening of the ear canal.

Deeper swabbing is risky, because if there is excessive ear wax, deep swabbing may pack it down into the canal, leading to complete blockage. Deep swabbing may also damage the eardrum and cause infection and bleeding. Fingers, pens, hair pins and even cutlery are sometimes used to clean the ears.

Natural defence

Ear wax is a part of our body's natural defence. It cleans and moistens the ear canal and traps foreign particles including dust, sand, insects and bacteria. Ear wax is a sticky liquid secreted by the cerumen glands in the skin of the outer part of the ear canals. It is expelled naturally from the ears. As the older ear wax reaches the opening of the ear, it dries out and falls away. So usually wax migrates out of the canal all by itself and does not need our help.

Sometimes ear wax blockage develops when the excessive wax accumulates in the inner part of the ear canal and blocks the eardrum. It causes a feeling of fullness and discomfort in the ears and sometimes hearing loss. Itching, noise or ringing in the ears (tinnitus) and pain are other symptoms.

Soften the wax

When using ear drops the head should be tilted, and it may be necessary to pull the outer ear up and back, to straighten the ear canal. The tilted-head position should be maintained for about 10 minutes.

Docusate sodium (Waxsol) ear drop is a useful softener for ear wax. Softening ear wax can hasten its expulsion from the ears. A combination of chlorobutanol, para-dichlorobenzene and peanut oil (Cerumol Ear Drops) is another effective option.

Simple ear wax-softening remedies such as a few drops of olive oil, mineral oil, glycerine or almond oil may be instilled into the ear canal twice per day for four to five days. A cotton plug may be placed in the outer ear to retain the oil. None of these ear drops should be used if the eardrum is known to be perforated (has a hole in it) or if the ear is sore or inflamed.

Since the ear and eardrum are delicate and can be damaged or irritated easily by excessive ear wax and even by some ingredients in the proprietary ear drops, a medical doctor should be consulted if the above options fail to remove the blockage after using them for four to 10 days or if symptoms persist.

The ear wax may have hardened or perhaps, it is not an ear wax problem at all. The doctor will use an otoscope, an instrument that magnifies the inside of the ear to see what is happening inside the ear. He or she may also use a small curette to remove the problem wax or use a syringe filled with warm water to flush out the wax from the ears. He or she may also use a suction device to remove the wax.

Ear candling

Ear candling (an alternative procedure in which a hollow cone-shaped candle is placed in the ear canal and the wick lit and allowed to burn for a short time to remove ear wax) is hazardous and ineffective.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.