Unnecessarily Detailed Information About Earwax and Ear Cleaning
Right now, I am laying on my floor in my pink, Turkish towel bathrobe. I am curled up on my side and in my ear is a not-quite-painful-but-oh-shit-definitely-not-comfortable bubbling sensation. I think it takes me longer to psych myself up to pour hydrogen peroxide in my ear than it does for me to jump off a cliff into a river. (Which honestly is probably not a big shocker, since rivers are, you know… fun.) But damnit, I want to hear out of my right ear again!
Mammals produce earwax (known among the fancier people as cerumen) in the outer cartilaginous section of the ear canal. It is composed mostly of hunks of dead skin and secretions by the sebaceous glands, coming out to about 60% keratin. Unsaturated fatty acids, various alcohols, squalene, and cholesterol make up the rest. Because the auditory canal is a messy maze, gunk and shedding skin would just hang out in the ear canal forever if earwax wasn’t there to push it out. The earwax cleans the canal and keeps it lubricated.
In theory, your ears ought to be self-cleaning. Indeed, earwax is a natural part of your body’s “get this shit out of my ear” process. However, my guinea pigs are also supposedly self-cleaning, and they have a remarkable propensity to pee on themselves. Analogously, my ears like to fill to the brim and trigger unnecessary hearing impairment. Fuck you, ears.
Lest you think I am just particularly disgusting, earwax-related issues cause a need for specific management in about up to 6% of the population. It can even interfere with medical care for individuals with health issues like diabetes or compromised immune systems. Occasionally, it may even require surgery to correct. Given the sheer number of people who don’t trust their ears to clean their damn selves (I speculate that most of us have had a plugged up ear or two), it would seem that someone might have been able to figure out how we’re supposed to take care of the problem.
Unfortunately, that is not that case. People have been trying to figure out how to get this gunk out of our heads for centuries. Documents of baffled physicians trying to clean their ears date back to the 1700s. Still, even today, peer reviewed literature reviews on the subject do all but throw their hands in the air and say, “We have no idea”. (They said it more eloquently: “Despite excessive and impacted cerumen being common, the literature review presented in this paper suggests that its physiology, clinical significance and management implications remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments. The dearth of rigorous evidence negates any attempt at systematically assessing optimal management strategies, our original intention when planning this review. Indeed, the lack of rigorous evidence precluded a formal systematic review in any of the areas covered.”)
In primary care, there are two ways that earwax is removed from the ear. Curettage, which involves using a little plastic scooper to scrape out the wax, and irrigation, which involves using a syringe-like tool to pour in water and flush out the wax. However, those do involve tracking down a doctor… and neither method is ideal. (When the rare complication does arise, it can be pretty unfortunate.) Alternatively, you can buy earwax softeners and sort of hope that that will fix the problem. Unfortunately, with no well-designed, double-blind studies to test the efficacy of earwax softeners, it’s sort of a crapshoot to bother with them. Even of the crappy studies that exist, most of them tested the softeners for a full 24 hours. I am the first person to love a lazy day in bed, but I am not laying on one side with ear drops in my ear for a full turn of the earth. The ubiquitous q-tip, of course, is the classic method of earwax removal, despite mountains of evidence that it should never be used. Any conversation that involved the words “punctured eardrum” is sure to adjust my behavior towards the safe side. There are also some weird methods out there. Ear vacuums (or “ear vacs”) are available over-the-counter… Hilariously, a study testing their efficacy showed that they removed literally zero earwax. Literally none at all. The most eye-roll-y, of course, is the ear candle method, which purports to “remove toxins” (it doesn’t; the residue you find leftover comes from the candle itself) and which can cause significant injuries. Practitioners note, “Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk.”
As I already mentioned, I went the hydrogen peroxide route, pouring a 1.5% solution in my ears. When hydrogen peroxide H2O2 hits your earwax, it breaks down into water and oxygen gas, filling your ears with tiny, painful bubbles. Contrary to popular belief, the hydrogen peroxide doesn’t dissolve the earwax. Rather, the mechanical effect may help to loosen up stubborn wax. Sadly, I discovered today that the evidence for this method is also pretty scarce. There are an almost shocking number of studies that have shown that water actually breaks down earwax faster than hydrogen peroxide. I guess that’s a trip to the drugstore that I could have saved…
So, what are we left with at the end of the day? We have treatments that are either ineffective, dangerous, inconvenient, or all three. Well, shit.
I can only hope that one day in the future we will look back on this as an age of darkness, where foolish individuals did not know how to properly remove goop from their ears. Until then, I can only hope that something restores my damn hearing.
LET’S GET ON IT, SCIENCE.