Thursday, 09 December 2021

Never put something smaller than an elbow in your ear

I WAS rather disappointed to learn that Guinness World Records did not have a section on ear wax.

Considering they have categories including most tooth picks in a beard, farthest arrow shot using feet and largest haggis, to leave ear wax out seems harsh. The closest they came was longest ear hair (18.1cm by the way). I think ear wax deserves a greater voice.

The technical term for it is cerumen, named after the Latin word “cero”, meaning wax.

If one were to list a recipe for ear wax, the main ingredients would consist of sebum (a secretion mostly made of fats), dead skin cells, sweat and dirt. Not an appealing concoction I will grant you, even less so when you consider it used to be used in early lip balms.

That aside, it certainly has its uses. Primarily, it acts to protect the ear canal and the deeper structures of the ear from foreign bodies and infection.

If present in the right amounts, it actually helps to clean the ear. The skin lining the ear canal has a natural migratory movement outwards so all the dirt and bacteria that ends up inside the ear is collected by the wax and gradually ousted as the wax is conveyed towards the outside world.

If you have too little of the stuff, the canal can get dry and itchy and will potentially become more prone to infection. In fact, some studies have suggested that ear wax can have bactericidal effects. However, many others implicate ear wax in actually harbouring bacteria and encouraging infection.

Although no official consensus exists, there is a distinction to be made that might explain this inconsistency. It all comes down to the different types of wax we have, wet or dry.

There are many simple traits that are actually very complex genetically and differ from person to person. By contrast, there are relatively few traits that are governed by a single change in a single gene (the Mendelian form of inheritance).

The latter gives rise to a binary expression of a trait, for example, whether you have the ability to roll your tongue, or whether you have a chin dimple.

Ear wax is the same. You have either wet or dry. In genetic terms, wet ear wax is dominant and tends to be most common in Caucasian and African populations, whereas East Asian and Native American populations invariably have the dry kind. It is not unreasonable to hypothesise that the wet kind of wax provides a better breeding ground for bacteria than the dry. But this is by no means proven and should not take away from the benefits of either kind, as long as it stays present in the right amount.

This brings me to probably the biggest issue with wax. According to some estimates, between 1.3 and 3.9 million people in the UK experience wax build up.

This can occur due to a number of factors but tends to be more common in those who wear in-ear headphones, ear plugs and hearing aids.

It can also be triggered in those who have overgrowth of hair that can tangle and anchor the wax and in those who use cotton buds to clean their ears (something which just pushes wax further in and packs it down).

If the ear becomes clogged with wax, one might experience a feeling of fullness, hearing loss, tinnitus (that high ringing sound), vertigo and irritation. In days gone by and still in some cases, various substances have been used to try to clear such blockages including various oils and honeys.

Another method in ancient times was ear candling, a process which involves placing a hollow candle with a flame next to the ear to heat up the wax and draw it out.

This method is still used by alternative medicine providers but experts advise against it as, according to the British Tinnitus Foundation, there is no evidence it is actually very good but there is plenty of evidence that it can be harmful to place a heat source so close to the ear.

The more effective solution and one used traditionally in modern medicine is ear syringing. This is done by way of a high pressure jet of water being spurted into the ear to loosen the wax.

In the early days of this, it was done manually and resulted in quite a high rate of complications, including infection and perforation of the ear drum.

More recently machines have been employed to maintain a regulated pressure, making it a tad safer. Even so, syringing has been increasingly going out of favour in recent years due to residual concerns about these complications. With the coronavirus pandemic, syringing stopped completely for a time.

The emerging alternative to ear syringing is ear suction. This involves using a machine to hoover out the ear and is favoured by ear specialists who find the method to be quicker while potentially causing fewer complications. It can be quite noisy, though.

Unfortunately, for the last year or two, the NHS has no longer listed ear wax removal as one of its core services. This means that, where GP practices used to be given funding to provide the service, this is no longer the case. Furthermore, they are technically prevented from providing it privately to their own patients for an “at cost” price.

In some areas, local commissioning groups have banded together to fund the service regardless, although this is not the case in Oxfordshire. This has resulted in people having to find costly private alternatives.

We as GPs still have huge demand for removal of ear wax and I think it is important to highlight the fact that a build-up of wax can have a huge impact on one’s life.

This is particularly the case in the elderly but anyone who struggles to hear will experience a significant decline in quality of life, leading to depression and social withdrawal. Many will not be able to afford the price of private removal. It seems bizarre that an issue which affects so many to such a degree, with such a simple solution, is not being addressed. In the local Henley SonNet GP network, there is an ear suction machine that is largely unused as a result.

We as GPs have few options other than to refer those who require wax removal to the hospital ear specialists who clearly are busy enough as it is. We would welcome support therefore in asking the Oxfordshire Clinical Commissioning Group to consider funding such a service that could be run at network level.

So if you’re sitting there struggling to hear the TV because of the wax in your ears, feel free to write to the Henley Standard or commissioning group to voice your support.

In the meantime, you could try using some oil (over the counter drops are available but you can just use olive oil if you need to) in your ear to loosen the wax. This means lying on your side and dripping a couple of drops of oil into the ear, leaving it for two minutes and dabbing the residual off before sitting up. Do this every day for one or two weeks for an acute blockage. If it’s a recurrent problem, you could consider doing this once every week or so.

You could perhaps switch to over the ear headphones rather than the in-ear type. And remember, never use cotton buds or hairclips in the ear — nothing smaller than an elbow is the rule!

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