Good intentions to keep ears clean may be risking the ability to hear. The ear is a delicate and intricate area, including the skin of the ear canal and the eardrum. Therefore, special care should be given to this part of the body. Start by discontinuing the use of cotton-tipped applicators and the habit of probing the ears.

Why does the body produce earwax?

Cerumen (or earwax) is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating and antibacterial properties. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of earwax and skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where it usually dries, flakes and falls out.

Earwax is not formed in the deep part of the ear canal near the eardrum, but in the outer one-third of the ear canal. So when a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as cotton-tipped applicators, bobby pins or twisted napkin corners. These objects only push the wax in deeper.

When should the ears be cleaned?

Under ideal circumstances, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is called cerumen impaction, and may cause one or more of the following symptoms:

  • Earache, fullness in the ear, or a sensation the ear is plugged
  • Partial hearing loss, which may be progressive
  • Tinnitus, ringing or noises in the ear
  • Itching, odor or discharge
  • Coughing

What is the recommended method of ear cleaning?

To clean the ears, wash the external ear with a cloth, but do not insert anything into the ear canal.

Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax.

Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home, using a commercially available irrigation kit. Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water, saline or wax-dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes, a perforated eardrum, tube in the eardrum, or a weakened immune system.

Manual removal of earwax is also effective. This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have diabetes or a weakened immune system.

Why shouldn’t cotton swabs be used to clean earwax?

Wax blockage is one of the most common causes of hearing loss. This is 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.
The outer ear is the funnel-like part of the ear that can be seen on the side of the head, plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass; narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out, and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off.

Are ear candles an option for removing wax build up?

No, ear candles are not a safe option of wax removal as they may result in serious injury. Since users are instructed to insert the 10- to 15-inch-long, cone-shaped, hollow candles, typically made of wax-impregnated cloth, into the ear canal and light the exposed end, some of the most common injuries are burns, obstruction of the ear canal with wax of the candle, or perforation of the membrane that separates the ear canal and the middle ear.

The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.

Based on the growing concern associated with the manufacture, marketing and use of ear candles, the FDA has undertaken several successful regulatory actions, including product seizures and injunctions, since 1996. These actions were based, in part, upon violations of the Food, Drug and Cosmetic Act that pose an imminent danger to health.

When should a doctor be consulted?

If the home treatments discussed in this page are not satisfactory or if wax has accumulated so much that it blocks the ear canal (and hearing), a physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an otolaryngologist (ear, nose and throat specialist) may need to remove the wax using microscopic visualization.

If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Certainly, washing water through such a hole could start an infection.

What can I do to prevent excessive earwax?

There are no proven ways to prevent cerumen impaction, but not inserting cotton-tipped swabs or other objects in the ear canal is strongly advised. If you are prone to repeated wax impaction or use hearing aids, consider seeing your doctor every 6 to 12 months for a checkup and routine preventive cleaning.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Age-related hearing loss is the most common cause of this condition and is more prevalent than hearing loss caused by excessive noise exposure. However, exposure to excessive noise can damage hearing, and it is important to understand the effects of this kind of noise, particularly because such exposure is avoidable.

What causes hearing loss?

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound vibrations to the inner ear. Here, the vibrations become nerve impulses, which the brain interprets as music, a slamming door, a voice, and so on.
When noise is too loud, it begins to kill the nerve endings in the inner ear. Prolonged exposure to loud noise destroys nerve endings. As the number of nerve endings decreases, so does your hearing. There is no way to restore life to dead nerve endings; the damage is permanent. The longer you are exposed to a loud noise, the more damaging it may be. Also, the closer you are to the source of intense noise, the more damaging it is.

How can I tell if a noise is dangerous?

People differ in their sensitivity to noise. As a general rule, noise may damage your hearing if you are at arm’s length and have to shout to make yourself heard. If noise is hurting your ears, your ears may ring, or you may have difficulty hearing for several hours after exposure to the noise. Noise is characterized by intensity, measured in decibels; pitch, measured in hertz or kilohertz; and duration.

Can noise affect more than my hearing?

A ringing in the ears, called tinnitus, commonly occurs after noise exposure, and often becomes permanent. Some people react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid. Very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

How can I protect myself against noise?

Wear hearing protectors, especially if you must work in an excessively noisy environment. You should also wear them when using power tools, noisy yard equipment, or firearms, or riding a motorcycle or snowmobile. Hearing protectors come in two forms: earplugs and earmuffs.
Earplugs are small inserts that fit into the outer ear canal. They must be sealed snugly so the entire circumference of the ear canal is blocked. An improperly fitted, dirty or worn-out plug may not seal properly and can result in irritation of the ear canal. Plugs are available in a variety of shapes and sizes to fit individual ear canals and can be custom-made. For people who have trouble keeping them in their ears, the plugs can be fitted to a headband.

Earmuffs fit over the entire outer ear to form an air seal so the entire circumference of the ear canal is blocked, and they are held in place by an adjustable band. Earmuffs will not seal around eyeglasses or long hair, and the adjustable headband tension must be sufficient to hold earmuffs firmly in place.

Earplugs and earmuffs can be found at most pharmacies.

Will I hear other people and machine problems if I wear hearing protectors?

Just as sunglasses help vision in very bright light, so hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.
Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. However, it is essential that persons with impaired hearing wear earplugs or muffs to prevent further inner ear damage in very noisy places.

It has been argued that hearing protectors might reduce a worker’s ability to hear the noises that signify an improperly functioning machine. However, most workers readily adjust to the quieter sounds and can still detect such problems. If a worker is already hearing impaired, he or she needs expert advice about how to protect against further damage. In some cases hearing aids can and should be used under earmuffs.

How can I tell if my hearing is damaged?

Hearing loss usually develops over a period of several years. Because it is painless and gradual, you might not notice it. What you might notice is a ringing or other sound in your ear (tinnitus), which could be the result of long-term exposure to noise that has damaged hearing nerves. Or you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as a crowd or a party. This could be the beginning of high-frequency hearing loss; a hearing test will detect it.

If you have any of these symptoms, they may be caused by impacted wax or an ear infection, which are relatively easy to correct. However, you may suffer from noise-related hearing loss. In any case, take no chances with noise – the hearing loss it causes is permanent. If you suspect hearing loss, consult a physician with special training in ear care and hearing disorders (called an otolaryngologist or otologist). This doctor can diagnose your hearing problem and recommend the best way to manage it. For more information on the laws for on-the-job noise exposure, please refer to the information provided here.

Sound Measurements

Decibels (dB) measure the intensity of sound. The scale runs from the faintest sound the human ear can detect, which is labeled 0 dB, to more than 180 dB, the noise at a rocket pad during launch. Most experts agree that continual exposure to more than 85 decibels is dangerous. Recent studies show an alarming increase in noise-related hearing loss in young people.

  • Approximate examples of decibel levels:
  • Faintest sound heard by human ear 0 dB
  • Whisper, quiet library 30 dB
  • Normal conversation, sewing machine, typewriter 60 dB
  • Lawnmower, shop tools, truck traffic 90 dB
  • Chainsaw, pneumatic drill, snowmobile 100 dB
  • Sandblasting, loud rock concert, auto horn 115 dB
  • Gun muzzle blast, jet engine (such noise can cause pain and even brief exposure injures unprotected ears) 149 dB
  • The Occupational Safety and Health Administration’s limit for noise without hearing protectors 140 dB

Pitch is the frequency of sound vibrations per second measured in hertz or kilohertz, and duration. A low pitch, such as a deep voice or a tuba, makes fewer vibrations per second than a high voice or violin – the higher the pitch, the higher the frequency. Loss of high-frequency hearing also can make speech sound muffled.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Better Ear Health

Many medical conditions, such as those listed below, can affect your hearing health. Treatment of these and other hearing losses can often lead to improved or restored hearing. If left undiagnosed and untreated, some conditions can lead to irreversible hearing impairment or deafness. If you suspect that you or your loved one has a problem with their hearing, ensure optimal hearing healthcare by seeking a medical diagnosis from a physician.

Otitis Media

The most common cause of hearing loss in children is otitis media, the medical term for a middle ear infection or inflammation of the middle ear. This condition can occur in one or both ears and primarily affects children due to the shape of the young Eustachian tube (and is the most frequent diagnosis for children visiting a physician). When left undiagnosed and untreated, otitis media can lead to infection of the mastoid bone behind the ear, a ruptured ear drum and hearing loss. If treated appropriately, hearing loss related to otitis media can be alleviated.

Tinnitus

Tinnitus is the medical name indicating ringing in the ears, which includes noises ranging from loud roaring to clicking, humming or buzzing. Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. Hearing nerve impairment and tinnitus can also be a natural accompaniment of advancing age. Exposure to loud noise is probably the leading cause of tinnitus damage to hearing in younger people. Medical treatments and assistive hearing devices are often helpful to those with this condition.

Swimmer’s Ear

An infection of the outer ear structures caused when water gets trapped in the ear canal leading to a collection of trapped bacteria is known as swimmer’s ear or otitis externa. In this warm, moist environment, bacteria multiply causing irritation and infection of the ear canal. Although it typically occurs in swimmers, bathing or showering can also contribute to this common infection. In severe cases, the ear canal may swell shut leading to temporary hearing loss and making administration of medications difficult.

Earwax

Earwax (also known as cerumen) is produced by special glands in the outer part of the ear canal and is designed to trap dust and dirt particles keeping them from reaching the eardrum. Usually the wax accumulates, dries and then falls out of the ear on its own or is wiped away. One of the most common and easily treatable causes of hearing loss is accumulated earwax. Using cotton swabs or other small objects to remove earwax is not recommended as it pushes the earwax deeper into the ear, increasing buildup and affecting hearing. Excessive earwax can be a chronic condition best treated by a physician.

Autoimmune Inner Ear Disease

Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body’s immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. Prompt medical diagnosis is essential to ensure the most favorable prognosis. Therefore, recognizing the symptoms of AIED is important: sudden hearing loss in one ear progressing rapidly to the second and continued loss of hearing over weeks or months, a feeling of ear fullness, vertigo and tinnitus. Treatments primarily include medications but hearing aids and cochlear implants are helpful to some.

Cholesteatoma

A cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum. This condition usually results from poor eustachian tube function concurrent with middle ear infection (otitis media), but can also be present at birth. The condition is treatable, but can only be diagnosed by medical examination. Over time, untreated cholesteatoma can lead to bone erosion and spread of the ear infection to localized areas such as the inner ear and brain. If untreated, deafness, brain abscess, meningitis and death can occur.

Perforated Eardrum

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge with possible pain. The amount of hearing loss experienced depends on the degree and location of perforation. Sometimes a perforated eardrum will heal spontaneously, other times surgery to repair the hole is necessary. Serious problems can occur if water or bacteria enter the middle ear through the hole. A physician can advise you on protection of the ear from water and bacteria until the hole is repaired.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The ear has three main parts: the outer ear (including the external auditory canal), middle ear and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum (tympanic membrane) separates the ear canal from the middle ear. The middle ear contains three small bones which help amplify and transfer sound to the inner ear. These three bones, or ossicles, are called the malleus, the incus and the stapes (also referred to as the hammer, the anvil and the stirrup respectively). The inner ear contains the cochlea which changes sound into neurological signals and the auditory (hearing) nerve, which takes sound to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the external ear canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the three small bones of the middle ear, which transmit them to the cochlea. The cochlea contains tubes filled with fluid. Inside one of the tubes, tiny hair cells pick up the vibrations and convert them into nerve impulses. These impulses are delivered to the brain via the hearing nerve. The brain interprets the impulses as sound (music, voice, a car horn, etc.).

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Your child has an earache. After your first visit to a physician you may hear some of the following terms related to the diagnosis and treatment of this common childhood disorder.

Acute otitis media – the medical term for the common ear infection. Otitis refers to an ear inflammation, and media means middle. Acute otitis media is an infection of the middle ear, which is located behind the eardrum. This diagnosis includes fluid effusion trapped in the middle ear.

Adenoidectomy – removal of the adenoids, also called pharyngeal tonsils. Some believe their removal helps prevent ear infections.

Amoxicillin – a semi-synthetic penicillin antibiotic often used as the first-line medical treatment for acute otitis media or otitis media with effusion. A higher dosage may be recommended for a second treatment.

Analgesia – immediate pain relief. For an earache, it may be provided by acetaminophen, ibuprofen and auralgan.

Antibiotic – a soluble substance derived from a mold or bacterium that inhibits the growth of other bacterial micro-organisms.

Antibiotic resistance – a condition where micro-organisms continue to multiply although exposed to antibiotic agents, often because the bacteria have become immune to the medication. Overuse or inappropriate use of antibiotics leads to antibiotic resistance.

Audiometer – an electronic device used in measuring hearing for pure tones of frequencies, generally varying from 125-8000 Hz, and speech (recorded in terms of decibels).

Azithromyacin – an antibiotic prescribed for acute otitis media due to Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Also known by its brand name, Zithromax®.

Bacteria – organisms responsible for about 70 percent of otitis media cases. The most common bacterial offenders are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

Chronic otitis media – when infection of the middle ear persists, leading to possible ongoing damage to the middle ear and eardrum.

Decibel – one tenth of a bel, the unit of measure expressing the relative intensity of a sound. The results of a hearing test are often expressed in decibels.

Effusion – a collection of fluid generally containing a bacterial culture.

First-line agent – the first treatment of antibiotics prescribed for an ear infection, often amoxicillin.

Myringotomy – an incision made into the ear drum.

Otitis media without effusion – an inflammation of the eardrum without fluid in the middle ear.

Otitis media with effusion – the presence of fluid in the middle ear without signs or symptoms of ear infection. It is sometimes called serous otitis media. This condition does not usually require antibiotic treatment.

Otitis media with perforation – a spontaneous rupture or tear in the eardrum as a result of infection. The hole in the ear drum usually repairs itself within several weeks.

OtoLAM™  – a myringotomy performed with computer-driven laser technology (rather than manual incision with a conventional scalpel).

Pneumatic otoscopy – a test administered for the middle ear consisting of an inspection of the ear with a device capable of varying air pressure against the eardrum. If the tympanic membrane moves during the test, normal middle ear function is indicated. A lack of movement indicates either increased impedance, as with fluid in the middle ear, or perforation of the tympanic membrane.

Recurrent otitis media – when the patient incurs three infections in three months, four in six months, or six in 12 months. This is often an indicator that a tympanostomy with tubes might be recommended.

Second line treatment – antibiotics prescribed when the first line of treatment fails to resolve symptoms after 48 hours.

Trimethoprim Sulfamethoxazole – an alternative first line treatment for children allergic to amoxicillin.

Tympanostomy tubes – small tubes inserted in the eardrum to allow drainage of infection.

Do not hesitate to seek clarification from your physician if he or she uses a term that you do not fully understand.