The author explains why mechanical self-cleaning
makes for unhealthy ears, including impacted earwax,
outer ear infection, and failed hearing aid
trials. Reader Inquiries may be directed to "Contact
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DigiCare Hearing Research & Rehabilitation
A Monologue on External Ear Self-Cleaning Processes
By
Max S. Chartrand, M.A.,
DigiCare Hearing Research & Rehabiliation
Key words: Self-cleaning, external ear canal,
eardrum, desquamation, tissue migration, umbo,
stratum corneum, keratin, epithelium, fungus, yeast,
pseudomonas, vagus (Arnold’s reflex), video otoscopy,
earwax, cerumen, sebaceous secretions, sensorineural,
conductive, external otitis, botanical solution, wax
impaction
An oft-repeated caution in the doctor’s office to
patients goes something like this: “Put nothing
smaller than your elbow in your ears.”
Comes the refrain from the patient: “But, Doctor,
how do I keep my ears clean?”
The answer to that simple query is, of course, “You
don’t; the ears are self-cleaning if you allow
natural processes to do their work.”
Our purpose here is to explain the process of
epithelial migration and desquamation of tissue that
unique to the external ear canal, and the resulting
self-cleaning and protective properties of the
normal, healthy ear. Furthermore, we will discuss
what happens when one takes matters into their own
hands, and tries to foil Mother Nature.
Conveyor belt-like action
To illustrate the movement of debris and foreign
objects out of the ear canal, we place a piece of
sand at the umbo (center) of the eardrum and watch
it travel at the rate of just under 1mm per day. By
the end of about 3 months one could reach up with
fingertip at the opening of the ear canal and lift
off that same piece of sand at that point in time.
It makes no difference whether the object is earwax,
discarded hair, household dust, insect dander, dried
mold spores or fungi, dead bacteria or pseudomonae,
dead skin cells, or soap residue, in the normal
migration of an outer covering called stratum
corneum or the keratin layer of the ear canal, these
items are as if on a conveyor belt transporting them
outward to the opening of the ear canal.
If this were not so, for most of mankind’s history
we would have had a relatively deaf (and
unsurvivable) human species before the invention of
modern otoscopy and mechanisms for clinical removal
of impacted earwax. In fact, historically, impacted
wax appears to be a uniquely modern phenomenon,
coinciding with the invention of another modern
invention, the common cotton swab. For cerumen and
sebaceous secretions (together they make “earwax”)
only exist in the outer 1/3 of the ear canal. Yet,
in years of practice with thousands of patients,
this author notes a relatively high incidence of
impacted earwax in the inner 2/3 of the ear canal!
Of course, it’s no mystery in how it got there.
“But,” you protest, “Isn’t it healthy to keep my
ears clean?” The answer comes with a sounding
refrain, “Not really. An overly clean ear can be an
unhealthy ear.”
Danger Ahead: Impacted Wax
Let’s talk about the potential dangers of attempts
at self-removal of earwax in terms of impacting the
wax deeper into the ear canal, sometimes occluding
the ear for months or years at a time before
anything is done about it. In doing so, we will
recite below some of the consequences, from the
trivial and aggravating to the most serious (and
potentially fatal) possibilities, as well:
Impacted earwax more often than not is caused by one attempting to
remove wax mechanically with cotton swab,
matchstick, hairpin, or any variety of other blunt
objects. Deeper and deeper into the canal goes the
wax intended for removal, scraping of the stratum
corneum (or keratin) along the way, so that the wax
couldn’t come out on its own if wanted to!
Over time, the wax dries out; debris and dead
skin tissue collect into a hard mass that would
almost require a chisel to break it up. As debris
continues to gather and impact over time, one may
develop a hacking cough, because of pressure on the
vagus nerve (Arnold’s reflex). In some cases, this
can be quite serious, and cause upper respiratory
problems, as well.
A conductive hearing loss of about 30-40
decibels develops, of course, creating an isolating
barrier between the sufferer and the world around
them. Many patients describe this sensation as
“being deaf”, although, if their hearing is
otherwise normal, the condition is a far cry from
truly debilitating deafness. On the other hand, if
they also have a permanent sensorineural (nerve)
deafness in the high frequencies, the blockage of
the lower frequencies due to wax impaction would
cause them to indeed experience “deafness”. In other
words, impacted wax can expose an otherwise
undiscovered serious high frequency loss of hearing.
The sufferer will also talk so softly that
others must strain to hear them. This is because of
the occlusion effect, increasing their own voice
internally about 15-20 decibels. Children who talk
softly should always be suspected of middle ear
infection, wax impaction, or undiscovered hearing
loss!
In some cases, a long-standing and untreated
impaction case can actually turn septic, and cause
serious health consequences. Over many years of
practice, the author has seen at least a half dozen
patients who were hospitalized for this very reason,
and in most cases the cause of the problem not
discovered until weeks or months after vigorous
medical treatment. In other words, untreated
impaction can be potentially life threatening!
Even a small piece of wax pushed up onto the
eardrum can cause an interaural attenuation
(reduction of hearing sensitivity) on the
contralateral (opposite) ear of as much as 20
decibels!
That same tiny piece of wax on the eardrum can
also cause the tensor tympani muscle go into spasm,
causing a “roaring” or “buzzing” tinnitus.
Now, for the “Mundane”
Let’s say one was actually successful in cleaning
their ears on a frequent or daily basis, without
impacting their ears. What are the consequences
then?
For one thing, there will be little or no
protective keratin layer on the ear canal, leaving
the ear open for trauma and infection.
Without keratin the ear cannot maintain surface
pH and fungus, yeast, bacteria and pseudomonas begin
to grow, causing chronic itching in most cases, and
almost incurable chronic external otitis in some
cases.
The simple act of making an ear impression on
such an ear can be an excruciating and uncomfortable
experience, although such a reaction does not
necessarily warrant medical referral under existing
FDA Red Flags.
The outer ear can bleed easily upon the lightest
touch as millions of tiny, thin-walled capillaries
are exposed to the surface of the epithelium. This
is especially true in cases of certain medications (cumadin,
aspirin, high doses of Vitamin E or anticoagulants),
or if the patient has varicose veins, vascular
disease, or diabetes mellitus. Ears cleaned at the
medical clinic nearly always come out bleeding and
in serious need of epithelial repair!
Another phenomenon is increased sensitivity of
the neuroreflexes of the external ear canal. These
reflexes fall into two basic categories 1)
biological monitoring of one’s own voice, and 2) to
cause physical changes in protecting the eardrum
from mechanical or vibratory invasion. This problem
has been discussed at length in other forums, but is
important to mention here, because this little known
problem is the root cause of many unnecessary
remakes, credit returns, and trial failures in
hearing aids. Hence, without a thick layer of
keratin and the natural insulation it provides,
these neurological trip switches are set off as sure
as the most sophisticated security system today!
Not so mundane, huh? In fact, the above phenomena
are at the root of more than a few failed hearing
aid trials, self-inflicted external otitis (outer
ear infection), and ongoing (yet resolvable) speech
defects.
What’s the answer, then?
The following represents simple rules for external
ear care that are good for everyone:
1.Never use boric acid, hydrogen peroxide or other
harsh solutions in the ear. Mineral oil based
solutions also cause dermatitis and make the ear
otherwise unhealthy.
2.Use only botanical or natural solutions that are
gentle to the ear. In the case of excessive was
production, daily application of a good botanical
may dilute and migrate the wax gently out of the
ear.
3.If ears itch, instead of using a mechanical object
for its relief, reach for the botanical solution,
pouring it into the ear canal until it reaches the
eardrum. A wad of tissue can be placed at the
aperture of the ear for a period of about 15-20
minutes to keep the solution from running back out.
4.Have your ears examined by a qualified ear
professional on a video otoscope. The image of your
ear will be magnified onto a high definition screen
for all to see. No guess work!
And, oh yes, nothing smaller than your elbow goes
into your ears, right?
Dr. Chartrand serves as director of research at
DigiCare Hearing Research & Rehabilitation in Rye,
CO, correspondence:
www.digicare.org.
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