Sunday, September 1, 2013

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.

This earwax is way prettier than mine.
Source: http://en.wikipedia.org/wiki/File:Earwax_on_swab.jpg
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.

17 comments:

  1. Earwax is the bane of my life. Not because mine are particularly waxy (I've had to have them syringed once because I went deaf for four days) but because of my 8 year old son. That child produces more wax in one day than an entire army would in a week. Every morning I have to practically hold him down and clean the stuff out of his ears. It's baffling to me, WHERE DOES IT COME FROM. Every.Single.Day.

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  2. Wow, just when I think you can't be thinking my thoughts any more than you already are, you come out with this!
    I had surgery to put tubes in my ears (for the 7th time!) two weeks ago, and one ear keeps draining, and I just last night was googling to try and determine what this stuff is.

    I admit to ! very gingerly ! cleaning my ears with a q-tip after each shower, and to being jealous that my BFF has the cleanest ears I've ever seen.

    As an aside: can you talk about SLSs, and if they are actually scary, and whether or not they need to be in toothpaste, and am I dreaming when I feel like my hair is less oily when I use shampoo without them?

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    1. I can't wait to read that. What I've read is that hair definitely gets less oily on its own than with sulfates, because the sulfates strip it of its natural oils (or anyway the scalp's natural oils) and then the scalp overproduces to make up for it. Leading people to use more sulfates. Vicious and profitable circle. Just like regular skin and using moisturizers instead of trying to wash all the oils off.

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  3. "LET'S GET IT ON, SCIENCE!" <--My new catchphrase!

    My mom has problems with earwax too; she went to the doctor about it, who performed the irrigation method on her. It worked, but, they weren't thorough enough, and they left some wax in, trapping the water inside, which is super risky for infection.

    This was a great post! I hope your earwax troubles clear up soon.

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  4. Oh man. My sister is one of the waxy crowd. SO GLAD this is not me. Good luck.

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  5. Both myself and my sister have struggled with terrible earwax! Once, for a week in high school I was entirely deaf. After a doctor failed to remove the earwax with the water-syringe method (she tried for an HOUR--I was crying by the end), I started going to an ENT. They have big complex machines that they use to suction earwax out of my ears, and trust me, they work. I'm deeply disturbed by the amount of earwax I have every time I have the procedure done. You should talk to your General Practitioner, and see if they would refer you to an ENT in your area!

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    1. That wax vacuum sounds deeply satisfying.

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  6. I stumbled across this while devouring your excellently honest reviews (no sugar coating, so refreshing!). Someone understands! Since childhood I've suffered from ear and earwax problems. I've used Debrox (a miserable, cold earwax softener) and I've have my ears curetted several times. I used to refer to the curette as the "hurtful thing" as a child and feared it more than vaccines. It was a metal stick with a thin wire loop on it. I have crooked ear canals so it felt AWESOME ! Don't try it, I promise the juice is not worth the squeeze.

    To Makeup in Memphis, how often do you have to go to the ENT if I may ask? Also, is it horrifying and scary to have it done?

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  7. Hydrogen peroxide was my mom's go-to remedy for earwax. I am pleased to find someone else who does it!

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  8. My kids have the waxiest (that word just looks wrong to me) ears I have ever seen. It's disturbingly fascinating the amount of wax that little people can produce. We have taken our daughter to the dr a few times for ear issues to be told her ear was totally blocked up with wax and then they used the plastic scoop-y thing and OMG the shit they pulled out was INSANE. And gross. BUT. Apparently you can purchase a little hook-y/scoop-y device at Walgreens by the pharmacy to scoop your own wax. It has a little shield so you can't go too deep but holy crap it is aweome. And by awesome I mean super gross in the wax removing-abilities. We tried the drops first but that is freaking painful. No screaming with the scoop LOL.

    PS I just discovered your blog and it was a total time suck :) In the best way. I am slightly obsessed with All. The. Information. now! You are fabulous. Try to find the ear scoop tool thing. I think it will help!

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  9. I am ashamed to admit that while I know Q-tips suck, I am kind of addicted to using them at least once every two days. They just feel soooooooooooo good. Why would jamming something in your ear feel good? Especially since, inevitably, after each use in the morning I'll get in my car, drive five seconds and suddenly feel waves of ear wax dislodging and sliding around in my ears and try to resist the desire not to squash the sides of my head against my shoulders as if that would do literally anything. :/

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  10. Yikes!! I just discovered your blog and this post today. I felt obligated (as a pharmacy intern) to tell you that hydrogen peroxide can put you at risk or ear infection and, well, hurt! Lol! There's a better option and it's carbamide peroxide, found OTC at a pharmacy. There are actually other drugs, too! Ask a pharmacist! ;) I'm loving your blog so far.. Do you use instagram?

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