Column: House Calls

Cerumen (ear wax) impaction is a common cause of hearing loss. Ear wax buildup blocks the external ear canal resulting in a decreased ability to hear sounds, tones and frequencies. This condition affects people of all ages and is especially apparent in the elderly, as they often have additional reasons for difficulty with hearing.

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Cerumen is a yellow, brown or gray waxy substance made up mostly of keratin (a protein), skin cells and cholesterol. In general, ear wax is believed to help lubricate and clean the outer ear. Some studies suggest that it may also aid in helping to prevent certain bacterial infections. Some individuals, however, overproduce this substance, resulting in undesirable side effects.

Symptoms of ear wax may include ear pressure or fullness, a sensation of water in the ear (especially after swimming, taking a shower or bathing), itching, ringing in the ears or even dizziness if the wax is pushed up against the tympanic membrane (eardrum).

It is not well understood why some people are wax producers while others are not, although it is believed that there could a genetic predisposition. In addition, some people will have hard wax while others may have soft wax. Regardless of the type of wax involved, both can result in hearing loss.

Diagnosis typically involves a visit to your doctor. Physicians can visualize the wax using a medical device called an otoscope. Once the wax is detected, there are several ways to remove it. Most commonly, the physician will flush the canal using warm water and a syringe. Although a strange sensation, the procedure is rarely painful or uncomfortable. Your health-care professional may also insert a small curette into the canal and manually remove the wax build up. There may be some slight discomfort depending on the amount and the depth of the wax. Furthermore, it is not uncommon to have a small amount of bleeding after these procedures, especially if the wax has been around for a long time. However, this is ultimately the most efficient way to remove the cerumen.

There are many over-the-counter products designed to remove ear wax. Those most effective are drops containing hydrogen peroxide, which helps soften and dissolve the wax buildup. Be careful, however, since some products such as ear candles are generally ineffective and can result in worsening symptoms or burns to the ear canal itself. Also, do not try to remove ear wax with a Q-tip. Instead of helping the situation, more often the wax is actually pushed deeper into the canal, worsening symptoms. In addition, Q-tip insertion can result in penetration of the ear drum, causing pain and bleeding.

The elderly seem to benefit the most from ear wax removal. As we age, our ability to distinguish sounds, tones and frequencies diminish. Frequently, older individuals require the assistance of a hearing aid to better discriminate conversations, hear the television or even the telephone. Ear wax removal in this age group is truly rewarding in that you are able to change the quality of a person's life simply by removing this obstruction. Therefore, it is advised that all caregivers and family of elderly patients have their hearing evaluated by a health-care professional with special attention given to a diagnostic ear examination.

Ear wax may be a minor problem, but can also significantly and adversely affect one's life. If you are heaving any hearing loss or unusual ear sensations, visit your physician for an exam. Hear me when I say that removal of ear wax can change your life for the better.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at