An ear wax rant

Time for a few anticipatory answers.

1. No, there's nothing wrong with having dark brown wax. Any shade of brown, all the way down to pale yellow, is fine. It should smell like ear wax, though. (Don't know the smell of your own ear wax? Stick finger in ear. Twirl. Smell it.) If you think you are going to lose your lunch from the aroma, you may have an infection. You need to see your doctor.

Green and pitch black are not acceptable colors, by the way. Green suggests a bacterial infection, black, a fungal infection.

2. No, you do not need to live with an itchy ear. This is soooo treatable it isn't funny. Scratching at them with Q-tips is not the solution (see my January 17 post).

3. No, I can't tell you how to clean your ears. Everyone's wax is different, and different types of wax respond to different cleaning techniques.

The Ear Wax Compendium

A. No wax. This is not abnormal. Most people's ears are self-cleaning. By the way, if your ears are itchy and you "have no wax," the "lack of wax" isn't causing the itchiness. Your incessant cleaning is causing the itchiness. See #2.

B. Dry, scaly wax. This isn't all wax, but flakes of skin combined with wax. This is nearly impossible for you to clean at home, and it's not too easy for me to clean, either. Interesting fact: I see this most often among people of Asian descent.

C. Hair impactions with variable amounts of wax mixed in. This is the absolute worst. It's irritating to the patient, impossible to clean with Q-tips or over-the-counter ear wax remedies, and it's a devil for me to clean, too. TRIM YOUR EAR HAIRS, puhlease.

D. Hard wax. Assuming you have an intact ear drum, it is safe to put oil in your ears to soften the wax: vegetable oil, baby oil, anything but motor oil. Don't waste money on "sweet oil," as this is just overpriced olive oil.

E. Soft wax. This will respond to the use of over-the-counter ear wax kits, assuming you haven't waited to long. Which brings me too . . .

4. Don't wait too long to seek a doctor's help. Once the wax gives you an unremitting hearing loss, it's too late to clean it with Q-tips or over-the-counter wax kits. You'll only make it worse.

It saddens me whenever I have to clean out wax that has been present since the Truman Administration. This is a patient who has had treatable hearing loss for decades. For heaven's sake, practitioners, look in your patient's ears.

5. Irrigation (the most common cleaning technique used by nurses and non-ENTs) probably works about 99% of the time (number pulled from where the sun doesn't shine) but it's that 1% that'll get ya. Yes, I have seen serious injuries due to over-forceful irrigation. For what it's worth, I've never seen any injuries from self-irrigation using a kit. When they're doing it to themselves, folks generally know not to use too much force.

Irrigation is not pleasant, though. If you're doing it to yourself, make sure the solution is at body temperature, or you may get very dizzy.

Important: If you think there is any chance you have a hole in your ear drum, STOP. Do not put anything in your ear canal. Do not irrigate. Do not let the doctor or the nurse irrigate. Repeat, STOP. This is a job for the ENT.

6. When you see your ENT, do not say any of the following things. We've heard each one of these 'jokes' so many times, it makes us want to scream when we hear it again.

A. "Can you see through to the other side?" (No, ma'am. There are two peas rolling around which are obstructing my view.")

B. "Huh?" (Unless you really mean it.)

C. "I was always told you shouldn't stick anything in your ear smaller than your elbow." (I see. You did a damn good job jamming the wax in with your elbow. Or did you use your foot?)

Which brings me to . . .

7. Yes, it is okay to use Q-tips, with several warnings:

A. Make sure you don't forget about the Q-tip and leave it dangling from your ear. This makes cell phone conversations quite hazardous. Yes, I have seen two ear drum perforations (separate patients) by this mechanism.

B. Make sure no one, but no one, is nearby who might bump into you while you are cleaning. This goes double for big dogs.

C. Don't go too deep. If you pinch the stem of the Q-tip behind the cotton, you'll prevent yourself from going too deep.

D. If you wait until you have a hearing loss to use a Q-tip, you have waited too long. You'll only pack it in deeper.

E. If you use Q-tips too frequently, you'll give yourself itchy ears.

F. Once a week is probably often enough. Do it after you shower, since that's when the wax is softest.

G. If you think you might have a hole in your ear drum, see #5 above.

8. Don't even dream of getting your ears candled. If you are a candling practitioner, or if you are a person who loves getting your ears candled, and if you would like to send me hate mail, please do so in the comments. I dearly love reprinting candle fanatics' letters. They are soooo special. And, no, I don't disparage candling "to keep all the money to myself." I disparage candling because it is quackery.

Betcha didn't know someone could wax on about wax, eh?

D.