Dr. Murray Feingold: Waxing on about a common ear problem

Dr. Murray Feingold

Today's topic is not a glamorous or exotic one, but one that is responsible for 12 million visits to the doctor each year.

The subject is cerumen, more commonly known as wax - as in earwax. The reason for the doctor's visit is removal of impacted cerumen.

The main purpose of cerumen is to protect the ear from bacteria and fungi and to keep the ear canal clean and lubricated. However, at times, there may be too much of a good thing resulting in impacted earwax.

Excessive accumulation of earwax can cause symptoms such as decreased hearing, a feeling of fullness in the ear, discomfort, itchiness, discharge, odor and balance difficulties.

Impaction of cerumen can also decrease the hearing of older individuals who already have some hearing loss and people who wear hearing aids. Its presence may also prevent the physician from adequately visualizing the ear of a child with ear pain.

These symptoms can be severe enough to require medical intervention.

Recently, guidelines were formulated concerning the management and treatment of impacted cerumen.

There are basically three types of treatment: placing medications into the ear to help break up the cerumen; irrigating the ear canal to dislodge the earwax; and, the doctor manually removing the cerumen.

The guidelines did not state that one method was better than the other, leaving the decision up to the physician in individual cases.

The guidelines did not recommend the use of any home treatments such as cotton-tip swabs or jet watered irrigators.

Cotton-tip swabs are associated with doing more harm than good, including irritating the ear canal, which can result in a subsequent infection.

Also not recommended was ear candling or coning which is the process of inserting a cone-shaped device into the ear canal with the purpose of extracting earwax with the aid of smoke or a burning wick.

If physicians can now transplant hearts and kidneys or remove cataracts in just a few minutes and send the patient home shortly thereafter, why can't medical science find better methods to prevent the excessive formation of something as mundane as earwax?

Dr. Murray Feingold is the physician in chief of the National Birth Defects Center, medical editor of WBZ-TV and WBZ radio, and president of the Genesis Fund. The Genesis Fund is a nonprofit organization that funds the care of children born with birth defects, mental retardation and genetic diseases.