A word in your ear about wax

In the same way that a tiny hole in your tooth can feel gigantic to your tongue, a minor health problem can cause major angst if you’re the person affected. Nothing exemplifies this phenomenon like earwax. If it’s not your own ear that’s bunged up, it’s just vaguely revolting; if it is your ear, it soon becomes disproportionately aggravating.

Although it can feel like an echoing tunnel, with the end located infuriatingly just out of reach, the ear canal is not in fact very long – about two-and-a-half centimetres, shorter than a matchstick. It has a couple of kinks in it before it reaches the eardrum (which is why your doctor pulls your ear up and outwards before attempting to look in – this helps to straighten out the view). The wax-producing glands lie in the relatively robust skin of the outer third of the canal. As you go deeper, entering the skull, the skin becomes much thinner, like a layer of cling film over the underlying bone; this region is correspondingly more sensitive.

Earwax is a benign substance, which the body has its own arrangements for removing. The skin cells lining the ear canal travel a minuscule distance every day, moving at about the same rate as nails grow. They form a kind of slow-moving conveyor belt, carrying wax (and anything stuck in it) gradually out of the ear. But perhaps your earwax is unusually hard, or your ear canals are unusually narrow, or you’ve messed up your conveyor system by pushing objects, such as cotton buds, in the opposite direction.

In these cases, the wax can build up and get stuck. It can irritate the delicate skin of the inner canal, causing itching or popping or a feeling of fullness; or it can occlude the eardrum and block sound transmission, rendering you deaf.

Earwax is not a modern problem: ancient civilisations found it traumatic as well. The Roman author Celsus suggested a mixture of cucumber juice and crushed rose petals for dissolving wax, which sounds lovelier than most contemporary ear drops and is probably about as effective. There is no good evidence to suggest that sodium bicarbonate, sodium chloride, olive oil or almond oil work any better than plain water, though I have failed to convince an eminent professor of this fact. (His preferred remedy makes a fizzing noise in his ear: a crackle similar to what you get when you put popping candy on your tongue, though Heston Blumenthal has not yet experimented with the sensory possibilities of ear drops.) Wax sufferers are also prone to digging with fingers, cotton buds, hairgrips, paper clips and anything else small, scratchy and problematic: sadly, the wise advice to “never put anything smaller than your elbow in your ear” always falls on a deaf ear.

Syringing offers an efficient method of wax removal, although you need to use drops beforehand if you want it to work. Most GP practices offer this service, using a machine that directs a jet of warm water into the ear to sluice out the softened wax. It feels odd and not always pleasant, though it is magical when it works (as a patient said afterwards: “Birds! I can hear birds!”).

If your ears aren’t suitable for syringing, the specialist alternative is microsuction. This involves vacuuming inside the ear canal with a miniature device: the noise this generates inside your head is considerable. Specialists can also use a selection of tools – crocodile forceps, or the fantastically named Jobson Horne probe – to haul out recalcitrant lumps. It is all basically disgusting: and yet I’ve never met a patient who didn’t want to see, as well as hear, the results.

Sophie Harrison is a hospital doctor in South Yorkshire

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