Dr. Wright's Blog

All About Earwax – Facts, Safe Removal, Management at Home

Funny chihuahua with big ears managing ear wax

By Martine Schlagintweit, M.Sc., AUD, Aud(C), RHIP

Everything you need to know about earwax, how to remove it safely (never use Q-Tips or cotton buds!), and pointers for managing build-up at home.

What is cerumen?

Earwax, or cerumen (pronounced seh-ROO-men) as it is called clinically, is an orange, reddish-brown, or light-yellow substance in the ear canals. Cerumen protects the ear from dust, germs, and foreign particles, and keeps the skin in the ear from being irritated by water. However, the unique cul-de-sac shape at the end of the ear canals can trap earwax. In some cases, earwax builds up to a point where it needs managing.
 
Believe it or not, there’s more to earwax than just simply ‘wax’. Earwax is made up of skin cells shed from the ear canal walls, mixed with secretions from glands that are in the skin in the outer two-thirds of the ear canals. Two types of glands make the main parts of earwax: sebaceous glands and ceruminous glands. Sebaceous glands contribute lipids, or fats, as well as alcohols, wax esters, and cholesterol. Ceruminous glands add peptides, or amino acids. How much each gland contributes affects how the earwax holds together; for example, more lipids will mean a more ‘wet’ or soft consistency (Guest et al., 2004). 

The ear expels wax naturally

If left alone, ear wax is expelled from the ear canal in a six to twelve-week cycle. Because chewing and talking move the ear canal, these actions can speed up the process (Guest et al., 2004). However, placing items in the ear canals can stop the process by pushing the wax back in. For example, the use of Q-Tips or cotton buds notoriously leads to earwax buildup, as it pushes wax further in and dries the wax out in the process. Hearing aids can also lead to a buildup of wax just past the point where they sit in the ear canal. 

Removing earwax safely 

Twirling cotton buds in your ear canal is not a successful method of removing earwax, so what is? The best thing someone can do to manage their earwax is to ask an Audiologist or family physician about the status of their ear canals. 
 
The clinician will be able to advise if there is a lot of earwax in the canal and whether it has reached a point where it should be removed. If so, they may extract the wax by:
  • Using vacuum suction
  • Flushing with water
  • Manual removal with a curette

Creating a management plan

Once the wax has been removed, a wax management plan can be put in place; this may include recommendations for the use of Cerumol, an at-home earwax removal kit, or an earwax softening substance.
 
Common recommendations for at-home wax management:
 
Soften the wax
Placing one to three drops of olive oil in the ear canals at night to keep the wax soft so it will come out on its own. 
 
Flush with warm water
Rinsing your ears in the shower, or submerging your ears in the bathtub can soften the wax and help it move out of the ear canal.
 
Rinse the ear canals
The Mayo Clinic recommends gently rinsing the ear canals with a solution of ½ part white vinegar and ½ part rubbing alcohol periodically, in addition to the softening and flushing regimen.
 
Before you try removing earwax, you should talk to your Audiologist to make sure your ear canal and eardrum will tolerate an at-home remedy. If you have questions about cerumen management, call the Broadmead Hearing Clinic at 250-479-2969 or the Oak Bay Hearing Clinic at 250-479-2921.
 
 
References:
Guest, J.F., Greener, M.J., Robinson, A.C., Smith, A.C. (2004). Impacted Cerumen: composition, production, epidemiology and management. Quarterly Journal of Medicine, 97: 477-488. Doi:10.1093/djmed/hch082
 
 
 

Social Distancing: What Does This Mean For People With Hearing Loss?

Managing hearing loss while social distancing

 

During the COVID-19 Pandemic, we have been hearing a lot about social distancing. Provincial Health Officer Dr. Bonnie Henry has asked British Columbians to practice social distancing to avoid the spread of COVID-19. 

 

What is social distancing?

  • Limit activities outside your home
  • Try connecting online or by phone with others
  • If you are out in public, try to keep 2 meters between yourself and others
  • Keep your hands at your side when possible
  • Stay home when you are sick
  • Avoid social activities in large gatherings

While social distancing is essential to help stop the spread of COVID 19, it’s important to touch on the fact that this could be challenging for people with hearing loss. People with hearing loss often rely on visual information and proximity to the speaker to fully understand the conversation, even with their hearing aids in.

Hearing aids can help

Here are some ways hearing aids can be helpful during times of social distancing and self-isolation:

Partner or remote microphones

Most hearing aids have the option of connecting to a manufacturer-specific remote microphone. This can be worn by a family member and can transmit their voice to the individual’s hearing aids. Many of these devices can work up to a distance of 30 or more feet. If you have questions about how to use your microphone or to see if your hearing aids are compatible with one, email us at erin@broadmeadhearing.com

Facetime/Skype/Video calls 

Most hearing aids can connect wirelessly to your phone, tablet or computer. Free applications such as Facetime, Skype and other video platforms allow the hearing aid user to hear the person’s voice and see their face while having a conversation. It helps them pick up on visual cues and facial expressions that would otherwise be inaccessible in a normal phone call. 

Enable closed captioning

The best recommendation is to stay home right now. As you are staying home and perhaps watching the news, make sure you enable closed captioning on your television so that you can get typed words at the same time as hearing. Many news reporters speak quickly and sometimes parts of a message are missed. Most hearing aids are able to directly connect to your television using a manufacturer specific Bluetooth adaptor. The sound from the TV can stream directly into your hearing aids. If you are unsure if your hearing aids can do this, feel free to email erin@broadmeadhearing.com

Take care of each other

Now is the time to take care of our community by participating in social distancing and do our part to stop the spread of COVID-19. Broadmead and Oak Bay Hearing Clinics are here to assist you during this time. We are not seeing patients in person, except for emergency cases. You will notice social distance practices in our offices (telehealth appointments, drive-through hearing for clients in need of supplies, and emergency services). For accurate updates and information, there is a new app called BC COVID-19 Support available from the government of BC that you may find useful. We will continue to update you as more information unfolds. 

 

Study Shows Positive Effect of Hearing Aids on Cognitive Function

Hearing aids help cognitive function of the brain
 
 
 
Recently there has been a lot of research questioning whether hearing loss has any effect on long term cognitive function. Cognitive function refers to mental abilities including learning, thinking, problem-solving, memory and decision-making. The body of knowledge around this question is increasing, so we have summarized the most recent article published in January 2020 for you.
 
Click this link for the full study.
 
The study examined the effect of hearing aid use on cognitive function in adults. Ninety-nine adults aged 60-84 years old with mild to moderate hearing loss were evaluated in multiple areas: audiometry, speech perception testing, cognitive screening and assessment, and health, quality of life, lifestyle and ease of listening questionnaires. The measurements provided a baseline for comparison at the end of the study.
 
Participants were fit with hearing aids and reassessed on the same measures after 18 months of regular hearing aid use.
 

The study found:

  • Improved speech perception both objectively (based on data) and subjectively (feelings and opinions).
  • Almost 2/3 of the group reported significantly reduced auditory/communication disability while wearing hearing aids. (Meaning they could hear and communicate better wearing hearing aids.)
  • Significant improvement in cognitive function across the whole group for executive function, the mental processes that allow us to plan, focus attention, remember instructions, perform multiple tasks.
  • Clinically significant improvement in working memory, visual attention and visual learning for females in the study. 
  • Participants self-reported overall quality of life was significantly improved. 
 
The researchers acknowledge they had a small sample size and based on the design of the study we can’t determine any cause and effect relationships. However, it does show that hearing aid use may be correlated with improved cognitive function after 18 months of hearing aid use.  Further studies will need to be done to confirm whether the use of hearing aids can delay or mitigate against the effects of cognitive decline. 
 
The results of this study highlight how important it is to identify hearing loss in adults early so that an appropriate treatment plan can be put in place without delay. If you’ve already had your hearing tested – you’re on the right track. If it has been more than 2 years since your last hearing test, or if you have been noticing changes in your hearing, we recommend you make an appointment with one of our Audiologists. 

 

Hearing Mentors Offer Support for People with Hearing Loss

woman on a texting session with her hearing mentor

 

Are you looking for support in managing your hearing loss? Have you recently been diagnosed with hearing loss or finding that even though you’ve had hearing loss for years that is becoming a more difficult factor to navigate in your life?  Or, are you an experienced hearing aid user who is looking to help? The Canadian Hard of Hearing Association of BC has a new online mentoring program that I highly recommend to those who are need of support and those who are looking to give back.

Program benefits

One of the benefits of the program is that participants develop more successful and stress-free lives living with hearing loss. When they have someone who has been through similar challenges, sometimes just hearing another say “You’ve got this” and “I can help” can be a great comfort. Also, if you are someone who has spent years learning strategies and tips, finding great Audiology services, experienced the struggles and frustrations related to hearing loss, you have valuable knowledge to offer to others. You can consider becoming a mentor for people who are new to hearing loss! 

The best thing in our opinion about this new program is that is it completely online and both parties (the mentor and the mentee) can maintain anonymity. There is no expectation for any relationship outside of this platform. The sessions are designed as a weekly one-hour text chat that is set up through a secure site which is purpose-designed for this program. For more information, click this link to the Mentor Program.

The Importance of Assertive Communication

Changing communication styles with hearing loss

 

An often-overlooked aspect of managing a hearing loss involves the person with hearing loss changing their communication style. A hearing loss can cause some people to become passive, limiting their participation in conversations or avoiding social situations altogether. Others can be aggressive, dominating conversations to avoid having to listen and potentially mishear what other people say. The ideal communication style is to be assertive.

Communication styles

The two scenarios below illustrate the difference between passive and assertive styles of communication:

Scenario 1 - A passive approach

Jim, a person with hearing loss, had lunch with a group of friends at the Med Grill.  The dining room was loud, and he hadn’t been able to hear well. Not wanting to embarrass himself by mishearing what someone said or saying something that was completely off-topic, he spent most of the meal sitting back, smiling, and nodding, not participating much in the conversation.

A few minutes after they finished eating, the waitress asked Jim a specific question. After asking her to repeat herself three times, Jim still could not understand her. He decided to venture out of his comfort zone and guess what she might be asking. Seeing that she was holding a pitcher of water and his glass was empty, he assumed that she had asked if he wanted a refill.

“No thank you,” Jim said.

The puzzled look and smile on the waitress’ face and the laughter of his friends told Jim that his response had been unexpected. Jim smiled and laughed along with them, trying not to draw any more attention to himself. As he saw his friends pull out their wallets, he realized the waitress had been asking if they wanted “one bill,” not a 'refill'. Though not what he intended, Jim realized that his response made sense as a deadpan joke.

“I had to make sure I was hearing you right,” Jim said, leaning toward the waitress and gesturing to his friends. “I paid for these guys last week. Not a peep from any one of them until I said I wasn’t going to do it again. You think one of them would step up? Not a chance!”

The group laughed as the waitress passed the bills around to everyone.

As he was driving home, Jim felt relieved that he had been able to cover up his inability to hear the waitress. He had even made the situation funny. Still, he was anxious about what might happen next time. Everyone had loved the food, and when one person suggested they make it a weekly thing, they all agreed. He began to think of a way to avoid the weekly lunch.

The above scenario shows some of the common issues that a person with hearing loss encounters. Things that a person would once look forward to, like lunch at a busy restaurant, can become sources of anxiety and frustration.

Scenario 2 – An assertive approach

Jim, a person with hearing loss, had lunch with a group of friends at the Med Grill. Knowing that getting stuck at a table in the middle of the restaurant, surrounded by noise, would make for a less-than-enjoyable social outing, Jim called ahead to reserve a table. He mentioned his difficulty hearing in restaurants and asked when the restaurant was quiet (the answer – never, but it was quieter between 2:30 and 4:00 pm). Jim asked if there were any booths or corner tables available, preferably away from the kitchen or front door. There was a corner table available at 2:45.

Jim called two of his friends to let them know about the reservation, so they could pass the information along to the others. One of them complained about the late reservation time. Jim told him that he had trouble hearing in restaurants, and that the manager told him it would be quieter at 2:45. His friend said that he hadn’t thought of that and mentioned that he also had trouble hearing in background noise, and that it would be nice to have a conversation without shouting.  

Jim arrived at the Med Grill fifteen minutes before his reservation. He told the hostess that he had a reservation under his name. After waiting for the table to be cleaned, she led Jim to a table for six in the corner of the restaurant. Jim chose a seat where his back would be facing the bulk of the restaurant, which, in his case, would be the source of noise he did not want to hear. A few minutes later, Jim was joined by one of his friends, and shortly after, a waiter arrived with water and menus.

“There will be six of us,” Jim told the waiter. “Before it gets too busy, I wanted to let you know that I have trouble hearing what someone is saying when it gets noisy. I know how busy you are, but if you could speak slowly and clearly, while facing me, I’d really appreciate it.”

 

The benefits of changing communication styles

In the first scenario, Jim was worried about others noticing his hearing loss. His only active participation came in the form of a bluff, when he misheard the waitress multiple times and decided to guess at what she was saying. In that case, the bluff served its purpose – Jim was able to continue to hide his hearing loss. In the long run, however, bluffing is not a good strategy. It involves a lot of effort and reinforces the belief that hiding a hearing loss is more important than hearing. Eventually, the person with hearing loss will guess wrong, and it will be obvious to everyone involved.

There are a few examples of Jim being assertive in the second scenario:

  • He controls his environment by calling ahead to reserve a table in a quieter area of the restaurant.
  • He waits until after the lunch rush is over.
  • He arrives early, allowing himself to choose where he wants to sit.

Good communication takes practice. Changing from a passive to an assertive approach to communication is one way to limit the frustrations associated with hearing loss.

If you are interested in learning more about communication breakdowns and different strategies that can help improve communication, sign up for one of our monthly Communication Strategies classes.

Photo credit: Volodymyr Hryshchenko on Unsplash