An Earful: Do You Clean Your Kids’ Ears…Or Not?

Geez, our ears’ ears must be burning, for as a health topic, they’ve been in the media quite a bit of late.  Some of the news is timely: summertime is swimmer’s ear time, and a recent MMWR report found that one in 123 Americans visited doctors for the problem, at a cost of half a billion dollars annually.  Other news is timeless: a recent article in The Week described how a cookie-loving Taiwanese teen would rub her ears as she reclined in bed. Eventually, ‘dozens’ of ants were removed from her ears having followed the smell of food to her ear canals. Um, ick.

Both issues beg the frequently asked question: is there an ideal approach to ear canal hygiene? (Kinda) Aren’t we morally obligated to go after ear wax and the junk that oozes out of ear canals with our quivers of Q Tips? (Heck no, and I’ll explain why).  And lastly, are stories like the ant/earwig/roach in-the-ear true? (Yes, and more such tidbits below).

Ear canals–and their wax– are the centerpiece of this story, of course. Most people don’t think about their ear canals much. And, when they do, they probably inadvisedly stick a pinky in their ear and dig around. O fiddledee dee!  In the US, conventional wisdom dictates that parents clean whatever drips, oozes, or leaks out of their offspring’s orifices. For example, this is abundantly clear in the nosewiping seen on playgrounds across this great land. And, usually by 2-4 years old, children can be taught to blow their noses and facilitate the management of a goobery mess. Clean nose, happy child, right?

To date, we have yet to see someone ‘blow their ear’ due to excess wax.   I receive questions every week from frustrated moms who are aghast at the proliferative gunk that leaks out of their wee one’s ears: Q Tips don’t seem to stem the problem, what should they do?   When I perennially quote the old medical school maxim: “Never stick anything smaller than your elbow into your (or your child’s) ear,” I have to explain the key points to make the moment a teachable one.

For a healthy child with no concerns of ear pain or discomfort, ear wax should be left alone.  When you take a look at the intelligent design of an ear canal, it makes a bit of sense. The ear canal is a skin-lined tube that deadends at the eardrum.  Like your oven, it is self-cleaning.  If you were, say, a cookie-seeking ant with a headlamp, you might observe that the outer third of the canal is where earwax is made. Legions of specialized sebaceous glands and modified sweat glands secrete an oily matrix, into which sweat, debris, and the skin cells of the ear canal slough.  This cocktail of keratin, lipids and oils both protect the canal from drying out and becoming irritated, and exert a hardy antibacterial and antifungal effect. In days of old, it was used as a balm for cracked lips. Nice. Customarily, earwax moves in conveyor belt fashion, flowing from the eardrum outwards, getting moved along gently by the motions of our jaws in daily meals and gossip sessions. Eventually, the wax exits the ear, to deposit embarrassingly in our earlobe, or to fall unseen and unappreciated onto our bedding or clothing.

Interestingly, ear wax varies a bit by who you are, how you are, and how old you are. Children tend to produce more of the stuff, and it’s production tapers as we age. Stress, anxiety, and increased sweating can boost earwax production. Get this: ear wax texture varies by ethnicity. East Asian and Native Americans tend to have a dryer, flakier gray colored variety.  Individuals of African or Caucasian descent, by contrast, tend to have a wetter variety with different colors, ranging from beige to orange to nut brown.

The trouble with Q tips.

The use of cotton swabs, bobby pins, fingers, and other hardware tends to cause more harm than good.  Truth is, they rarely collect more than a small amount of wax at the outermost aspect of the canal. Scooping unseen into the canal tends to push earwax deeper, creating plugs of material that can dry out and get stuck, or that can block the canal altogether.  Children and adults with so called ‘impacted cerumen’ may experience a range of symptoms, including decreased hearing, dizziness, ringing in the ears, and pain when it presses upon the eardrum. What’s more, tooling about with swabs or other instruments of hygiene may injury the fragile lining of the canal, and cause painful inflammation or infection.  More than once, I have been asked to remove a painful foreign body from a child’s ear, only to find that it is a broken piece of cotton swab. Hence, for at home care for ear wax, elbows–and pretty much anything else–should not be stuck into the ear, unless specifically directed to do so.

In the pediatric office, I peek in ears all day. It somewhat amuses me that kids and teens (or their parents) apologize for having ‘dirty ears’ when I look in. In fact, a waxy ear is a healthy ear in most cases. A clinician like myself may attempt to remove wax in a child for the following reasons: it is thought that the earwax is impacted, and is a source of pain or discomfort, or the wax plug is blocking the view of the eardrum, which may need to be seen out of concern for a middle ear infection.

In children who can cooperate (kids over four are more game, or babies who can be held easily), we can use a spoon-like curette and a otoscope light to visualize and scoop out the wax. Often, this can be achieved in just a few minutes.  In many cases, however, the wax plug is too big, too stuck or dried out, or the whole business is too difficult for littler kids to tolerate;  we may recommend employing softeners a couple of times a day for a week or so.

Ear wax softeners, known in the parlance as cerumenolytic agents, come in a variety of forms.  If the cause of the ear pain is not clear, or if a child has a history of ear tubes or a hole in their eardrum, and if no health care type has looked inside that ear, a visit to clinic is prudent before these remedies are tried at home. Most primary care clinicians will recommend the use of comfortably warmed fluids, such as supermarket grade mineral oil, carbamide peroxide (aka Debrox), hydrogen peroxide solutions, or even docusate, a stool softener. Caveat here: applying fluids that are too warm or two cold may make a child puke, or feel really, really dizzy. Gentle flushing with warmed water nightly may help soften the clogged wax, allowing it to exit on its own. Sometimes, gentle irrigation may be used to help this process along.

A few homegrown approaches are either ineffective, or just not a good idea. Ear candling, the practice of using hollow candles made of paraffin and beeswax, involves holding a lit candle near the ear canal opening. The theory: the candle will generate pressure that will dislodge impacted wax. Studies have not demonstrated this works very well. The idea of an open flame near my kiddo’s hair makes this a non starter in my book.  Waterpiks or water jet devices may actually injure the ear canal or damage the fragile eardrum. Eschew. Ear vacuums are marketed in some quarters, but I don’t recommend them due to potential to traumatize the fragile structures of the middle ear.

So how to care for your ear then?

Benign neglect works. As noted, most kids’ and teens’ earwax will work itself out, literally. Parents should train their kids to avoid getting water, soap or shampoo into the ear canal when bathing. And, kids should learn to shake out water from your ears after swimming (no matter how goofy it makes them look).  And, in all instances, take ear pain seriously. If a child is old enough or able to communicate that there is an owie in there, it merits examination. Intervening early prevents messy and painful problems altogether.

Which brings us to foreign bodies. Kids find or stick all sorts of items in their ears. Insects may declare themselves by a creepy crawly feeling, or even make sounds as they spelunk in the ear canal. Food of all varieties can be found, especially seeds, kernels of corn, and the like. A rule of thumb is: if you find an object in the ear, check the nose. You never know! Toy parts, beads, erasers and other small fare can be stuck in the ear canal. Pretty much all of these generate pain and inflammation and a foul discharge if in there long enough. Disc or button batteries are an urgent concern: the battery contents can rupture, and can cause serious injury to the ear drum. Sometimes these items can be removed with careful preparation and technique in the pediatric office, or ER. In the toughest cases, kids will go to the OR!

Be good to your ear, and leave your earwax alone. That’s best. You hear?

Photo 1 by cerdas08; Photo 2 by wuteverpix; Photo 3 by imnumberhalf

Cartoon below by me

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