Is It a Hearing Loss or Just Sulfur Plug?

One of the most frustrating symptoms is losing hearing, particularly if it is sudden. Most people think it is a sulfur plug or too much wax buildup in their ear canals and they may be right. There are many ways to safely remove the ear wax or cerumen. There are also many methods to avoid.

It is important to look further to an ENT specialist if multiple attempts are unsuccessful or if the hearing loss persists and if there are other symptoms such as tinnitus (ringing), ear drainage, or dizziness which continue.

What is ear wax (cerumen)?

Ear wax is a natural oil that our ear canals produce. Some of us produce too much, some of us too little, and fortunately many of us, just the right amount. Even though it seems the bane of existence would be the production of too much wax, in fact, the opposite is true. Those of us who produce a very thin, watery wax or none at all, have the most problems because there is nothing to protect the fine lining within the ear canals and that leaves the person subject to more infections or other issues. These patients warrant a separate discussion.

Ear wax gets mixed with a combination of glandular secretions and desquamated epithelial cells, or cells from the top layer of skin that fall off naturally. Again, the ear wax and its combination of cells clean, protect, and lubricate the ear canal. There are natural bacteria that exist in the ear canal and ear wax giving it an odor, hence the name sulfur plug.

Upwards of 5% of healthy adults, 10% of children, over half of the elderly in nursing homes, and one-third of people with mental retardation can experience ear wax which needs attention. It should always be treated if the patient has symptoms such as hearing loss, itching, pain, or tinnitus. Or ear wax should be removed if it limits examination in patients who cannot communicate their symptoms such as in those with dementia or developmental delay.

When should ear wax be removed?

Technically, nothing should be done for ear wax unless it is causing impaction or in those patients who are unable to report their symptoms or hearing loss as described above like with dementia or other issues.

Ear wax impaction has a variable definition. In most cases, impaction means there is a noticeable loss of hearing and discomfort. The blockage does not have to be complete, even 50% can be significant.

What are the options to help reduce cerumen?

Despite common thinking, no foreign bodies should be inserted into the ear canal, and that includes cotton-tipped swabs and candles. Cotton-tipped swabs can push the wax in further or damage the ear canal skin or even the eardrum itself, causing more problems. Ear candles means lighting the one end of a hollow candle, placing the other end in the ear canal, and hoping the flame creates a negative pressure to draw the ear wax out. This method is fraught with issues and does not work in many instances.

Accepted preventative measures include:

  • Alcohol or hydrogen peroxide drops or irrigation
  • A mixture of hydrogen peroxide and apple cider vinegar drops or irrigation
  • Over-the-counter preparations which include a combination of the above to lower the pH of the ear canal in drops
  • Having your ears checked by a hearing professional if you wear hearing aids or hearing protection for work or a hobby
  • Over-the-counter preparations which include a bulb syringe or irritation kits. Caution should be taken to not apply these methods too vigorously
  • Physical removal of earwax by a clinician
  • Topical, over-the-counter earwax softening agents

Methods to be avoided include:

  • Ear candling
  • Olive oil drops or spray
  • Probing the ear canals with foreign objects such as cotton-tipped swabs, paper clips, needles, pen tops, and other sharp objects

What are some of the best cerumenolytic agents?

In other words, what are the best, commonly used topical preparations used to dissolve or remove wax. Sometimes, it should be emphasized that it takes time, whatever is used. Letting the solution dissolve the wax slowly can be effective. In our clinic, we may let the solution sit for a while before attempting removal or even have the person come back another day once the wax is softened.

Some popular softening agents include:

  • Acetic acid, 2.5%
  • Docusate sodium
  • Hydrogen peroxide, 3%
  • Sodium bicarbonate, 10%
  • Triethanolamine polypeptide oleate condensate, 10% (not to be used long-term)
  • Water ( to be used with no prior softening, poses a risk if the water gets trapped behind the wax)
  • Carbamide peroxide
  • Choline salicylate plus glycerol
  • Almond, arachis, or rectified camphor oil
  • Mineral oil

What else can I do if home remedies do not work?

Most clinicians have become skilled at removing earwax out of necessity for their patients. Usually, the earwax is removed without difficulty, even if it takes a few attempts either at home or in combination with seeing a clinician.

Many patients with difficult earwax problems will need to resort to seeing an audiologist or ENT specialist. Many patients will experience symptoms in addition to the earwax. Some of those symptoms may be a result of trying to remove the earwax. Patients can develop swelling, inflammation, and ear infections. Others have unusual anatomy, a history of an eardrum perforation or prior surgery, or have undergone head and neck radiation.

A final word

Earwax impaction or a sulfur plug can be a medical problem that should be taken seriously. The range of signs and symptoms we have seen in our clinic from earwax is astonishing. The key is making sure that the problem is just the wax, not some other underlying problem.

For this reason, ENT specialists are particularly attentive to those patients who find themselves referred to them. ENT specialists will use standard techniques also, but often placing the patient under an in-office microscope with the proper tools, including gentle suctioning is the best and safest method, providing the result everyone is seeking.

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