EARWAX EXPLAINED
What is earwax any way?
Earwax, aka cerumen is a natural substance produced by glands in your ears. It is there to protect your ears against infections.
It also protects against foreign objects. Often, if something gets into your ear that shouldn't (like the end of a cotton bud, naughty naughty), the wax will cling to and encase it. As the skin cells in your ear canal naturally migrate outwards towards the canal entrance, they carry the wax with them, along with the foreign object.
However, in some cases, the glands get a bit 'wax-happy' and produce too much. It builds up in the canal faster than it can migrate out and this is when it can become an issue.
Wax is also bitter-tasting (be honest, you've all tasted it, whether accidental... or not!) and there's a reason for it. That bitterness has evolved to make the ear canal a hostile environment that kills germs and microbes (and other living things that can wind up in there).
A common issue that we see in clinic is when the wax has been pushed too far down the ear canal into the inner third, known as the bony portion (cotton buds, I'm looking at you again here; as well as rolled up tissues, car keys, oh and knitting needles!). Once the wax is here, it tends to get stuck due to slower migration and due to the shape of the canal.
Remember being told as a child not to put anything smaller than your elbow into your ear? Bet you wish you'd listened now hey? 'Scuse the pun.
SMALL SPACE, BIG PROBLEMS
What problems can wax cause?
Earwax that completely blocks your ear canal is called occluding wax. If we can see a gap around or through it and we can view part of your eardrum, we call this non-occluding wax.
Non-occluding wax isn't usually a problem, so long as there's even a little gap, it won't greatly affect your hearing (unless it's right at the eardrum), but left untreated it's really only a matter of time before it will become occluding. Once this happens, sounds from outside your head will be dulled, whereas sounds from inside your head and body (such as chewing, swallowing and even your own voice) can seem quite loud. Some people say that it sounds as though they are under water.
Although the colour of earwax can change according to your ancestry, generally speaking when it is first produced it is light in colour, sometimes even white. Over time it turns from white to yellow and eventually very dark brown. So the darker your earwax appears, the longer it has been sat there!
If left unchecked, earwax can build up and cause a whole host of problems including reduced hearing, pain/discomfort and even infections.
Wax and hearing aids
How does wax affect my hearing aids?
Earwax doesn't have to be completely blocking your ear canal for it to play havoc with your hearing aids.
First of all, if the wax is soft, you'll notice it continually blocking up the tube and stopping the sound from coming out. It will either dull the sound or completely stop the sound from coming out and you'll think the battery has run out or that your hearing aid is broken.
Secondly, if the wax is sat right at the canal entrance to the ear canal, over the part where the sound comes out, not all of the sound from the hearing aid will reach your eardrum and you'll notice you're not hearing as well with your aid.
Another tell tale sign that you have excessive wax is if your hearing aid begins to whistle a lot. This is because the sound that should be going down your ear canal to your eardrum is instead hitting the wax and rebounding, escaping out of your ear. The hearing aid itself then picks up on that escaped sound and 'thinks' it's a sound in the environment that it should be turning up, so it increases the volume of the escaped sound and puts it back down your ear and then this leaks out and so on and so on. It has the same effect as when you place a microphone too close to a speaker and it squeaks. We call it feedback, because it literally is a feedback loop. Often, you'll think that your hearing aid is broken and you'll go back to your audiologist to have it repaired, only to be told that you have wax and that's causing the issue.
Not only does wax cause an issue with hearing aids, but hearing aids actually exacerbate the problem. This is because your ear produces more earwax than usual if it detects the presence of a foreign object (like an earmould or an in-the-canal hearing aid). Not only does the ear produce more wax, but that wax can't migrate out like it usually would because the ear piece is trapping it in there and even pushes it back in! So you may find that you need to regularly have wax removed if you're a hearing aid wearer.