By Dr. Billy Goldberg and Mark Leyner
In the great drama that is medicine, there are obvious villains: cancer, heart disease, trauma. And there are glorious heroes: vaccines, antibiotics, artificial hearts, etc. It’s easy to wax poetic about such august matters. But we prefer the bit players on the medical stage – the unsung, largely forgettable conditions. Of these, nothing is as gloriously mundane as earwax.
Earwax – or cerumen, as it’s known in the biz – is made up of keratin (the stuff of dead skin) along with fatty secretions, a mix that protects the ear canal from water and infection.
There are two types of cerumen: wet and dry. Wet cerumen, which is light or dark brown and sticky, has a relatively high concentration of lipid and pigment granules. Dry cerumen, which is grey or tan and brittle, tends to have less fat and pigment. The wet wax tends to be most frequent in Caucasians and African Americans, while the dry version is found in the ear canals of Asians and Native Americans. (We’re surprised that no enterprising screenwriter has come up with some nightmare, doomsday scenario in which the world is ultimately Balkanized into two warring camps, The Wet Cerumens and The Dry Cerumens, whose internecine battle results in the destruction of the planet.)
Speaking of Hollywood, who could help but be overwhelmed with sympathy for poor Keanu Reeves. Whereas some stars suffer the indignity of being photographed with a big rock of cocaine hanging out their noses, Keanu was recently photographed leaving the Crown Bar in Los Angles with an enormous hunk of earwax protruding from his ear. (Perhaps Keanu could have used this ancient gold earwax spoon that was found in a sunken Spanish galleon off the coast of Key West, Fla.)
But don’t judge Keanu too harshly. If he were to have gone digging for gold in his own ear, he would be violating the new national guidelines for earwax removal issued today by the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF).
As an ER doc, Billy has a great deal of personal experience with ear cleaning. Many people come to the ER for a good aural irrigation. In fact, approximately 12 million people a year in the U.S. seek medical care for impacted or excessive cerumen. It is surprisingly rewarding to treat these patients as they often are suffering from hearing loss, and you can’t imagine how happy someone is after you’ve unpacked their ears and they can hear clearly again.
In the ER, we don’t just reach for a cotton swap or a gold earwax spoon. Usually, we break up the plug with a cerumenolytic (wax dissolving agent) such as hydrogen peroxide, mineral oil or docusate sodium (colace), a stool softener.
But, as the new guidelines advise, don’t try this at home. Cotton-tipped swabs tend to pack the wax in and cause impaction.
Of course, none of us wants to end up like Keanu, with gunk literally falling out of our ears. So, if you need to use a Q-tip, be sure to only swab the visible, outer portion of the ear. Treat the ear canal itself like a self-cleaning oven.
The new rules also come out against ear candling, a practice in which a hollow candle is inserted into the external auditory canal and lit. The theory is that the combination of heat and suction is supposed to remove earwax. Unfortunately, candled patients often end up with more wax in the ear or even burns to their ear canals. People sometimes do the strangest things.
While we’re heartened that the AAO-HNSF has issued guidelines about earwax impaction, we’re a little perplexed about our government’s indifference to the potential exploitation of the substance, especially given our current debilitating dependence on foreign oil. Why hasn’t the Department of Energy or DARPA investigated how to turn earwax into fuel? It’s available in enormous quantities and is eminently renewable. Keanu himself could probably produce enough to light a small Midwestern city.
Many creatures excrete precious substances. Oysters produce pearls. Ants produce formic acid. Civets produce musk. Wouldn’t it be a glorious irony if the humble and oft-maligned human earwax turned out to be the great global panacea?
