Ear wax is a naturally-produced substance that is made by your body. It is partially composed of an oily substance which is made by glands in the skin of your ear canal. The other major component of ear wax is dead skin layers which have been sloughed off from inside the ear.

Most people never have serious problems from ear wax. It will typically fall out of the ears on its own with time. Some people make very large amounts of wax or very thick wax which can block up the ears and cause problems hearing or infection. These are the people who should see a doctor for wax cleaning.

I recommend that no one put any object inside their ear to clean wax. This would include Q-tips, bobby pins, or anything else. Q-tips are especially bad because they can cause part of the wax to be packed down onto the ear drum. This is no fun for you or for me to clean out. Remember the old saying: “Nothing smaller than your elbow can go in your ear!”

A better option is to use liquid drops in the ears to help soften ear wax. My favorite option is either baby oil or mineral oil. These are very inexpensive and you can use a dropper to put several drops in each ear at bedtime. Put a cotton ball in the ear to keep oil from draining out on your pillow!

You can also use hydrogen peroxide (I recommend mixing half and half with water) or a variety of over the counter wax softening products. Some kits will provide irrigating bulbs to flush out the wax- this works well for a lot of people but be careful to not flush too forcefully.  Debrox is the most common brand and is available in any drug store or grocery store.

I have several different ear suctions and instruments to help clean wax. I can usually get the ears cleaned completely in one visit but in certain difficult cases with lots of thick wax packed onto the ear drum, I will usually have you use baby oil drops at bedtime for 2 weeks and then come back. After this, it’s usually very easy to suction out the rest of the wax. New patients coming to see me for ear wax cleaning can get this process started early to make things easier.

Some patients naturally make a lot of wax and need to be cleaned every 3 to 6 months. If this is you, I recommend starting baby oil or other wax softening drops 2 weeks before your appointment.

Noise in the ears (Tinnitus) is a very common problem among adults. It is usually described by patients as a ringing or buzzing sound in one or both ears. It can be very aggravating and annoying for some people.

Tinnitus is caused by hearing damage, usually with a measurable amount of hearing loss (though not always). There is frequently a history of loud noise exposure in the past. (Tinnitus is very common among veterans, musicians, and industrial/construction workers).

If there is an easily treated form of hearing loss like an ear wax plug or fluid behind the eardrum, this can be treated and usually the tinnitus will go away. Unfortunately, most longstanding tinnitus is not so easily fixed.

While tinnitus can be very annoying, it is not a dangerous or life-threatening problem.

The noise sometimes is constant and other times it can come and go. Typically it is more noticeable (louder) in quiet settings like trying to sleep at night or sitting in an empty room. Background noise usually helps to drown out the tinnitus (we call this “masking”).

There are many factors that are known to make the tinnitus louder. These include stress, depression, anxiety, use of stimulants, caffeine, smoking, medications such as aspirin/ibuprofen/naproxen.

Most importantly, the more you focus on your tinnitus and worry about it, the louder it will seem. Conversely, the more you put it out of your mind and relax, the less it will bother you.

I like to use the analogy of walking into a room that smells bad. After several minutes, your brain will “tune out” the bad smell and you don’t notice it anymore. The same is true for tinnitus, though it will take longer than a few minutes. Our brains are very good at filtering out things that are not important.

Regarding treatment of tinnitus, there is good news and bad news. The good news is that tinnitus is not a dangerous problem like cancer or heart disease. The bad news is there is not an easy “cure” for the problem (despite what you might read in ads for certain herbal products).

I feel like the one best thing you can do is to relax and try to put the noise out of your mind. Just let it fade into the background. Your brain will eventually get the hint and the noise will stop bothering you so much.

A simple change that can help is to keep some background noise around you at all times. Run a fan or white noise generator in your room at night.

There are several other treatments that can be useful in patients with tinnitus. Hearing aids for patients with significant hearing loss can help with tinnitus. Also, there are devices called maskers which look similar to hearing aids but produce a noise at a similar pitch to the tinnitus to help drown it out. Both these options are dispensed by audiologists.

Lifestyle changes such as cutting down on smoking or caffeine, or avoiding aspirin/ibuprofen/NSAID medications can help as well.

Antidepressant medications such as amitriptyline and nortriptyline can be helpful in some patients (even without depression). Patients who ARE depressed can have a very difficult time with tinnitus, and they should work with their primary care doctor or psychiatrist to maximize the treatment of their depression.

Stress relief techniques including exercise, meditation, and yoga can be helpful.

Finally, there is an option called tinnitus retraining therapy (TRT) which is offered at certain centers around the country (though currently none in Texas). See www.tinnitus.org for more information.

There is also an association between tinnitus and pain in the jaw joint (temporomandibular joint or TMJ) and in the muscles around the jaw and ear. If this is the case, the TMJ pain should be treated.

 

Pain in the ears can be caused by a number of different problems, both inside the ear and out. I see a lot of patients with ear pain who are convinced that they are having ear infections because their ear hurts. Sometimes they have received several rounds of antibiotics with no help.

Ear infections and problems inside the ear can certainly cause earache, but there are many other problems away from the ear that can cause referred pain to the ear.

Causes of earache:

1. Problems inside the ear:  

• Middle ear infection (otitis media). Caused by fluid buildup behind the eardrum which becomes infected. Will ALWAYS have associated hearing loss because the fluid limits the normal transmission of sound to the inner ear
• Outer ear infection (otitis externa, a.k.a. “swimmers ear”). An infection outside the eardrum within the ear canal.  Can be triggered by water that gets in the ear from swimming or bathing. Usually patients will notice drainage from the ear but not always. There is usually pain with manipulation of the ear.
• Ear wax impaction can sometimes cause pain.
• Eustachian tube dysfunction.  Caused by blockage of the Eustachian tube between the middle ear  and the back of the nasal cavity (usually due to allergy or upper respiratory infection). This causes the pressure behind the eardrum to become different from the atmosphere around you. This sometimes can lead to otitis media if fluid builds up behind the ear drum.
• Tumors or other growths in the ear (fortunately, these are rare).

2. Problems in areas next to the ear

• TMJ pain (temporomandibular joint pain). Caused by arthritis or stress in the jaw joint which sits directly in front of the ear. This is very common.
•  Muscle pain: usually in the chewing muscles, the sternocleidomastoid muscle     (below the ear), or the temporalis muscle (above the ear).
• Fibromyalgia: this is a whole-body pain disorder that can affect the ears and muscles around the ears.

3. Problems in areas remote from the ear. All of these are due to referred nerve pain from other areas:

• Tonsillitis/throat infection/sore throat
• Sinus infection
• Acid reflux
• Tooth pain or infection
• Teething in infants
• Cervical spine problems in the neck
• Cancers in the back of the nose or throat

4. Nerve pain (pain produced by the brain or from abnormal nerve signals)

• Migraines.  A newer concept of migraines is that they are not only headaches but are a “global disorder of sensation.”  Many unpleasant symptoms can be caused by migraines including pain in the ears and throughout the body, nausea/vomiting, dizziness, ringing in the ears, and allergic symptoms in the nose.
• Neuropathic pain: This is pain produced by the nerves themselves.  It can be caused by diabetes or other underlying disorders.

When any patient comes to see me for ear pain, the first step is to take a careful history and perform a head and neck physical exam.  A good clue that the ear pain is not caused by an ear infection is the absence of hearing loss.  In certain patients, further testing such as an audiogram (formal hearing test) or tympanograms (a test to check the pressure behind the eardrum) might be helpful.