Posted tagged ‘earwax’

How to help your pediatrician examine your child’s ears

November 28, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

Let me tell you a secret: Examining eardrums in a squirming, angry child is really difficult—if not impossible. If the doc in your screaming, struggling child’s ear for a half-second, it’s unlikely that anything useful was seen.

Sometimes, it is just impossible to get a decent exam. But there are ways that parents (and doctors!) can help at least increase the chance that we can get a good look.

First, work together to help keep the child relaxed. No one should rush, and no one should immediately start holding anyone down. The minimum hold is best—more of a reassuring hug than a hold, really. And even before that, I like to give toddlers a chance to look in my ears, and mom’s ears, and their teddy bears ears. Look look look, and practice first. Parents can even buy a cheapo otoscope to practice with at home, on themselves and kids and plastic dinosaurs. If it has ears (of even if it doesn’t), Junior should practice looking in them and telling stories about what they see.

About stories: I used to see monkeys in ears, and over the years the monkey stories have gotten more and more elaborate. Now the monkeys are opening presents and eating lunch and watching movies. I’ve found if I tell kids what the monkeys are up to, in a quiet but excited voice, they sometimes hold very still to see what will happen next.

Don’t even think about saying the word “hurt.” That word ought to be banned from pediatrician’s offices forever. You might say “This won’t hurt,” but I guarantee all the child hears is “HURT PAIN HURT HURT PAIN”.  Another thing not to say: “He hates having his ears examined.” I already knew that. Thanks for reminding us.

Children of every age pick up on the mood of the parent and doctor. Calm, confident, secure—that’s the way to go. Don’t fret or apologize or wave toys at the child. Even if you think things won’t go well or aren’t going well, pretend that they are.

About earwax: It’s natural, it’s normal, everyone has some, and some kids have more than others. Parents are not at fault if Junior has earwax that’s blocking the view. To help keep wax at bay, wash ears with a soapy washcloth, and be sure to rinse the ear canals gently afterwards. Don’t use Q-tips or swabs—those just pack the wax tighter and push it farther in. More details about earwax control, here.

Some kids find ear-looks (and doctor visits) more worrisome than others, just like some parents and some doctors are more worried or rushed than others. Some visits don’t go well, but there are always ways that we can all try to make the next visit better. I, personally, find it very satisfying to get a good, tear-free ear look in a child—bonus points for a smile!

The Earwax Manifesto

February 17, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Gather ’round! Everything you always wanted to know about earwax, right here! Be the first on your block to know what earwax is for, and which way it moves in your ear! Delight and disgust your friends! That’s right, come close, don’t be shy!

Earwax is called “cerumen” by medical people, who after all need a different word for everything. It’s the waxy stuff that accumulates in your ear canal, the tube that goes from the outer ear on the side of your head down to your eardrum. You can stick your finger right in there, right now. Go ahead. Now take it back out, you don’t know where that finger’s been!

The waxy stuff is made by glands lining your ear canal, and does have an important job. It acts to moisturize and lubricate your tender ear canal, while preventing infection and trapping dust and other debris. Earwax naturally gets pulled along the skin as it grows from the inside outwards, kind of like a conveyor belt.

Usually, you don’t have to do anything about earwax. In fact, a policy statement from the American Academy of Otolaryngologists (the “ENTs”, and I don’t mean Tolkien’s giant talking trees) states that earwax ought to be left alone unless it’s causing problems like hearing loss or pain.

What kinds of problems can excessive wax cause? Occasionally so much wax can fill the canal that hearing is affected; rarer still, the full feeling of wax can cause pain. In a pediatric office, the most common “problem” from earwax is that it prevents us from getting a look at your child’s eardrum. There’s no magic way around that. Earwax cannot be looked through. If you want to get a good look, a heavy wax accumulation that’s filling the canal has got to come out.

In the office, I like to use a little plastic scraper thing; with a kid that holds still, it’s reliable and quick. We also sometimes use a device similar to a Water-Pik to wash the wax out, especially if it seems to be flaky and hard to pull out with one gentle scrape.

For home use, there are several products available over-the-counter, or a number of home remedies that can be tried. These include using a few drops of hydrogen peroxide or olive oil to loosen the wax. Whatever you do, don’t stick a Q-Tip in there. That just pushes the wax back further, making our job more difficult.

The best way I know of for parents to keep waxy ears clean is to use a soapy washcloth draped over a finger to gently clean the outer part of the ear. A little soapy water will dribble into the ear canal, and that should be rinsed out with a splash of water or a squirt from a little rubber bulb. Always use warmish, comfortable water to rinse out the ears. You only need to do this if your child has especially waxy ears that have required medical removal.

One novel way to remove earwax uses a super-soaker squirt gun, but I wouldn’t try this at home.

Stay away from “ear candles,” an alternative health fad that’s been touted to remove wax and other impurities from your head. Candling makes no sense, and has caused serious burns and death from fire. C’mon, now: this is just wax we’re talking about. There is no need to ignite your head.

Earwax has its purpose, and isn’t something that most people need to think about or try to scrub away. If your child accumulates a lot of wax that prevents good ear exams, you can keep it at bay with simple, safe, and easy steps.  You heard it here first.

EDIT 3/6/2010: News about ear candles from The National Council Against Health Fraud:

“FDA acts against ear candles.

The FDA had warned three large manufacturers to stop marketing ear candles and has posted a consumer warning to its Web site. The warning page states that during the past decade, the FDA has received reports of burns, punctured eardrums, and blockage of the ear canal that required outpatient surgery. An ear candle is a hollow cone about 10 inches long made from a fabric tube soaked in beeswax, paraffin, or a mixture of the two. In ear candling, also called ear coning or thermal auricular therapy, a patient lies on his or her side while a candle is placed in the outer ear and lit. Marketers claim that warmth created by the device produces suction that draws wax and other impurities out of the ear canal. However, tests by Health Canada have found that ear candles produce no measurable effect in the ear and have no therapeutic value. [Don’t get burned: Stay away from ear candles. FDA Consumer Update, Feb 18, 2010]