Ear wax is generally considered to be something that is easily removed from the ears, but it can be difficult for the elderly in whom it may cause additional health problems if it becomes impacted. The country’s leading otolaryngology association has sounded the alert that ear wax in the elderly needs to be checked regularly because if it goes undetected it can contribute to additional health problems such as hearing impairment.

Ear wax performs an important function in protecting the ear. It collects dead skin, dirt and other particles and usually comes out of the ear naturally. However, in some cases the ear wax becomes lodged in the ear canal and, instead of exiting the ear, it blocks the canal partially or completely. This can impair hearing and cause other health problems.

For the elderly, when ear wax blocks the ear canal it can become a classic “slippery slope” because it can cause hearing loss which can then lead to cognitive decline. For those with dementia, the inability to hear can lead to behavioral issues and worsen cognitive decline.

For these reasons and more, the American Academy of Otolaryngology – Head and Neck Surgery (AAO) issued a new Clinical Practice Guideline regarding ear wax and its potential to become impacted. According to the AAO, “more than one-third of the geriatric population” has “excessive or impacted” ear wax that is “underdiagnosed and likely undertreated.”

According to the AAO clinical practice guideline, ear wax can cause many different symptoms including:

• Hearing loss
• Tinnitus
• Fullness
• Itching
• Otalgia (ear pain)
• Discharge
• Odor
• Cough

These symptoms can be especially problematic for elderly patients suffering with dementia. As the disease deteriorates the individual’s ability to speak, he or she may not be able to verbalize the pain and discomfort caused by impacted ear wax. In turn, that may cause behavioral disruptions that are not understood by caregivers. When ear wax is checked and removed proactively, that spiral can be avoided.

 
Ways to avoid impacted ear wax
There are ways to avoid ear wax impaction and obstruction. The most effective way is to avoid using cotton swabs, or Q-tips, to clean the ears. Rather than cleaning the ear wax out of the ear, cotton swabs actually push the ear wax deeper into the ear canal.

For the elderly, regular examinations by a trained professional using an otoscope (a medical device used to look into the ears) are the best way to avoid ear wax impaction. In fact, that strategy is at the heart of the recommendations of the AAO clinical practice guideline. The AAO believes that if elderly patients are checked regularly by a professional, and action is taken when impaction is detected, the health consequences of impacted ear wax may be avoided. The recommendations include:

1. Clinicians should help to educate elderly patients and teach them about proper ear hygiene in order to avoid ear wax impaction. Education includes informing the elderly about the dangers of “overmanipulating the ears” with cotton swabs and the risks of using ear candles and cones to remove ear wax.
2. Clinicians should identify individuals with ear wax impaction who need further diagnosis and intervention. This is especially important in those individuals who may be cognitively impaired and unable to express the symptoms of ear wax impaction, like pain and difficulty hearing.
3. Individuals wearing hearing aids should always receive an examination with an otoscope, regardless of the reason for the physician/patient appointment.

 
Another way to avoid the build-up of ear wax is to use softening products several times a month. These products include:

• Hydrogen peroxide dripped into the ear from a cotton ball soaked with the solution
• Warm water dripped into the ear from a rubber ball syringe
• Mineral oil dripped into the ear from an eye dropper
• Over-the-counter ear drops

 
The use of these products is advisable only if the elderly person knows how to use them properly and does not have any cognitive impairments. Otherwise, regular examinations by a physician is the best way to avoid ear wax impaction.