In This Series
If you think your ears are a mystery, you’re not alone. And you won’t be surprised to know you’re probably not looking after them properly. Chris Aldren, a consultant ear, nose and throat surgeon and president of the British Society of Otology (the study of the ear), answers Coach’s questions…
First things first: what exactly is earwax?
It’s a combination of dead skin and oily secretions from modified sweat glands – the only others are in the female breast, which I think is a different conversation. If you like, earwax is the ear’s way of cleaning itself. Dead skin is drawn out of the ear with the wax, which also offers protection against water and foreign bodies, such as insects. What’s more, it has antibiotic and anti-fungal properties. I know nobody likes it, but it’s normal and healthy to have wax in your ears.
What’s the most common cause of hearing loss in younger people?
There’s a condition called otosclerosis that affects the stapes, or stirrup bone – the smallest bone in your ear – causing unwanted new bone to grow across it. The condition is genetic – half the people who get it have a first-degree relative who also has it – and is a result of bone turnover in the ear, where old bone is replaced by new growth. Sufferers can either choose to wear a hearing aid or undergo a simple operation, called a scapiotomy, to replace the bone altogether.
I think I know what you’re going to say, but should we use cotton buds?
Don’t use cotton buds. They’re almost exactly the same size as the ear canal, which means they simply push wax further into your ears. We see a lot of patients whose ears were fine until they fiddled around with a cotton bud and impacted the wax. They push it right down onto the eardrum and suddenly they can’t hear. It’s easy to fix, but it’s so unnecessary. They don’t usually damage their ears, because the eardrum is very sensitive, making it too painful to push too far, but occasionally the bud is knocked and they shove it through the eardrum. This is often caused by partners or children knocking against the person while they have it in their ear. Luckily, correcting a perforated ear drum is a straightforward procedure.
What about headphone-related hearing loss? Have we all been collectively deafening ourselves since the advent of the Walkman?
There’s no question that noise damages your ears, and in the old days people who worked in coal mines and ships’ engine rooms were exposed to loud noise over a long period of time. The damage is related to how loud the noise is and how long you’re exposed to it. The acceptable level of noise is 85 decibels, and headphones can produce a lot more than that. However, we see young people complaining of hearing loss and ringing in their ears as a result of loud music in general, such as from nightclubs, for example, rather than just headphones.
And can it be reversed?
It’s irreversible and untreatable. Once your hearing is gone, it doesn’t come back. We all lose hearing with age, and any hearing loss you get from noise is in addition to that.
What’s actually happening in there?
No one knows exactly. The cochlear, which is about the size of the tip of your little finger, has 20,000 tiny hair cells. These are only visible with an electron microscope, so they’re impossible to look at in living people. When scientists have looked at animals with noise-induced or age-related hearing loss, the hairs look like a field of corn that has been blown over by a hurricane. In terms of physical damage, it seems that the noise actually creates molecules called free radicals in the ear, which damage cells.
If this happens to everyone with age, there must be a lot of research into possible treatment.
You’re right – there’s a lot of interest. For people who have no hearing at all, there are cochlear implants that stimulate the nerves directly, but they’re only effective in cases of total deafness. Cochlear hair cells don’t regenerate in humans but they do in some reptiles and birds, so researchers are looking at how we might use stem cells to unlock this property in humans. Sadly, it’s still some time away. I’d estimate that it will take 15 years or so.
How is the ear involved in balance?
This is pretty complicated, but our sense of balance comes from the vestibular system, which is connected to your inner ear. Tellingly, the organ involved is called the labyrinth. It has two components: the semicircular canal system, which senses rotation, and the otoliths, which detects linear movement. They contain fluid that moves with the head. This movement is picked up by special cells that convert it into nerve impulses, allowing you to keep your eyes fixed on a point as your head moves, and adjust your body’s posture.
These systems sound vulnerable – is this why a knock to the head can make you dizzy?
One specific condition we see arises from head trauma. There are little crystals in the otoliths, and if you hit your head hard enough, you can knock them off. Once they’re loose, they can go into another canal, which leads to a condition called benign positional vertigo. The condition usually affects old people, but young, healthy people can also suffer from it if they get a hard knock to the head when boxing or playing rugby, for example.
Ear Remedies
Entrepreneurial types see the ear as a commercial opportunity– but should you buy their wares?
Hopi Ear Candles
Claims that burning these thin candles will dislodge earwax are, in medical terminology, nonsense. The Hopi of North America deny knowledge of them. Others claim they emerged in Egypt or South America – along with snake oil, perhaps.
Aloe Vera Ear Drops
Aloe vera soothes irritation, as anyone who’s had sunburn knows, but this has led to excitable claims. It can ease an ear infection but is best used with medication. If you manage to sunburn your ear canal, though, go for it.
Home Ear Syringing Kits
These work – after all, getting wax out of your ears isn’t exactly brain surgery – but as with any procedure that involves sticking something into one of your orifices, you have to be careful, and it’s usually better to have an expert do it for you.
Garlic Oil – and so on
The natural remedy club makes all kinds of claims about garlic, tea tree and coconut oil, and they won’t do any harm to an infected ear. But who do you trust more – some guy in a kaftan, or decades of trials and peer-reviewed research?
Bee Propolis
The holistic crowd make big claims for the antibiotic properties of this resin, which bees use to repair their hives. Some also say eating it protects against cancer. This is nonsense, and it can be dangerous for people with insect allergies.
Mumbai’s War on Wax: How Indians do it
Whether you need a shoe repair, a haircut or the ministrations of a holy man, there aren’t many services you can’t get on the streets of Mumbai – and ear upkeep is no exception. The city’s famous kaan saaf wallahs – or ear de-waxers – are more than happy to remove the unwanted gunk from your ears in exchange for a few rupees. They use more or less the same methods as their predecessors did in the 18th century, when the practice is thought to have started in the south of India. A metal needle wrapped in cotton wool is inserted into the ear, which soaks up wax and is slowly removed. A pair of pincers is also on hand to pick up any rogue nuggets of wax or cotton. If you go for the premium option, they throw in some lotion or coconut oil.
In a teeming city where the air quality isn’t exactly pristine, it’s an impressively low-tech solution. Sadly, like so many traditional crafts, it’s dying out, as a younger generation turns to more trusted medical approaches. It’s still better than cotton buds, though.
