The skin in the human ear is highly innervated with neural fibers and very sensitive to the touch. A little excessive moisture, some dry/dead skin, excessive ear wax, or a slight irritation can drive a patient crazy. We all want happy patients, but they won't be happy unless the skin in their ears is healthy and free of irritation. This month, I want to start a discussion on ways we can help our patients maintain healthy ears. But first, a strong word of caution.
A normal, healthy ear has an unbroken surface of skin. So, before you initiate a program of ear treatment, make sure the skin in the ear is intact and free of perforations, ulcers, or lesions. Also, do not use any of the ideas below if the ear tissue has been modified by surgery or disease. Instead, refer patients to their physician.
Three concepts are critical in an ear care program. They can be summarized in three words: dry, clean, and lubricated.
- The skin in the ear should be dry, but not too dry.
- The ear canal should be clean and free of all debris. Even a single hair in the canal can cause itching.
- The tissue should be lubricated naturally by ear wax or by oils, creams, or glycerin.
KEEP THE EAR DRY
Many people believe they need to wash their ears often. This idea may have come from their mothers telling them, “Don't forget to wash your ears!” But, she was talking about their external ears, not down inside the canal.
Ear wax, also known as cerumen, is a complex substance that contains oil, wax, and dead skin products. Explain to your patients, “Ear wax is not soluble in water.”
If hearing aid wearers saturate their ears with water several times a week to clean their ears, their hearing aids will trap the water in their ears and make them prone to fungal and bacterial invasion. Moist tissue tends to itch! So, tell patients, “Never wash inside your ears. The natural ear is self-cleaning.” The outer layer of skin migrates out of the ear canal. Keeping the canal clean is a job for the professional.
Patients with moist ears can often benefit from water plugs to keep their ears dry. I offer patients a choice between the inexpensive instant plugs we make in the office and the higher quality plugs made at the earmold laboratory.
If a patient's ears are chronically moist, an alcohol/vinegar wash may be in order. When needed, I give people the following make-your-own ear wash formula:
- 1 teaspoon of white vinegar
- 1 teaspoon of rubbing alcohol
- Mix ingredients together in a cup.
- Use an eye dropper and put 6-8 drops of this mixture into the ear.
- Tilt your head so the wash runs all the way down inside of the ear. Then tilt your head the other way and let the liquid drain out.
For prophylactic purposes, tell patients to use this ear wash twice a day for 4 days. If you are drying a chronically moist ear, tell the person to use it twice a week for several months. Note: it is critically important to monitor the ear visually from time to time to be sure the ear wash is producing the desired effects and not unwanted side-effects.
Alcohol evaporates at a low temperature and is a good drying agent. Vinegar is highly acidic and it changes the pH factor (acidity level) of the skin. Combined, alcohol and vinegar can be highly effective in reducing moisture and preventing bacteria and fungi from growing in the ear canal.
Alcohol and vinegar washes must be applied with caution. Overuse of alcohol can result in too much drying, which can cause the skin to crack and bleed. When I recommend an alcohol and vinegar wash (drops), I make sure the patient comes back periodically so I can re-evaluate the situation.
AN ALTERNATIVE WASH
When I began my practice, the older ENTs were using alcohol saturated with boric acid as an ear wash, while the younger ENTs preferred alcohol and vinegar. To make the first earwash, slowly add boric acid to a bottle of alcohol. When the acid starts to accumulate at the bottom the alcohol is saturated.
I researched the topic, talked to a few ENTs, and decided there was little difference between the two approaches: alcohol/vinegar and alcohol/boric acid. The literature suggests that they produce similar results: creating an environment in the ear canal-where pathogens (bacteria, fungus, etc.) cannot live.
In the months to come I will discuss other ear issues. Please remember, these are not medical discussions, and the suggestions I am making are not to be used with “sick” ears. These are hearing health issues to be used prudently with healthy ears free of any perforations or infections.