WALLA WALLA -- Folks not hearing the jing-jing-jingle of Christmas might suspect hearing loss. Chances are good, however, there's a different Grinch to blame.
Excess cerumen, which is neither sexy to researchers nor unusual enough to elicit much "big pharma" interest, is presented nearly daily in Dr. Philip Morgan's Walla Walla practice.
"Ear wax is a constant issue," he said.
Often the patient is concerned their hearing is fading or they've been sent in by a hearing aid dealer, the ear, nose and throat specialist said. "And any good audiologist is going to take a quick look before doing a hearing test."
Then there are the folks who schedule regular visits to a doctor because they are genetically waxy, predisposed to producing more of the stuff than is typical. "They can't stay ahead of it themselves," Morgan said. "And often it's just one ear, over and over again."
According to the American Academy of Otolarynology, ears should be cleaned when there is a fullness in the ear or sensation the canal is plugged, in addition to hearing problems or pain.
Cerumen impaction can also be signaled by ringing in the ear, odor, discharge and coughing.
In itself, ear wax is a wonderful and healthy gift from our body. It cleans the ear, lubricates and is a shield against bacteria, Morgan said. "It also keeps the skin waterproof."
The wax also traps dust and keeps small objects from entering and damaging the ear, noted the National Institute of Health.
Indeed, people who don't produce enough of it suffer from itchy skin on ears and elsewhere, plus low-grade earaches, the Walla Walla doctor said.
And typically, our bodies are designed to perfectly deal with ear wax, the.
"The ear skin is one of the only places on the body where the skin starts in one place and moves laterally."
If one were inclined to put a droplet of ink on the eardrum, two months later the dot would be in the ear canal, Morgan said. The migration of ear debris from in to out, where it dries and flakes off, is just regular maintenance.
Unless you're a cotton swab devotee, and end up pushing the wax the opposite direction. Ear wax forms in the outer third of the ear canal, but when it's shoved into the bottom part of the canal, it tends to stay lodged there, experts say.
And not always by itself. Those Q-tip fans sometimes -- wait for it -- forget the swab is in their ear canal and then bonk it into a door or something else, Morgan said. It happens enough that "those pay the light bill around here."
There are better methods, most of them do-it-yourself. The point of most treatments is to soften the wax enough to allow it to be flushed with water.
Debrox" is widely available and is big seller.
"It's good," Morgan said. "We use it in the office, put it in then suction it out with this nifty little vacuum we have."
At home, Debrox users can employ a "perfectly good" flush bottle that comes with the kit, he added. "Room temperature. Cold water will make you dizzy."
A common home remedy is a solution of equal parts white vinegar and rubbing alcohol that leaves behind an antifungal and antibacterial residue, "so nasty things can't grow," Morgan said.
Then there are the digging instruments that make many shudder -- keys, bobby pins and the small loop of an unfurled paper clip. Morgan is not entirely opposed to such methods, he said. "As long as they are gentle, it works."
He cannot vouch the same for ear candling, although the specialist has heard testimony of its powers from more than 100 patients.
The technique is a popular and inexpensive treatment for ear wax removal often touted by alternative health providers, who say that placing a hollow candle into the ear canal and lighting the other end creates a vacuum that draws the wax out.
While Morgan has never seen the procedure, "what I know about physics and the ear, candling doesn't make sense to me," he said. "It seems like flimflam."
According to Dr. Daniel Seely in Spokane, complications from the procedure can be serious.
Among the problems cited in a survey of candling users, there were 21 injuries among 20 of the subjects, including 13 burns in the external canal and seven cases of canals subsequently blocked with candle wax.
Some experienced eardrum perforations and a few suffered temporary hearing loss.
In a basic science evaluation of ear candling, the substance found at the end of the hollow candle turned out to be candle wax, without a molecule of ear wax from the testers, Seely said in a conference presentation.
Olive oil, instead of snake oil, is a better answer, Morgan said. "As a softening agent, it works great."