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Ask the doctor: I'm worried about my hearing - could it be wax?

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While earwax protects the ear from foreign particles, too much can cause problems

While earwax protects the ear from foreign particles, too much can cause problems

While earwax protects the ear from foreign particles, too much can cause problems

Q I am in my 40s and I'm worried about my hearing. Normally I would've had my ears syringed by now if we weren't in lockdown - I have had it done a fair bit by my GP. I used drops from the chemist about two weeks ago and I feel my hearing is worse since.

When can I get a test from an audiologist and what, if anything, could account for this other than wax? Also, my wife says I used cotton buds too much on my ears.

A There are three types of hearing loss; conductive, sensorineural or, mixed conductive and sensorineural hearing loss. From your history above, it appears you may have conductive hearing loss due to simple wax impaction. Some people are more prone to wax impaction than others. It is annoying but very manageable with proper aural toilet and maintenance.

What usually happens is a gradual build-up in wax (cerumen) in one or both ears, that ultimately leads to complete wax impaction and a plugged ear feeling. It can be described as like being underwater when you can hear sounds but they are muffled. Of course there are many causes of conductive hearing loss that are usually related to abnormalities of the outer or middle ear.

One cause you don't want to miss is otitis media, a middle ear infection, as this can lead to permanent hearing loss if not detected and treated fully. Thankfully otitis media is usually associated with ear pain, sometimes fever, a sensation of ear fullness and, decreased hearing on the affected side. Conductive hearing loss occurs because fluid builds up in the middle ear space preventing the tympanic membrane (TM) from vibrating adequately, thereby diminishing movement of the ossicular chain involved in hearing. A doctor can examine the ear with an auroscope and see signs of inner ear infection on the TM.

With appropriate treatment, resolution of the inner ear infection and fluid can take up to 12 weeks. In approximately 10-15pc of cases the fluid fails to clear and patients need to attend an Ear Nose and Throat (ENT) specialist to undergo a procedure to puncture the TM and allow fluid discharge and normal air movement which allows healing and repair.

Another common cause of conductive hearing loss is due to TM perforation. The degree of hearing loss depends on the size and location of the perforation (or tear) in the TM. Small perforations and those located in the anterior/inferior quadrant of the TM tend to cause the least amount of conductive hearing loss. Conversely, near total or posterior/superior quadrant perforations of the TM have a much higher chance of causing significant hearing loss. Most acute TM perforations heal on their own. After an acute traumatic perforation, the ear should be examined by a doctor to ensure that skin is not trapped on the under-surface of the TM.

You mentioned using cotton buds in your ears. It's true that our ears are designed to clean themselves with hairs that promote the movement of wax from inner to outer. Obviously a cotton bud can inhibit this natural movement from inside to outside by pushing the wax back down the ear canal potentially leading to complete wax impaction. You should attend an audiologist for a full assessment and education on how best to clean your particular ear canals. I am sure you will be able to get an appointment very soon with the phased lifting of Covid-19 restrictions. The audiologist will be able to tell if you need to attend a doctor for further assessment or not.

Dr Jennifer Grant is a GP with Beacon HealthCheck

Health & Living