Excessive Earwax Buildup in Children: When to See a Pediatrician

All children have earwax or cerumen, but most parents don't think much about it besides trying to figure out the best way to keep their kids' ears clean.

Of course, parents may be a little more concerned if their kids have too much earwax, especially if that excessive earwax is causing any symptoms. Seeing a pediatrician clean out earwax when examining their child's ears can also lead many parents to question how good a job they are doing at keeping their kids' ears clean.

It might also lead to questions about why their child even has earwax, and then, how they can prevent them from getting even more.

When There Is Too Much Earwax Buildup

Although having too much earwax may not cause any symptoms at all, in some cases, symptoms of excessive earwax might include:

• Hearing loss - ranging from 5 to 40 dB
• Tinnitus or ringing in the ears
• A sensation of fullness in the ear canal
• Itchiness in the ear canal
• Otalgia or ear pain
• Discharge or ear drainage (otorrhea)
• Odor from the ear canal
• Dizziness
• Cough

In addition, excessive earwax can sometimes cause problems when your pediatrician needs to look into your child's ears and the wax blocks her view.

The Purpose of Earwax

Earwax serves an important purpose. It builds up naturally in the ear canal from a mixture of secretions from sebaceous glands, sweat glands, and skin cells. It then works to help keep the ear canal clean, carrying dirt, dust, and other small particles with the wax as it naturally travels out of the ear canal.

Have your kids ever gotten sand in their ears after a day at the beach or playing in a sandbox? As earwax builds up and moves out of your child's ear, it will likely carry that sand with it. Earwax can also help to protect and lubricate the ear canal and may even help to prevent external ear infections (otitis externa or swimmer's ear).

Pediatric Earwax Removal

To routinely clean your child's ears, most experts recommend that you simply use a washcloth to wipe away wax that makes its way to the very outer part of his ear.

Surprisingly, there is no single method to remove excessive earwax that has been proven to be better than others. Experts do recommend three main methods of earwax removal if the excessive wax is causing a problem, including:

• Wax-softening agents (cerumenolytics) - ear drops, including water-based (acetic acid, hydrogen peroxide, or sterile saline), oil-based (olive oil), or non-water, non-oil based products (carbamide peroxide, which goes by the brand name Debrox). Most can be bought over-the-counter at your local pharmacy, often with some type of earwax removal tool, such as a bulb syringe.
• Irrigation or ear syringing - a popular method that is done in a doctor's office using a manual or electronic irrigator to flush wax out of your child's ear.
• Manual removal - another popular method in which your pediatrician manually removes earwax using a plastic or metal curette or another tool. Wax can also be manually removed by aspirating or suctioning it out, although you may have to go and see an ENT specialist to have the wax removed this way. Manual removal is especially useful when you can't use wax-softening ear drops or irrigation, such as when kids have ear tubes or a perforated eardrum.

Combining one or more methods can be helpful. For example, some doctors will place a wax softening agent into a child's ear before trying to manually remove earwax with an ear curette.

Remember that observing the earwax buildup or simply waiting for it to go away on its own might also be an option if the wax is not causing any symptoms and it is not blocking your pediatrician's exam.

Preventing Buildup

Although there are treatments to help your child with excessive earwax, if you have dealt with this problem, you will likely be asking what you can do to keep the wax from building up in the first place. Wax-softening agents often take time to work and neither irrigation nor manual removal of earwax is very pleasant for most kids. To prevent the buildup of excessive earwax, it usually best to simply let the earwax come out naturally.

Other risk factors for building up excessive earwax include wearing hearing aids and regularly using earbuds, or in-ear headphones, which are a popular way to listen to music with an iPod, iPhone, and other portable devices. Children with narrow ear canals, including many kids with Down syndrome, are also at risk for having too much earwax.

In addition to avoiding those things that are associated with the buildup of excessive earwax, it might help to prevent earwax buildup if your child routinely uses a preventative wax-softening agent, has his ears irrigated, or sees his pediatrician every six to 12 months to have them manually cleaned.

Wet, Dry or Dark? What You Need to Know

Some other things to know about earwax include that:

• It is thought that up to 10% of children have excessive earwax.
• There are two distinct types of earwax - wet and dry. Dry earwax is more flakey than wet earwax and is tan or gray, whereas wet earwax is more dark brown and sticky. The type of earwax you might have has been mapped to a single gene, with the trait for dry vs. wet earwax often depending on which ethnic group you are from. Asians and Native Americans are more likely to have dry earwax, while wet earwax is most common among those of African and European ancestry.
• Earwax should usually be left alone if it is not causing symptoms and is not preventing your pediatrician from examining your child's ear.
• Buy your child noise-canceling headphones instead of earbuds, as they may be less likely to damage your child's hearing and have the added benefit that they won't contribute to excessive earwax.
• Earwax irrigation should likely be avoided in children with diabetes or who have immune system problems, as it may put them at risk for external ear infections. On the other hand, manual removal of earwax might be a risk for children with bleeding disorders.
• Ear candling should be avoided. It is not thought to produce enough negative pressure to actually remove earwax and there is a risk of burns.

If your child continues to have trouble with excessive earwax, a pediatric ENT specialist can likely help with further management.