Improper Ear Cleaning Leading to Facial Paralysis and Hearing Loss: Doctor's Advice on Earwax



An elderly woman in the UK experienced permanent damage after seeking help to clean her earwax at a clinic. This raises the question: how can ear cleaning lead to such severe consequences?

A 70-year-old woman visited her family doctor to clean her earwax. A nurse used an irrigation method to wash her ears, a standard procedure abroad. However, shortly after, the woman complained of ear pain, loss of hearing in her left ear, and discharge of blood and pus. She immediately sought help from an ENT specialist, who diagnosed a severe outer ear infection and prescribed ear drops. Despite the treatment, three days later, she experienced facial paralysis on the left side, unable to close her eye or mouth, leading her to the emergency room. Further examination revealed a perforated eardrum.

Although the ear infection healed with antibiotics, the facial paralysis remained despite botulinum toxin injections and facial rehabilitation exercises. Her hearing did not recover, and she now relies on a hearing aid. This case was published in the *Journal of the American Medical Association: Otolaryngology--Head & Neck Surgery (JAMA Otolaryngology--Head & Neck Surgery)*.

Dr. Muhammad Nayeem Ahmed from the University of Leeds, who presented the case, noted that reports of eardrum perforation due to ear irrigation are rare, with only two documented cases of resulting facial paralysis, including this woman. The first case fully recovered.

Can ear washing really be this severe? Do doctors in Taiwan also use irrigation for ear cleaning? Dr. Li Bohong, Director of the ENT and Audiology Center at Jihsin Hospital, mentioned that such cases are rare, and ear irrigation is not common practice in Taiwan. "The severe outcome could be due to the stubbornness of the earwax and the excessive force used during irrigation, injuring the outer ear canal. The bacteria invaded the injured area, leading to severe infection. Since the facial nerve passes through the middle ear, it resulted in facial paralysis." He added that such paralysis is usually temporary, but the reported case of permanent paralysis is extremely rare.

Avoid Self-Cleaning of Earwax

Many people use fingers, sticks, or ear picks to clean their ears, but doctors advise against self-cleaning. Earwax consists of shed skin cells and secretions, sometimes mixed with dust. It naturally falls out of the ear canal during jaw movements like chewing, so deliberate cleaning is unnecessary.

The outer ear canal is curved, with thin and fragile skin cells. Frequent scratching and digging can easily cause outer ear canal inflammation, leading to itching, swelling, pus, and severe pain. Accidentally perforating the eardrum can cause hearing loss. "The best way to maintain ear health is not to touch it," said Dr. Li.

Moreover, using unclean tools can lead to fungal infections in the ear, causing severe itching and affecting hearing. Such cases require medication for treatment.

Besides preventing injury and infection, earwax can block foreign objects from entering the ear and has antibacterial properties to protect the ear canal.

What to Do About Earwax?

If earwax becomes a problem, seek professional help. Some people have a genetic tendency to produce oily earwax, which is hard to expel and can accumulate, causing blockages and itching, affecting hearing. In these cases, it's best to consult a doctor.

Earwax comes in two types: dry and wet. The type is determined by genetics, but changes in body conditions can alter earwax characteristics. The approach to handling them differs slightly.

For dry earwax, use a cotton swab with a bit of petroleum jelly to gently turn it inside the ear, without pushing it in, as this could push the wax further in. For wet earwax, use a thinner cotton swab to lightly dab and turn it without pushing. Wet earwax doesn't fall out as easily as dry earwax, so if necessary, seek an ENT specialist's help.

To identify your earwax type, observe its appearance. If it's brittle or powdery, it's dry. If it's sticky or peanut butter-like, it's wet.


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