Why do we have earwax?
Wax is part of the ear's natural protection or defense against germs and other particles. The only way to determine presence of earwax buildup is by a doctor examining the ear with an otoscope. Practically speaking, the main difficulty is that the wax can completely cover the ear drum. When a doctor examines the ear he/she cannot see the eardrum and therefore cannot determine if there is an infection or other problem.
Contrary to popular belief, wax build up does not cause ear infections or any other serious problems. In very rare cases, the wax can build up so much the that it can actually block hearing. This can easily be corrected by cleaning out the wax. Some children tend to have more earwax than others and we really don't know why. Certain families tend to produce more earwax and others tend to produce less. Similarly, there are also families that tend to make harder, thicker wax while others to produce thinner, more liquidly earwax
How can earwax be cleaned out?
Parents sometimes get overzealous in trying to clean a child's ear but the first thing that I tell them is that Q-tips or any other long objects should not be inserted into a child's ear. This can potentially damage or pierce a hole in the eardrum. When bathing a young child, gently washing around the outside of the ear with a wet washcloth is enough. If a child tends to have a lot of wax, placing a few drops of mineral or baby oil in the ear and covering it with a cotton plug overnight may help. Doing this once or twice will usually do the trick. Parents often ask me about commercially available drops called cerumenolytic agents that are designed to melt or break down the wax. I do not recommend these because they tend to irritate the ear canal.
Sometimes the wax cannot be fully removed by the above approach, in which case it should be removed by a physician or qualified nurse. One technique, is syringing the ear. As the child is lying down, a syringe, full of warm water, is gently inserted into the ear and the water is flushed into the canal removing or washing out the wax. This may take a few tries before the wax is fully removed.
The other approach is curetting, when a thin instrument called a curette, held like a pencil, is used to directly remove or literally "pick out" the wax; Under direct visualization with a light, the doctor gently removes the wax using the curette. Generally these techniques are not painful but obviously will be more difficult to perform in younger children. If the wax is very hard however, sometimes the parents will be asked to go put apply oil or hydrogen peroxide drops before hand in order to soften the wax, making it easier to remove.