Genève returned to our office the other day with a hearing aid that was dead for the fourth time this year. The instrument, a high-tech receiver-in-the canal (RIC) model, had a little wax on the dome, but the dome was not plugged.
I then checked the internal filter on the receiver. It was completely plugged with wax. I looked in her ears: They were immaculately clean. No wax was visible. I removed the internal filter and placed the hearing aid back on her ear.
“Wow!” she said, “It’s working.” Then she asked, “How can the internal filter be plugged, and the external dome not be plugged? Plus, you say my ear doesn’t have any wax. What’s going on?”
Is this Dark Magic? Is that what explains how an ear that looks as clean as a whistle on otoscopic inspection can produce wax that shows up in some obscure remote location?
If truth be told, this is not dark magic. We often find earwax two or three inches away from the ear—in the earhook of a BTE, for example.
There was no earwax visible in Genève’s ear when she came into our office. Nonetheless, the wax glands in her ear canal were producing small amounts of wax that found their way through the dome on her hearing aid into the internal filter on the receiver.
HOW IT HAPPENS AND WHAT TO DO ABOUT IT
If you think about earwax as a solid, like soft candle wax, what happened to Genève seems impossible. But if you think of earwax as more like a vapor, you can easily see how it can move from an ear into a hearing aid.
The dark brown “stuff” we find in internal filters and BTE earhooks may not contain all of the substances found in human earwax. Though this “stuff” looks like earwax, it may be just the oils and other volatile substances in earwax that can vaporize and plug hearing aids.
This means that we need to educate our patients about earwax and related substances that can prevent them from hearing well. Patients who tend to produce earwax need to be seen on a regular basis.
We also have to do a lot of cleaning and maintenance to keep their system working properly. Moreover, the need for maintenance, cleaning, and testing increases every year. For unless hearing aids are cleaned on a regular basis, they are probably working poorly.
Image courtesy of the Mill Dam School.