Waxing lyrical: taking ear wax seriously

The liquid constituents of wax largely come from two different secretions originating in glands within the ear canal: sebum from sebaceous glands, and modified sweat from the so-called ceruminous glands – cerumen being a pretentious Latinised word for ear wax, first coined in the eighteenth century. The characteristic smell of ear wax – which people may find either repulsive or enticing – appears to result from oxidation of the resulting mixture and modification by bacteria.6 (The Germans, incidentally, do not call it wax at all but Ohrenschmalz or ear fat.) There are well-known racial differences in ear wax. Setting aside issues of clinical effectiveness, the doctor-patient relationship in communities may have been significantly altered because this intimate and painstaking procedure, which most patients would have undergone at some time, has now changed from a personal interaction with their family doctor that often led to instant relief, to a delegated and technological one. Many GP practices in the United Kingdom no longer offer the service and it is not a requirement for them or their commissioners to do so any more.9 Some patients are still entitled to referral to a hospital-based audiologist for reasons such as pre-existing hearing loss.