A 55 year old female lay midwife was seen at the Brigham Young University Audiology Clinic after she had burned her ear using an ear candle. The patient reported a severe pain during the use of the ear candle which prompted her visit to our clinic. She reported that "after using the ear candles I wasn't able to hear well out of my right ear and I noticed some bleeding in my ear". Visual inspection did not reveal any blood in the canal. However, this may either been a sanguinous or an ear candle residue which was washed out by the patient prior to coming to the clinic. The patient indicated that she used 10 ear candles over a 10 day period. Figure 1 shows a package of ear candles purchased and used by the patient. Figure 2 shows the package's printed information insert. Figure 1. Ear candles used by patient Figure 2. Ear candle package insert (click for enlarged view; 100kB file) Video otoscopy of her right ear revealed that liquid wax from the ear candle had dripped onto the tympanic membrane (Figure 3). Figure 3. Ear candle wax on TM (Click image for enlarged view) Routine pure tone audiometry revealed a conductive impairment with a 20-25 dB air-bone gap (Figure 4). Tympanometry presented reduced TM mobility when the ear candle wax was on the tympanic membrane (Figure 5)

Figure 4. Audiometric results obtained with ear candle wax adherent to the right tympanic membrane

Figure 5. Tympanometry performed with ear candle wax on tympanic membrane

She was referred to an otolaryngologist for consultation. Under a binaural surgical microscope, the otolaryngologist used a surgical hook to remove the plate of ear candle wax from the unanaesthetized surface of the TM. The procedure was without complication. A follow-up audiological evaluation was performed five days after treatment. Video otoscopy shows a significant improvement in appearance of the TM (Figure 6). Figure 6. Tympanic membrane 5 days after removal of ear candle wax (Click image for enlarged view) Pure tone audiometry demonstrated some improvement in air conduction hearing acuity, greater in the high frequencies (Figure 7), consistent with restoration of tympanic membrane mobility (Figure 8).

Figure 7. Audiometric results obtained 5 days after removal of ear candle wax from right tympanic membrane. Red dots = before.

Figure 8. Tympanometry performed 5 days after removal of ear candle wax from tympanic membrane

Figure 9 shows the remnants of the ten ear candles used by the patient in a single self-treatment session. Figure 9. Remnants of 10 ear candles used by patient over 10 day period The patient noted that she had been using this technique of self-cerumenectomy for a number of years but this was the first time she had ever burned herself by dripping hot wax onto her tympanic membrane. She easily became convinced that ear candles no longer constituted a preferred course of treatment for ceruminosis. Case contributed by Richard Harris, Ph.D.; Brigham Young University; Provo, UT Posted: March 5, 1999